December 16, 2017

Health Care in America—What to Do at the End of Life?

By Chaplain Mike

As you may know, I work as a hospice chaplain. Our service specializes in caring for people who are in the final season of life. A multi-disciplinary team of skilled professionals provides medical and personal care, psycho-social care, and spiritual care for our patients and support to their families. In order to qualify for hospice, a patient must be diagnosed with a terminal disease and likely have six or fewer months to live. The goal of hospice is to provide comfort and support so that patients and their families might achieve goals that are important to them at the end of life.

Hospice is one of the most wonderful services I have ever known. The people with whom I work are gifted and caring. The folks we serve almost always welcome us with grace and hospitality. They honor us with their trust. They open their homes, lives, and hearts to us every day. We in turn help them deal with the pain and symptoms of terminal disease, talk with them about their lives, their stories, their families, their fears, and encourage them to take care of unfinished business and find peace.

Every once in a while, I realize that many people have little conception of this world in which I work.

I have been so immersed in end of life care for the past 5 1/2 years that it startles me when I hear someone talk who doesn’t get it. For example, when the health care debate was going strong last year, it nearly drove me crazy to hear partisan politicians and uninformed citizens totally misrepresent proposals to pay for doctors to have end of life discussions with their patients, characterizing them as “death panels.” My jaw dropped recently when I heard a friend say she was going to have some surgery right away because she was sure “Obama” was going to make it so that Medicare would not pay for it in the future because she is a senior citizen. I’ve heard others express similar “convictions” that they will be abandoned by the health care system when they get old because health care reform means promotion of euthanasia and assisted suicide. To these people, “end of life care” means “the government doesn’t care, and they are going to end my life.”

Furthermore, apart from the health care debate, there is an entire cultural perspective that works against the idea of end of life care. It is firmly entrenched in our medical system, and reflects our society’s discomfort with the subject of death and dying.

Recently, I read the clearest article about this subject that I have seen to this point. It is in this month’s edition of the New Yorker, and may be accessed at their website. It is called, “Letting Go: What should medicine do when it can’t save your life?” by Dr. Atul Gawande.

Dr. Gawande is a surgeon and a writer, a staff member of Brigham and Women’s Hospital, the Dana Farber Cancer Institute, and the New Yorker magazine. In his article, Dr. Gawande describes the discomfort that doctors, including himself, have with discussing and dealing with the limits of saving life. He confesses that he knew little about hospice care, thinking it was little more than a morphine drip hastening a patient’s death. Then he made a visit with a hospice nurse and observed and learned about a different way.

The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.

Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.

I am engaged in the personal side of this issue, as one who has bought in fully to hospice philosophy, and who believes that it brings great benefits to people and their loved ones. Society has taken note of these matters because of economic and financial concerns. Gawande writes:

The issue has become pressing, in recent years, for reasons of expense. The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it. Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.

Spending on a disease like cancer tends to follow a particular pattern. There are high initial costs as the cancer is treated, and then, if all goes well, these costs taper off. Medical spending for a breast-cancer survivor, for instance, averaged an estimated fifty-four thousand dollars in 2003, the vast majority of it for the initial diagnostic testing, surgery, and, where necessary, radiation and chemotherapy. For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end—to an average of sixty-three thousand dollars during the last six months of life with an incurable breast cancer. Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.

Our health care system, like most things American, is built on the optimism, ingenuity, and “can do” spirit of the American people. Scratch deep enough, and you will find that it’s in our blood to conquer any and every challenge, even death itself. To that end, we throw every effort, every bit of knowledge, every intuition, every piece of technology, every conceivable intervention at terminal illness, even when our noble attempts make the end of life a season of discomfort and stress for the dying with no discernible extension of length of their lives and almost certain diminishment of the quality of their lives.

Perhaps, we simply cannot accept death. Certainly that attitude is commendable, and has led to innumerable breakthroughs in medical science and treatment. We want to keep fighting! However, in our fight to help the sick and conquer the devastating diseases that beset us, will we also deny those who are dying the kind of life they should have in life’s final season?

Comments

  1. Question:

    Is America going to collapse economically [which includes the health system]?

    I am hearing reports of a massive finacial collapse…….

    I really , really hope not.

    • Matthew, your question is about a sensitive topic in this country and we really don’t wish to discuss it, and anyway it is OFF-TOPIC and should be BANNED.

      [Will a house of cards fall? Is the Emperor really wearing any clothes?]

      Stay tuned…

      And, to get really off-topic, I think the growing anti-immigrant and anti-Arab sentiment in this country is indicative of the economy; and the USA may or may not resemble Germany in the 1930s.

      Stay tuned, and pray for us up here.

      Maybe I’ll move to Australia and join you.

  2. Yes, if those partisan politicians and uninformed citizens were calling end of life counseling a death panel, then they were wrong. End of life counseling has nothing to do with the Federal Coordinating Council for Comparative Effectiveness, which has been given the short-form label of death panel. This panel evaluates types of treatments, demographics, and economics and is expected, based on the published works of council members, to limit treatment based on cost-effectiveness. Actually the limitations would be indirect, since enforcement is expected to be administered by restricting payments to doctors for restricted procedures. So your grandmother’s doctor could do the procedure for her, but the doctor wouldn’t get paid, and could get paid less for other procedures as well.

    Matthew, the financial collapse would most likely occur if investors in government debt got more concerned about the government being able to tax people enough to cover both debt repayment and ongoing government expenses. First they’d demand higher interest rates, and then they’d stop buying new and rollover debt. Then the Federal Reserve would be pressured to buy that debt with money it creates, which would lead to dollar devaluation, meaning import prices would go up, and eventually prices would go up on US made goods as well.

    • Cost-effectiveness has been and will always be a concern in Medicare. We deal with regulatory changes all the time in hospice. Medicare is a system in crisis and we’ve seen it coming for decades. Demonizing various proposals for the sake of political gain is unconscionable, and that’s the state of our politics right now.

      • TruthbTold says:

        Is telling the truth if it disagrees with your perspective on issues “demonizing”?

        • I was referring to the political debate, not to what anyone has said in this conversation.

          But, to answer your question, no. We’re having a discussion here. I welcome back and forth.

  3. Danielle says:

    A friend sent me this article a few days ago. It was extremely helpful, as I haven’t faced these issues in my immediate family yet and didn’t really understand how the regular medical system reacts in such a case. I admit that I also had only a vague idea of what hospice does (other than try to make people ‘comfortable’).

    The article also helped me to understand why it is possible to get so much technical and treatment information from doctors and yet have communication fail. It think I had always assumed there was some kind of ‘there’s nothing more we can do” conversation; it hadn’t fully occurred to me that doctors rarely run out of *something* more they can do. That’s a great testament to the dedication of doctors, but I can see how it prevents people from really facing what is taking place and making decisions.

  4. Thanks for this post, Mike. I, too, can attest to the great work and great workers of hospice. As a lawyer, I work with the elderly on helping them with their anxieties about property, support, poverty concerns, medical decisions and surrogate decision makers and such. At some point much of this becomes irrelevant and a line is crossed. Hospice and hopice workers become front and center. Without one exception in over 10 years and hundreds of clients this “hand-off”, if you will, has been seemless and comforting. I, and all my clients who have or are experiencing hospice care, as terminal patients or caring family members, are extremely grateful for hospice and hospice workers. Hospice surely has become that rare new thing in the past couple of decades which seems to be a complete success, even though to those ignorant of its purpose it would seem to result in complete failure. Do not weary in well-doing, Bro.

  5. Loved your perspective. I can’t find it now, but I read a study a while back that suggested that evangelicals spend more on medical care after a terminal illness has been diagnosed than other citizens.

    It also seems to me that it is often not the person who has been diagnosed who rejects a graceful transition from this life, but those praying for a ‘miracle’ often pressure the person to try treatments in vain.

    • Often true.

    • People have to make sure their wishes are known before hand.

      I had this discussion with my mother a few years back. Not the easiest conversation to begin, but absolutely necessary. We wrote out everything. We planned her funeral, discussed end of life care, went through it all. She lives near my younger sister so we all agreed she should have final decision-making authority. My sisters and I discuss every medical issue that comes up. We tend to be on the same page.

    • It isn’t just terminal illnesses, but any sort of serious condition. Long after I as the person with the incurable disease have accepted it and moved on, well wishing people are still pushing hack scams and trying to muscle God into healing me. Lack of time devoted to such seeking is often maligned as a lack of faith. It isn’t a lack of faith. God can heal me anytime he so desires, and occasionally I ask him to. But he doesn’t need me to jump through hoops or fret, and I am busy living as full a life as anyone.

      • Sounds as though you have placed this matter into God’s hands. That is faith.

        “…he doesn’t need me to jump through hoops or fret” AMEN!

    • Headless Unicorn Guy says:

      I can’t find it now, but I read a study a while back that suggested that evangelicals spend more on medical care after a terminal illness has been diagnosed than other citizens.

      Wonder how much of that might be due to secret doubts? Evangelical culture encourages you to put up a Victorious Christianese front no matter what. Add in worm theology and Hyper-Calvinism and maybe they’re trying to put off Judgement/Hell (or Estus Pirkle’s version of Heaven) as long as possible. Or Name-It-and-Claim-It denial that anything’s wrong or that God Means Me To Be Well — actually withering away and dying isn’t Victorious. (Secret Sin in your life and all that.) Or not disappointing all the others around him who think God Will Always Heal.

      • Few actually believe that Christ has really, finally, totally and completely conquered death and that it’s a stingless wasp or a toothless lion. Yes, death lingers on in this world as a last enemy to be placed under Jesus’ feet, but He HAS SAT DOWN at the right hand of God and He’s just waiting for the final denouement of what He has already once-and-for-all(-time) accomplished.

        Easy to say, right? But I ask my wife this question: What effect does the Christian faith of her patients have on them when they are facing death? Does it seem to make a difference in terms of their attitude, fears, joy, etc.? Do the “Christian” patients seem to be decidedly different from the non-Christian ones when it comes to facing death? From her experience, she has not seen much difference in most cases. Which, ISTM, says something about American Christians’ attitude toward death and/or the strength of their faith. Or maybe it doesn’t say anything at all. When I had my kidney stone attack, I was at the mercy of the pain and it controlled my thoughts, attitudes and behavior more than anything, whether I prayed or not.

        • Headless Unicorn Guy says:

          One of my friends has an incredibly high pain threshold; I’ve seen him function with painful injuries that would have sidelined me.

          I have also seen him completely doubled over, a complete invalid from a kidney stone attack.

  6. Hospice is a wonderful organization. When my father chose not to undergo treatment for lung cancer Hospice helped him through his final days. They were absolutely wonderful! They were wonderful when years later my father-in-law needed them. I can’t say enough good things about Hospice. I am very glad this organization exists.

    But from what I have seen of elder care, particularly nursing homes where practically ever patient is on Medicare – government healthcare – we have every reason to ask questions about what these changes will mean for the care of the elderly. When Medicare won’t even pay for facial tissue for the patients, well this is fine if the family is there to help. But many patients are completely abandoned by family. I do fear the current situation could become much worse in the coming years. Ever worse would be if people assume that once the government takes care of everything, volunteers are no longer needed.

    • Actually, one of the main problems with nursing home care these days is that they are being bought up by private corporations to make profit with the growing elderly population . They cut staff and all kinds of amenities in order to make them profitable. It is about the bucks not the care, and the govt. has little to do with that.

      • But if Medicare is paying for the care don’t they have to meet government guidelines? I can’t imagine the government giving them money unless they are government approved. OK, a bit sarcastic I know.

        • I wouldn’t want to be in a facility that merely meets minimum guidelines.

          • Headless Unicorn Guy says:

            I’ve seen one. Someone I knew tangentially had a serious stroke without insurance and ended up a Ward of the State in a “facility that merely meets minimum guidelines.”

            I call it “A Wait-to-Die Warehouse.”

      • I have a good friend who is a nurse practicioner, and has done nursing home care. Don’t get him started on corporate buyouts and profits. Currently he does a lot of rural healthcare, in-home visits, and flights to offshore islands in Maine. His salary has been cut TWICE this year alone, yet his hours NOT decreased. To the contrary.

        The cutbacks in staff in nursing care facilities got him out of that business. Too much was demanded of the remaining staff, and he felt his license was jeopardized for the sake of corporate profits. He calls the whole game a sweatshop.

        This goes back to Matthew’s question, at the top of the page. So maybe financial collapse is on-topic after all.

        • The cutbacks in staff in nursing care facilities got him out of that business. Too much was demanded of the remaining staff, and he felt his license was jeopardized for the sake of corporate profits.

          That sounds like my wife’s description of what was happening at the last nursing home she worked at – and which caused her to leave nursing home work for home health, a decision she was not wanting to make (because she’d never done it before), but one which she was soon very glad she had made.

          • I’ve considered training as a GNA. But the thought of a 15-patient caseload (which seems to be what I can expect) is appalling…how is it even possible to do well by the patients?

    • Part of our Christian culture is currently insisting that government should not interfere with private business. Yet at the same time it is insisting that government should not decree any regulations about end of life care. But, then it swings back and insists that money should be available from someone in order to pay for ever possible medical treatment. But then it insists that it is wrong to raise taxes.

      Are you catching the drift? We have a schizoid Christian culture when it comes to health care.

      • Danielle says:

        So true.

      • You could apply that to more than health care. People like their roads. Stop lights. Fire departments. Police forces. And so on.

      • The Somalian model is what we are moving to. If you want a stop light at your intersection, then buy it and install one, because it is not my responsibility to save lives in your neighborhood. If you like police protection, then hire your own guards, but don’t expect me to pay for anyone’s protection but my own. Because we all know that cooperation is evil and leads to growth of government and reduction of corporate profit.

        If enough right-wing Christians moved to the libertarian paradise of Somalia in order to escape the evils of government and find the blessings of a totally for-profit world, they could convert that nation to Christendom.

      • Sorry for being off-topic.

  7. After more than 3 decades of working in nursing homes, a few years ago my wife started doing home health. From your essay it sounds like her work somewhat overlaps hospice care. I admire her devotion to her patients and the way-beyond-the-call-of-duty things she does. She’s seen the unhappy effects profit-making has had on nursing home care, and unfortunately the profit-making need/desire can affect some home health agencies. Inevitably and unsurprisingly, profit-making affects all aspects of medical care, as well as just about everything else in life. As or if the economy deteriorates, we’ll be seeing and experiencing changes, as everything will be triaged.

  8. Some MND patients are so impressed by hospice, they refuse to take a trache ventilator so that they are eligible.

    As a Christian, I live on the other side of the coin from the doctors in this article. I know suicide is prohibited, but to what point am I required to assent to life extending things? When my lungs fail, am I free to go? If I do go on machines, what are the practical limits after which I can have them turned off? It’s complicated!

    • This is a decision each person should make for themselves while they are capable of making their own decisions. Personally, I do not believe that refusing heroic treatment is the same as suicide. There is a time for letting go. I believe this decision is best reached prayerfully, placing oneself into God’s hands. We are all mortal. Every single one of us will die. Death is not the result of a lack of faith. Death is the result of being mortal.

      Lord, let Your Will be done in all things.

  9. Chaplain Mike, I have a question that maybe you have some insight into.

    My father was a hospice volunteer for many years. I think he started when a friend had terminal cancer, and my father wanted to help his friend. But he then continued for many years both with people assigned to him by hospice and with acquaintances who developed a serious/terminal illness. (I guess he wasn’t an official hospice volunteer before the acquaintances were on hospice, but he certainly used the knowledge he had gained while a hospice volunteer to assist the seriously ill and their families.) I was out of the house by the time he started being a hospice volunteer, so I didn’t observe it first hand, but my understanding is that he sat and talked with healthier patients, sat with more unresponsive patients to give respite to caregivers, ran small errands, kept in touch with the hospice nurse about anything relevant that he might have observed or been told while he was with the patient, etc. Basically a lot of the “neighbor” and “community” concepts that you write about, with the advantage of having a tie-in to the hospice professionals.

    Because of my father’s volunteering, I was more familiar with hospice and with end-of-life issues than I would have been otherwise. This familiarity was useful when my father-in-law moved to the terminal phase of his cancer, and my husband’s whole side of the family seemed completely unfamiliar with hospice and end-of-life issues.

    My father ceased being a hospice volunteer for a number of years, but recently decided to start again. When I asked how it was going, he was very dejected. He said he had gone to the volunteer orientation and had been informed that volunteers were no longer allowed direct patient contact, but were allowed only to help with fund raising.

    From what you have seen, is this a change just in this one hospice? Or is it a more general trend? If it is a general trend, do you know why? Even though I can, unfortunately, think up unhappy scenarios with dishonest volunteers (or scenarios with lawyers who worry about problematic volunteers), it would somehow seem that banning direct volunteer patient contact would be a step backwards in having the general community have any understanding of or compassion for end-of-life issues. Wouldn’t seem a step in the right direction in cost-effectiveness, either.

  10. cermak_rd says:

    This is a big issue. Last October, I took some vacation time at work so I could sit with my mother and watch out for her as she died (make sure she didn’t fall out of bed, was clean and dry, gave her drinks, etc.) This gave my mother’s partner an opportunity to get out to get liquid morphine for her, run errands, breathe, do church business (he’s a deacon in a small church), pick out a casket and others. No attempt was made to prolong her life, we just tried to make her as comfortable as possible. It was not a pleasant death for me to behold and I’m fairly sure it was not a pleasant death for her to die. She had Wegener’s Granulomatosis which would not pop into recession (she’d had it for 10 years) and the meds were starting to wear her body down. When faced with one more trip to the hospital, she gave up and stopped eating and refused to go. She died 2 months later. It’s possible she would have died even had she gone to hospital, I don’t know. I wish there had been hospice staff to talk with us about palliative options (mother’s husband didn’t know about liquid morphine until I got there and suggested it as she could no longer swallow).

    Right now I’m dealing with my dog Jackie who has failing heart valves which is causing congestive heart failure. We’ve had her since we got her from the shelter in 1997. There’s no curing this. So I give her pills (same ones for humans, in fact, Jackie has a discount card at Walgreens which is legit, they advertise it for pets) to treat the effects so she’s comfortable and doesn’t get an edema or pneumonia. I watch her closely to try to keep her from getting too excited so she doesn’t faint and hurt herself falling over. Mostly though, I just love her and cherish every day I have with her. I really, really wish I had had the same attitude when I cared for Mother instead of the fear and dread I felt at the time.

  11. 1) My dad died after 3 months on hospice.
    2) I am an MD in a field where people frequently die.

    I agree wholeheartedly that Americans in general, and Christians in particular, are not prepared for death. It has much to do with the idea of death as failure, which may spring from the American vision of progress and conquering all problems. Much of the cost at end-of-life is due to patient and/or family refusing to see the obvious. Often a good talk will alleviate this, but not always, and it only takes one paranoid child out of 12 to gum up the works.
    Hospice is an outstanding concept which, among other things, will often lessen the fear and anxiety surrounding death. It is also a God-send for the caretaker (in my case, my mother).
    The “death panel” rhetoric was overblown, but so is your condemnation of it. The fact is that a panel on cost-effectiveness will inevitably recommend limitations on care for those over age X, and the limitations will be inflexible. The British have been particularly stern in this regard, but Obama’s vision of an ideal system would lead in the same general direction.

    • In my view, simple economics will force us all to make difficult choices. No matter which party is in charge. Reality trumps politics in the end.

      I am also confident that American ingenuity will find ways to fill gaps that arise.

    • “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.” – Donald Berwick, the man Obama just made Administrator of the Centers for Medicare & Medicaid Services. He’s the guy who will be deciding whether or not a doctor can even treat you. He’s known for his praise of Britain’s National Institute for Health and Clinical Excellence (NICE) and how they have even calculated the value of a human life (roughly $45,000 by the way). Rationing care is already here.

      • Rationing has always been with us in one form or another.

        The cost argument in this post is more about the exorbitant amounts we spend for futile treatments of the terminally ill. There is a better, more cost effective way.

      • Headless Unicorn Guy says:

        He’s known for his praise of Britain’s National Institute for Health and Clinical Excellence (NICE)…

        N.I.C.E.
        Where have we heard that acronym before?
        Comment, Dr Ransom?

        …and how they have even calculated the value of a human life (roughly $45,000 by the way).

        Is that $45K figure for proles, Outer Party Bureaucrats, or Inner Party Government Officials?

      • Danielle says:

        Berwick’s quote merely points out the obvious: Resources are not limitless. Rationing occurs in all systems. The only question is how the rationing takes place. Berwick was probably just pointing out that it may as well be done on a fair and rational basis.

        Also, I am sure there are bones to pick with British health care — but you aren’t implying there is a $45,000 cut off, are you?

        • “Also, I am sure there are bones to pick with British health care — but you aren’t implying there is a $45,000 cut off, are you?”

          In very simplistic terms they will not approve treatments costing $45K per year of life extension expected.

          Sounds tough but they’ve taken the money allocated for health care and run the numbers and that’s the cutoff based on the pot of money allocated.

          Here in the US we (medicare and such) state what will be covered and then go to congress and tell them how much money they get to write IOU’s for. Because if you state coverage first you can almost never retract it and get re-elected.

      • Donalbain says:

        Indeed, rationing is here. It has ALWAYS been here. There is a limited amount of money, there will ALWAYS be alimited amount of money. It is just that now the rationing is done by insurance companies in the USA.

  12. Dana Ames says:

    I heard Dr.Gawande on “Fresh Air”. I found it significant that people who choose a “combined” approach (hospice without signing away all treatment) did the best of all.

    Eric at 1:08 is spot on. For American Christians, Jesus’ Resurrection is simply tacked on to the Crucifixion as “proof” that Jesus is God and that his sacrifice was acceptable. We have ignored what his Resurrection *meant*, which was the whole point of all the preaching of the first Christians, indeed the understanding that death is toothless and stingless and need not be feared- most of all because Jesus himself went there!

    As for our own selves, we don’t really believe in the Resurrection of the Dead, because our notions about life of the age to come are so anemic.

    Incredibly ironic given the amount of violence and death, real or simulated, we watch on our screens.

    Dana

  13. As both an American culture and as a Christian culture we are not dealing with end of life care. As a pastor, I have watched people twisting in pain while waiting for their medicine. I have also watched good Christian folk having a terrible time deciding when to say enough is enough because they are worried about approving euthanasia. But palliative care and euthanasia are two different matters.

    Most decisions that have to do with end of life care have little to do with prematurely ending a life. But, because of the cultural debates, we have made people afraid of making an ungodly decision. The reality is that other than a few rare groups, most of the discussion has to do with the difficult decision over how to decide when life has ended or when to keep aggressive treatment going. The reality is that our medical technology has currently outstripped our ability to decide when life has ended or when treatment has become unhelpful. This makes end of life decisions very difficult.

    • “But, because of the cultural debates, we have made people afraid of making an ungodly decision. ”

      I feel this is a part of the “how should we read the bible debate” which the discussion on K. Ham touched on.

      Medical care at the time of Christ and earlier was mostly make them comfortable while sick. Today the world is totally different. And taking bible verses literally in this area can lead to very strange results that seem to have nothing to do with leading a biblical life. As I see it.

      And just to be clear I agree with your statements. 🙂

  14. Forced to choose between my care being rationed by a for-profit organization like the insurance companies or a non-profit organization like the government, I’ll take the non-profit every time.

    It is a proven strategy that if the insurance companies can find a way to deny treatment, the patient will often die before the appeals have finished. Paying lawyers to deny care is a more profitable strategy than paying doctors to provide it. There are real horror stories out there that we close our eyes to.

    Where are the comments suggesting that the church is the correct organization to ensure everyone gets care? That’s an easy position philosophically, but when you see $50K bills per patient, it’s :crickets:

    • The problem with having the government do it is that in the end when electable politicians are at the end of the decision chain they will vote to borrow money from tomorrow’s taxpayers to pay for things that don’t cause them to loose votes today.

      The entire “death panel” debate is over trying to win elections with rhetoric, not facts like “the pot of money is not infinite”.

      What you call non profit I call non reality.

      • Your argument seems to be that that the finite pot of money is best administered by an organization that is going to take 30% off the top for their administration, lobbying, $10M CEO salaries and stockholder profit.

        If the pot of money is finite, and I agree that it is, why do you only want 70% of it going to patients?

        And the more profit a business makes, the better. Why do you seem to think this arrangement, in which the organizations providing the care have a strong, fundamental, legal requirement to minimize what they pay out, is going to provide the best care?

        To defend a for-profit system is to defend a system in which a company that finds a way to only pay out 60% of premiums is a better caretaker than a company that pays out 70%.

        Under that logic, an insurance company that finds a way to keep 100% of premiums and turn them into profit is the most moral company and best for our country and our people.

        I find it immoral that in our society we equate greater profit with greater morality. At that point, we are worshiping Mammon.

        • I did NOT say that.

          I said that you equating non profit with government health care leading to better results was a false proposition.

          For profit health care has issues. Big ones.
          Government health care has issues Big ones.

          But government health care isn’t non profit. It just moves the profits to other areas.

          Small non profits can be truely non profit in their scope. But once you get very large, and health care is nothing but large, then all you’re doing is shifting the profits to the suppliers. And there must be profits or things will stagnate.

          Do you bank where they return $.98 on each $1.00 you put into savings? Do you expect construction firms to operate without making any money? How about firms that supply sheets and clothes? Or build X-Ray machines? Or repair cars? Or do plumbing work? Or computer networking? Or elevators? And on and on and on.

          And if you don’t think that a government program in almost any area takes about 30% “off the top” you haven’t looked closely at how tax dollars flow.

          I’m not defending either direction as perfect. Both have big flaws. But in the end it’s easier to replace a company than a government program when they go bad.

          My $.02

          • Show me a US health insurance company that will return 90% of the premiums in the form of care, as does the Canadian government-run system.

            All the insurance companies have gone bad, and there is no replacement except for going without health care coverage.

  15. CM. I applaud your vocation. You perform in an area where many of us don’t want to tread or even contemplate that it exists.

    And that’s the problem. With both Christians and non alike. Many (most?) people are not willing to contemplate that “it’s time”. You see a lot of people who are at peace with things but how much of this is because the people who are not “at peace” never get near you?

    My wife and I both have mothers who are totally irrational about their age and how to deal with the end of their lives. Both are past 75 and their husbands dead. They do not comprehend (or totally refuse to think about) who pays for their medical bills and their incredibly poor choices. To one it’s God’s providence that their husband’s heath insurance and medicare paid for $200K in medical bills due to her ignoring a once trivial condition for 15 years. To the other if she’s not in severe pain she doesn’t want to visit a doctor and thus save money so conditions get very bad and then she pays much more. The current complaint is about $7,000 in dental work needed due to not visiting a dentist for basic cleanings for 10 years or more.

    So they both run up costs in both private and government heath care costs due to stupid decisions. But we can’t (legally) force them to be rational. So future taxpayers and/or employers get to pay for their incredibly bad decisions.

    This is what leads to rationing. As long as a non trivial portion of the population gets to make bad decisions and be bailed out by insurance and government then there will be panels who limit care to the available pile of money. And while it’s a very big pile, it’s not an infinitely tall pile.

    As I see it the only way out of this is to try and educate people on the limits of our ability to “fix” them medically. But politically this is an untenable position in our current political situation. Left, right, D, or R. Rational discussion in this area is going to get you voted out of office and replaced by someone who will not tell the truth.

    CM, keep up the good work.

    Oh, yeah, we’ve told out kids that if we act like our parents when we’re that age they get to slap us silly until we act right. And we plan to make a video stating this so they can show it to us when needed. 🙂

  16. Wow….heavy topics….

    When I was a member of a missionary community I lived and worked for a number of years at a nursing home that was set up for the “poorest of the poor”…and as such it was government and donation funded. The biggest problem I saw in relation to the government funding was that it was never reliably available. Never consistently arrived. Yet, because of this government connection any and all donations given had all this red tape attached to them that it wasn’t simply: here’s a need and God supplied ; the government had their hands in everything and this so so very often affected the resources available for patient care…the quality and quantity of hired help. We were in an inner city environment. Most of the help were immigrants (many illegal because it was cost effective given the financial reality and this was the ’80’s) and most didn’t speak much english or very poorly. Part of the nursing home was medically seen as a chronic care hospital, where people went to spend their last days. Back in the ’80’s volunteers were allowed to do way more than they can today. If it wasn’t for the volunteers patient care would have been extremely lacking.

    In response to the topic about Christians, health-care debate, end of life issues etc….
    One thought that came often to mind reading the previous responses was the truth about when the reality of “health-care” actually began and by whom…..Historically it was the first Christians who started long term care of the sick and terminally ill – starting up the first hospitals…being there to comfort those in their last days. It was something the Love of Christ compelled them to do. It wasn’t connected to the government nor financial profit. Life took it’s natural course….when medicine of the era couldn’t restore health, patients were cared for to be as comfortable as possible. To die with dignity. People prayed for miracles, and miracles did at times happen. It was not, however, seen as a lack of faith when one died of their illness. It was the cycle of life.

    The wonders of technology has brought the advance of science and medicine to cure illness and alleviate suffering. It has also brought about the idea that it is wrong to allow the normal course of life….People have been sued, called uncaring, said to be playing God, when they allow the simple course of life to take place, and allow someone to slowly die. Because there’s technology to “keep someone alive”, young or old, it’s seen by many as the legal and morally best option…..(she’s been brain-dead for years it’s only that feeding tube keeping her body alive {but her as a vegetable} so she’s not meant to die….or, it’s the breathing tube that’s keeping her alive, she can’t talk , lives confined to bed, needs help with all her needs…but her body’s alive, she’s aware, so she’s not meant to die…).
    On the other, because all this technology costs so much, others believe persons in such conditions should be left without even the basics to die with dignity, whether young or old. For them euthanasia is the answer.

    Because of my background in health-care and pastoral care of the sick I was able to deal with the care of my parents more actively. My mother died at home from cancer. She had a 6 month period of hospice care until she needed a feeding tube to eat when she could no longer swallow. A year before the doctors would only “ALLOW” her to go home because I was able to provide the “medical services” they said she needed. She had been in the hospital for 3 months and wanted out…but she, although completely mentally competent, couldn’t, was not “ALLOWED” by the hospital, to make that decision..She couldn’t walk and had blood sugar issues. Didn’t matter she had a loving husband and friends and family. The hospital and/or doctors I believe had concerns about possible lawsuits….that’s another reality they deal with that raises the cost of health care and complicates decisions.

    In my opinion, with governments and capitalism(regards to technology, medicine, insurance) involved with health care we are no longer in control, partially, but not totally.

  17. SPAM