How America Medicine is Destroying Itself

This article in The New Republic is well worth reading, unfortunately you need to be a subscriber to read the entire article so it might make more sense to buy the June 9, 2011 edition which is on news stands currently.

http://www.tnr.com/article/economy/magazine/88631/american-medicine-health-care-costs

The authors are 80 something years old and have practiced or observed the medical architecture of the country for a long time.  They have perspective and details that I only have had in my gut.

They point out that an enormous amount of our medical expenditures go to extending life for a limited amount of time:  a matter of months to a year or two.  They focus on the medical cultural goal of extending the average life expectancy of Americans.  But the easy success for this has already been gained and what are the expenses involved (or the quality of life) for adding a few months or a year or two to a terminal person whose body is failing.

I quote them: "Can we conceptualize something better?  Can we imagine a medicine that is more affordable?....Can we imagine a system that is less ambitious but also more humane - that better handles the inevitable downward spiral of old age?"  "The answer is yes, but it will require....a conversion experience on the part of physicians, researchers, industry and our nation as a whole."

This article outlines this conversion plan that would focus medical expenditures on (1) Public Health promotion and disease prevention; (2) Primary medical and emergency Care; and (lastly) high tech care for the chronically ill.  "The highest priority for $ would be children, the next highest productive adults, and the lowest would be those over 80".  Right now these priorities are reversed with the result that the extension in longevity has caused the cost of an additional year of life to rise from $46,800 in the 1970's to $145,000 in the 1990's.  These are averages and of course the actual number for a significant number of elderly is much higher.  My mother's end of life care was $100,000 a month and added 4 worthless months of unconscious life in an intensive care unit in 1999.  $400,000 of unnecessary expense because the Dr. would not counsel my father that there was no hope when it was obvious to me that there was no hope for a meaningful recovery.  A life without a mind is not a worthwhile life.

It is so unfortunate that the Republicans seized on the one aspect of the Affordable Health Care Act of 2010 that would have started to address this.  Counseling of end of life care became Death Panels when that might have been the single most effective cost control.  All "medical care is personal", but as the Republicans say, an educated consumer is better then a blind accepting consumer that any additional time is better.  But even educated consumers cannot have a Dr. Assisted End of Life except in Oregon because the Republicans will not allow it to pass in the other states.  The issue between the parties is not the concept of education but how you create that education for the whole population while not making good health care affordable by income class alone. The real benefit for society would be healthy children and adults who understand extra pounds and smoking shorten life spans.  Then we can afford to pay for good cancer and HIV care for productive people and reasonable procedures/pharmaceuticals for the elderly.

I have probably not done the article justice and urge you to find a way to read it yourself.