Glass half-Full and Glass Chimera

What's ironic is that Republicans are protecting Medicare, a program that originated in 1965 as a Lyndon Johnson extension of the Newdealian Social Security entitlements.
Great Societies make strange bedfellows. Forty years later, the Repubs endorse patients' end-of-life choices by protecting what already exists as government-financed health care.

As one concerned recipient famously objected: We don't want the government messin' with out Medicare.

The Dems, bless their bleedin' hearts, want to enact new programs (of course) so that everybody, young and old, rich and poor, can have immediate, subsidized access to the system. It's a noble idea; but the government-wary conservatives ask: will that public option thing really work as cost-effectively as you predict? The repubs don't think so, and believe that it's just a slippery slope into more bureaucracy, taxes, and probably poor health care.

But the Dems are pretty dedicated to this thing. They're searching out ways to locate the obligatory, deficit-defeating appropriations (at least on CBO paper) to legitimatize their proposed near-universal coverage. Meanwhile (back in September) the Washington Post reports that "a quarter of Medicare costs--totalling $100,000,000,000 a year--are incurred in the final year of patients' lives, and 40% of that in the last month."

So the progressives take a hard look at that big pile of Medi-money that we just know is wastefully expended to keep the elderly extended.

The repubs bellow and get all melodramatic about death panels when what they're really hittin' on is: advanced care planning consultations, palliative care and hospice care replacing extreme interventions where appropriate, medical councils setting policies to reprioritize taxpayer money spent on both artificial and authentic life supports.

And thus do we Americans discover that government health care programs are not unlike artificial life support. Dead if you do, dead, sooner or later, if you don't. Either way, you're a goner. Or aunt Em. Question is: how long does it take? And who pays for it? I mean, there are kids down in the ER just dyin' to get into this place.

Up on the fifth floor, here's an old guy strung up in a high-tech hospital bed. His feeble, comfort-seeking attempts to dislodge self from those irksome tubes and wires is, medically speaking, ill-advised.

The family hovers at the bedside; they're unsure of what to do. Perhaps they've never been in this situation before, or maybe they've seen it all before in some other relative's slow demise. Either way, their decisions are not easy.

The doc walks in. He's doing a good job, protecting that elusive, electrified heartbeat, enabling that regular intake and output of precious oxygenating air. In the back of his mind, tucked strategically behind the costly medical knowledge (expensive to acquire and expensive to dispense), he feels vaguely threatened by the ever-present possibility of a malpractice suit. It could be lurking anywhere between the pulmonary edema and the abdominal aneurysm; even now it could be adjusting its briefs in preparation to impose shock and awe upon a hapless jury. Or the doc could be preoccupied with someone down the hall who's in even worse shape than the unfortunate guy that he's now smiling at because the family is in the room and how many times a day does he have to do this, and doc's mind is troubled by the dim awareness that there's something he forgot to do, or some question he forgot to ask while in that other patient's room an hour ago. The busy doc doesn't really have sufficient time to spend with each patient and family in order to thoroughly discern their unique requirements and intents and end-of-life preferences and accompanying documents thereof and after all he's only human and how much more hectic and depersonalized would this pace become if it was all "socialized?"

Meanwhile the nurse palliates and monitors, with the aid of her arsenal of life-extending paraphanalia. She keeps the old guy hydrogenated and his electrolytes balanced. She facilitates the ongoing operation of bodily functions, some of which are quite disagreeable, just like the patients from which they efflue. She dutifully administers the meds, but only, of course, the ones that doc allows, even though she knows in some cases doses are inappropriate and orders are obsolete or insufficient. On this particular day, she may be my wife. But that's not my point.

The pressure's on. Life and death situations are hitting the fan every hour.

Downstairs in the ER, more patients are sitting in chairs, delauded by the droning TV, opiate of the people up on the wall. They wait expectantly to receive what the hospital has to offer; they're limping in with wounds, dragging in with their diseases, some with cancer who don't even know it yet, some with nothing more than sprained ankles.

On the third floor, the hospital's financial legions are trying to reconcile the bills--the hospital's own and also the ones being sent out to cover the complicated expense of all those life-extending services. Statements are being prepared for the patients and their families, their insurance companies, their Medicaid and Medicare, blahblahblah...

Oops. There goes an alarm. It's a code being called. The appropriate personnel gather and do all they can, but one on the sixth floor slips away in spite of their skillful efforts.

"Goodbye," she whispers.