Vicky Dickson
It doesn’t make sense to me. Our representatives in Washington, in a panic over the effects of current spending levels on the country’s long-term future, are proposing deep cuts in health and social programs. But they’re leaving one of the fastest-growing of those programs, Medicare, alone, despite a Congressional Budget Office projection that Medicare and Medicaid expenses will nearly double their share of the GDP in the next 25 years. If lawmakers are so concerned about our future, you’d think they’d be worried about that growth, and also about the negative effects that cutting programs like Head Start and WIC could have on the ability of our children to earn the money that will be needed to keep Medicare benefits coming.
Since cuts are often justified by the claim that they’ll merely root out waste, there’s further irony in the fact that Medicare spends about $50 billion a year on medical care for people in their last two months of life. Not all of that money is wasted, of course, but there’s no question that a significant amount is spent on futile operations and procedures for patients who are dying. And it’s not just the money that matters; too many people are ending their lives in painful, traumatic ways they’d never choose if they were able to think clearly about all their options.
End-of-life counseling can enable that kind of clear thinking. But the hornet’s nest Sarah Palin stirred up when she equated such counseling with “death panels†has apparently made lawmakers loathe to consider funding anything of the kind. So, since our leaders have abdicated their responsibility for ensuring that Medicare funds aren’t wasted on operations and procedures that are harming us, we need to take that responsibility upon ourselves.
This became clear to me when my 80-year-old father, suffering from both dementia and severe arthritis, was hospitalized for fainting spells. The spells were attributed to a faulty heart valve, which the doctor who saw him in the hospital told me could be fixed with an operation I would need to authorize. The doctor was shocked when I refused to do so.
Not being my father’s primary-care doctor, the attending physician didn’t realize the extent of my dad’s dementia. The conversation they’d had hadn’t lasted nearly long enough for the doctor to understand that his Princeton- and Harvard-educated patient could no longer read a book, remember what he’d told you three or four times in the past ten minutes, or understand that he was in a hospital. The doctor also didn’t know that we’d decided against a recommended knee replacement for my father because his hip-replacement operation had been so traumatic that he had repeatedly asked his nurses to just let him die.
I knew that the valve operation could kill my father, but was more worried that he would come out of it with increased dementia. (When pressed, the doctor admitted that being on the heart-lung machine the operation required often damaged a patient’s memory.) My dad was a person who deeply prized his intellect, and I knew how much he suffered over its loss. More importantly, I knew he didn’t want to undergo a major operation if he didn’t have the capacity to decide for himself, because he’d already said so in his living will.
It’s hard to go against a doctor’s recommendations, even when you’re aware that those recommendations are based on incomplete information. The stress of being faced with a life-altering choice between options you can’t fully understand makes it all too easy to simply rely on a doctor’s opinion, or to go beyond that opinion by requesting that “everything” be done to try to save a loved one, even though “everything” may well include a highly risky and painful operation your loved one would never have chosen for himself.
It’s therefore vital that we all choose ahead of time by making living wills and ensuring that our loved ones also make them. Living wills involve complicated choices, so we should demand that Medicare pay for medical consults that can help with those choices- regardless of whether such consults are labeled “end-of-life” counseling.
In the process, we should make it clear to our elected representatives that we don’t want them giving in to right-wing distortions and lies about our health care. And make it clear, as well, that we want them to reconsider the cuts they are proposing to children’s programs, since the future the cuts impact belongs to all of us.
Vicky Dickson is a columnist and co-owner of The Carrboro Citizen.