Nothing Up My Sleeve

With the national health care debate in full swing and the anticipated decision by the Supreme Court, it is surprising that I don't think I've heard even once an explicit discussion of what may be or should be the most significant aspect of universal care.  It isn't just about who is covered and who pays, nor is it about the myriad of important individual issues.  Yes, we can all agree that it would be great if everyone had excellent health care, but now the fun begins in defining what that means, what that costs, and how that can be payed for and delivered in a nation with so many people and so many people living longer.  But while most seem to focus on the former, I think that it's the latter that merits real debate. I have read that 80% of a person's lifetime health costs occur in the last 3 years of one's life, and 75% die in a hospital or nursing home.  It is end-of-life where the big money is, and big moral questions, too, yet these are taboo subjects.  So we at some point become infirmed with cancer, senility, or any number of terrible maladies and traumas, and if we are lucky we may be healthy and wealthy enough to live in a decent managed care facility or with our spouse/family.  But the point will probably come where we are too much for these others to care for, and into the nursing homes and other forms of major managed care we go, along with our life savings, and when that's depleted, then the government will warehouse us in cheap (only $50,000/yr+), dehumanizing facilities.  And when the end nears in that nursing home or hospital, expensive and extraordinary efforts will likely be taken (even when we've explicitly said no to this, often) to extend our low-quality of life.  We will not be allowed the dignity and freedom to control our end, which will probably come in a sterile hospital room, connected to various machines and tubes, and after perhaps a million dollars and unknown suffering.  Yes, there are many complex issues here, but the point is that many of us will not have a good death, not good for the individual, and not good for society.  But let's keep arguing about choice of physicians, generic prescriptions, and the like.  That's so much easier.

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