War and Medicine

I had a great conversation with a doctor Friday night. No, I wasn’t getting a physical. We were at a dinner party. He was one of those great young men that really want to heal but be rational at the same time.
I have been on a tear lately about medicine. I am in the system so to speak, since I now have Medicare. I must admit the is a lack of diligence on my part as I try to treat my wounded wing. There was treatment, cortisone shots and of course arm therapy. I cut it short. I said this is BS. I was getting sucked in.
In the late 50’s, Eisenhower (sorry kids) was president. He gave an amazing speech that warned of the formation of a military industrial complex in the US. It would so intertwine government and private industry that lines would blur. All in the name of national security.

As I went to an orthopedic group of some 30 doctors, replete with physical therapy, operating suites and a pharmacy I was literally blown away. At the number of people and the extent of treatment.

I went to see a friend who was in intensive care with some sort of liver disease. The unit was packed with poor souls trying to get back to life but for so many the route was one way. I began to think of the hundreds and thousands of doctor’s offices, ICU’s, operating rooms, therapy practices and medical suppliers all throughout this country.

Maybe it is my stage in life but it really is overwhelming. As I talked with my doc friend, I put forth that there has to be a finite amount of money we are going to spend on medicine. We can’t let it get to 25% of GDP from it’s present 15%. Which dwarfs the 6% we spend on the military today. We just can’t! It ain’t free! He agreed.

I imagine the same has been noted in the past for the military industrial complex. We have made the whole process of healing people a profit center. Okay boys and girls we have to show growth. We have to increase share price. Keep those people alive at any cost.

The war on disease is no different than our wars on other nations. We use weaponry of a different sort but damn the torpedoes and who gives a crap what it cost. We are talking human lives here. Just like national defense.

Yet I am struck by the fact that we save someone’s life late in life but that creates a myriad of problems that have to be corrected by a totally different subset of specialists. And on and on. Then lucky you will be able to spend years in a facility that will keep you living at any cost.

Am I harsh? Maybe. But is it harshness or pragmatism? I don’t want to die. At least not just yet. But there is a progression in life. It starts the day you were born. When we get to the point of being able to cure most anything I get scared. For myself as a human being and for my kids and grandkids who are going to wind up paying this bill.

It is interesting that we have waged war in Afghanistan and Iraq to the tune of $1Trillion. We have never had a raise in taxes to pay for it. In our war on disease we have never paid for it either. We are now saying bring our troops home. Maybe we should think about how far we have come in medicine and contemplate if it is time to slow down and see how we can pay for further gains.

Boeing and Northrop and Raytheon are up today. So is Pfizer, Healthsouth, St Jude Medical and Baxter. Somehow something doesn’t seem quite right. On one end it is feeding our IRAS but at the other end it is eating our lunch.

As Always

Ted The Great

Fact Thought: A person proposed a unique approach this week for those who are at odds in a discussion. Let’s just say I am a conservative and you are a liberal.

Before we start any arguing I have to spend twenty minutes telling you what you are saying about liberalism. Then conversely you take twenty minutes telling me what I am putting forth about conservatism. Now that we have that settled, let’s talk

If you can stand it here is a similar piece I wrote awhile back. Similar but at least we can get it out of the way and get me off my soap box.

Why Are We So Afraid To Die?

Kathy and I are updating our wills. You have to think of the mechanics of estate planning but you also have to address the end of life. Whether you are excited or disappointed about my prospects, I really don’t anticipate going anytime soon. But sooner or later the day comes.
I hate to say it but I am really not afraid. At least at this point. I think it is in part because I have been around 6 or 7 people either at or very close to their time of death. None of them beat the rap. They all moved forward on the path of life. Yes, all the stories had the same ending. And they should.
My mom was the best. I would visit periodically from Arizona during the last eighteen months of her life. She was determined of one thing. She was going to die at home. She fell about six weeks before she died. I swear to this day she probably broke her hip. But she wasn’t going to a hospital. That would only prolong things.
In the last days she determined she was ready to go. Why hang around she said? Her friends were gone and she wanted to see her husband and God. Kathy just wants to see God. One morning she said she prayed the rosary the night before so that she would die in her sleep. She wanted to know if I thought that was wrong? Are you kidding?
My brother wanted to spend the last day of his life playing golf at the National on Long Island. He wanted to shoot 75. He wanted to sit in the card room overlooking the Great South Bay He wanted a cigar in one hand and a martini in the other. He died in New York three years ago after 45 courageous but tortuous days in the ICU. Ugh!
Where am I going with this ? We live in an increasingly biotech world. Advances in science are hell bent on curing disease and ergo prolonging life. That’s both good and bad.
I have a neighbor with a pretty liberal bent. She felt we should provide every human being with the best in medical help. A worthy goal, but is it practical? I posed a question that tried to ascertain whether we should do this. Of course she said. But what if I have cancer and there is a treatment that could prolong my life by two months but costs a million dollars? Oh no we couldn’t do that. Am I missing something?
We have give or take 45 million baby boomers. Let’s say each one of those spends $100,000 in end of life procedures and care. Not a big number by today’s standards. Do the math. It just doesn’t work.
I am not talking about death squads but by the same token we have to inject some sense of sanity into the whole issue. As bioethicists, we have to establish parameters to long term care. As rational people we have to realize there are limits that grow with age, condition and hope for survival.
Yes this is my third rail. This is my adult conversation. I know I will hear about it but it is something that has been on my mind personally for a long time. As I set up living wills, there is an element of sobriety. There is a realism that I must feel not only as a human being but as a steward of my children’s and grandchildren’s future.
I have had a great life. If something happened tomorrow I wouldn’t in any way feel cheated. By the same token I work out hard and try to eat well so that the next 15 years of my life can be spent enjoying my grandkids and doing things with them.
If I make it beyond that I consider it gravy. If I make it too much further than that I might think God has already sent me to hell. Hang on to life. Yes, it is precious. But also read the highway signs and know when to exit.
As Always;
Ted The Great

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