Saturday, February 11, 2012

Longevity means outliving your value

An article (or column) from the Baltimore Sun was syndicated into the Palm Beach Post, a newspaper I read each day.  The author of this article is Susan Reimer.  The title of her piece is "Longevity happier in theory than in practice."
Ms Reimer relates crosscountry conversations with close friends whose mothers are very old and no longer functioning normally.  The conversation drifts into other personal talk but Reimer brings them back to discussing the end of life.
"We shouldn't be planning vacations," she says.  "We should be working on exit strategies.  The one of us who still has it together needs to promise to mix the pills in the applesauce for the ones who don't."
Serious stuff.  But then Reimer presents some facts.  In her own words:

"More of us are living longer and dying slower.  Estimates are that 70 percent of us will need some kind of residential care in the final years of life, and few of us have the savings or the insurance to pay for it - about $75,000 a year in a nursing home and about $20,000 a year for home care.  (It is not either/or.  And almost all of us who have home care will eventually need nursing home care.)
"The CLASS Act, part of the health care reform legislation of 2010, would have provided long-term care insurance for anyone who wanted to buy it, regardless of age or health.  But it was withdrawn last month when the Obama administration realized that it was wildly unaffordable.
"Private insurers appear to have made the same actuarial mistakes and are asking for permission to increase premiuns on policies they have already sold by 40 percent.  Some companies are getting out of the long-term care insurance business altogether.
The assumption that many of us have - that Medicare will pay for our care when we are both old and sick - is wrong.  Medicare only pays for short nursing home stays or short-term at-home care, under certain medical conditions.
"It is Medicaid that is bankrupting itself to pay these costs - and most of us are only eligible after we have drained our savings.  None of us wants to face up to end-of-life issues, let alone pay up thousands of dollars a year in premiums for long-term care insurance.
"And we can't seem to talk about any alternatives to prolonging even the most painful or undiginified life." 

Tough stuff, that.  In just a few paragraphs we have an outline of a serious national problem that will only worsen as more people continue to 'live longer and die slower.'
Please note that I write "national problem" because it can't be solved in any piecemeal helter-skelter way.  The favorite comeback of those who won't face  reality is to speak of extended care in the family.  Oh if it were only so. But the extended family of old is as rare as the two-parent, one-salary family of old.
Matters are made worse by new medical discoveries and technologies which extend the life of a terminal patient years past the natural time of death that was more common in the long ago. 
Today's politicians are full of talk about costs and how health care expenses are out of control.
I wonder, is "health care' the right phrase to use when discussing the cost of servicing terminally ill patients?


  1. Linc,

    A while ago you said you were going to stop posting; I am glad to see that you have changed your mind.

    Somewhere down the line an American generation will come to grips with the health/living too long/dying to slow dilemna that you have addressed. It will be there "World War 2" moment.


  2. One day, when I was in ethics class in college, the subject came up of the principal of double effect. Explanatory example: A person is terminally ill and in great pain. In order to relieve the pain, you must give the person an ever-increasing dose of painkiller. This will inevitably shorten what remains of the person's life by inevitably bringing on cardiopulmonary failure. You give to the person anyway because the primary end is to ease pain, not to cause death, though death is a necessary secondary effect. This, by the way, is Catholic doctrine. I went to a Jesuit college and this was a course in Thomistic ethics.
    That was the day I resolved never to take any extraordinary means to extend my life. I am 70. Given that my mother and grandmother both made it to well past 80, I have a good chance of being around for another 10 or 15 years. I plan on spending a part of them preparing for death.

  3. Thank you, Joe. I'm not posting as much as before. I still regard the computer as a 'hostile working environment.' I no longer conduct financial business online, i.e., I pay all bills by mail as I once did. But I'm sticking around untill it goes haywire again.

  4. I agree with your approach, Frank. I have signed a Living Will with DNR instructions.
    I also have decided that if I am ever diagnosed with terminal cancer, I will not subject myself to either radiation or chemotherapy treatment. I have learned from watching friends and relatives suffer from these treatments. Their last days were miserable due to the treatment. And it did nothing to extend their life.

  5. Yes, Lincoln, I think it is important in life - as in other things - to know when the jig is up and just try to get off stage with dignity. I just read a book by the modern Thomist philosopher Josef Pieper called Death and Immortality. He makes the point that death, ultimately, involves a moment of free choice on the part of the dying individual. We let go.