So, here’s what I’ve been thinking lately.
We all have to die, right? Really. We cannot live forever, even if we think we can.
So no matter how good we get at health care and taking care of ourselves, we are all going to die of something. And there will always be a “#1 killer of women” and a “#1 killer of men” for us to be afraid of.
And a cause to fight or a new drug to sell or a headline to scare us or funding that is needed from the government for treatment and research.
So when does it stop?
I mean, what happens when we’ve cured cancer and found the perfect statin or perfect diet? What will we do when the word “plaque” only refers to a thing you get to hang on your wall ? Or when diabetes is discovered to be from a virus and we get the vaccine, and when stem cells make Alzheimer’s and Parkinson’s obsolete…will there be anything left to die from?
Or will we all live forever?
And if we don’t live forever, how long will we all live? To 120 years old? 150?
At that point, will there be a group of people who are living to 150 and still look great but a whole lot of people will still be dying at 95 from heart disease because they can’t afford the best health care?
But that’s already happening, isn’t it? Just on an earlier scale.
I mean, here we are, just plowing ahead curing everything right and left, leaving many of us to live longer and longer while women and children are dying at young ages from thing like malaria, measles and infant diarrhea. Diseases we in the developed world left behind in the history books years ago.
Really, really think about that. While we sit here worrying about which statin to take because we won’t get off our fat ass to exercise, kids are dying all over Africa from malaria and measles.
That’s because there’s no master plan. There’s no prioritizing where the money is going on a worldwide basis.
Now I know those laisse faire capitalists out there are saying “Leave it alone. Let it evolve. It’s working, just not at the pace everyone wants it to. And not equally everywhere, but give it time. We’re figuring it out…”
But are we figuring it out? Or are we just figuring out best how to make money doing it?
Because if it’s really all about making money, then we should not be surprised that we spend so much on it. And we should all just shut up and spend the money and see where it takes us.
But we really don’t want to spend the money, do we? We want our cash for other things, like I-phones and HDTV and oil guzzling minivans and movie downloads.
Of course we can’t say that, so we talk about the uninsured and the poor who can’t afford health care.
But really, how much would it cost for us just to take care of those folks? Not much compared to what we are paying overall for health care we would rather get for free so we can spend our money elsewhere.
And certainly pennies compared with the billions we spend trying to hang onto every last second of life because we really haven’t come to terms with the fact that we all have to die. And that if that death happens to be unexpected, it doesn’t necessarily mean that someone did something wrong and we have to find someone to blame.
How many times have I heard people speak these words – “Why haven’t they found the cause of … yet?” or “Someone has to have figured this out by now” or “”How come they don’t know …?”, all spoken with the expectation that it’s someone’s responsibility to have figured these things out, and if it’s not done, then by god, someone’s not doing their job!
All of which leads to lawsuits and raises the costs of health care even further.
Or do I have it all wrong? Maybe health care costs so much because the system isn’t free market enough. After all, the price of most things goes down with time – like I-Phones and laptops. But health care just keeps getting more expensive.
Maybe the answer is to just set the beast free. Get rid of insurance companies and go back to the days when folks just paid the doctor. Then who knows what health care would look like? Maybe I’d become obsolete because someone else has figured out how to deliver health care more cheaply.
Uh, oh. This thought train is taking a turn I don’t like. I think I’ll stop and make some soup.
Hmm, maybe you should come hang out with my department folks; we excel at existential despair. And still, mostly, we get up and try anyway, even though we know it’s all meaningless.
I served in the Peace Corps. And at our 26th year group reunion, our newly retired program director came to speak. 26 years later, thousands of volunteers and folks working really hard, and things aren’t really better, and in some cases worse. Multiply that many times for all sorts of development workers.
You know what’s really amazing? Somehow, the efforts of many people managed to eradicate smallpox. But we’re not at all close to eradicating war or greed.
At least you turn to soup when you’re despairing. That’s a lot healthier than what most of us do.
Somewhere in your waxing prolific I found a thread of what I believe to be the biggest cause of most problems in the world today – entitlement. We are entitled to lifestyles that we cannot afford which has caused a record high numbers of foreclosures. We are entitled to being treated by doctors who are supposed to be superhuman and this has caused record numbers of ridiculous and greedy malpractice suits. And now apparently we are entitled to live forever.
Now I dont like the turn this is taking so I think I will go eat some soup:) (I leave the cooking to those who do it better)!
– OBS Housekeeper
Great post. This morning, the Wall Street Journal reported this:
“An analysis of millions of Medicare records shows that wide variations in health costs for chronically ill patients in their last two years of life are driven not so much by the price of individual services, but rather by the number of services provided, from specialist visits to days in the intensive-care unit.
Where more alternatives are available, costs tend to be higher — adding to the growing evidence that the supply of health care drives its use, said study co-author Elliott Fisher, a Dartmouth medical professor and director of its Center for Healthcare Research and Reform. Moreover, one effort to reduce costs by shifting care to rehabilitation centers, nursing homes and home health care doesn’t seem to work, the researchers found. “Care organizes itself around local capacity,” said David Goodman, a co-author of the Dartmouth Atlas of Health Care and a Dartmouth pediatrics professor. As a doctor, “doing more always feels better.”
So, like OBS Housekeeper suspects – entitlement and expectations drive many of the costs. But in the end, I believe higher-order thinking reveals that it’s the political and psychological influences that prevent true reform to our healthcare system, not just the creation of services that are more “efficient.”
TBTAM,
Let me guess, this was a cold weekend wrapped up in a down comforter watching Lifetime movies that finally got to you?
Or perhaps you were smoking weed and listening to Pink Floyd when you wrote this, man…? I so have Dorito munchies right now!
While the song, “What’s it all about, Alphie” runs through my head, I thought I would share my thoughts as I read your post.
I think it is amazing that you are so humble to be have this perspective, and yet, still be able to be a world-class physician. It’s a testiment to why you have the job you do for sure, and why it’s always so damn compelling to come to your blog in the first place.
Having the kind of thought pattern that you are having with this post is CRITICAL to future success. What is it that we need to achieve? Why do we need to achieve it? etc.
Your basic question, though, of do we think we can live forever is, to me, not as simple as you ask it. You are contextualizing things with the greater American crowd, which is not as evolved as you are, to come to terms with their death, and to accept responsibility for it as well. I think this is where most fall short. My experience is that when Americans find themselves not having an answer to a difficult question, that they drop this into the hands of others, and then want to hold them accountable for the responses. While this is absurd and unreasonable, the egos of the masses need to be maintained. Perhaps this would have been Newton’s 4th law had he had lived longer…
I stipulate above that this is an American perspective. Go to Germany and ask the elderly about chemo therapy, and likely they will tell you that they are too old to participate in treatments like this, that quality of life is far more important than quantity. Go to India, where nearly 1 billion people believe in reincarnation and ask them about living forever. They have NO DESIRE to do this since they want to come back in the next life higher on the pecking order – as a cow.
But we here in America practically have a constitutional right to other people being responsible for making everyone else’s life better. This, without doubt, includes healthcare. It’s not fair, but it is reality because the mass of people cannot accept that they play a role in their own death.
Another ego factor is that family members cannot accept that death happens. Therefore, we form foundations, and raise money for research and awareness. Many times this is GREAT. Many times this is ego, and trying to make others share in the responsibility for the loss of someone they love. It’s nobel for sure, but clearly absurd. However, how are we going to get new medical centers if some rich person’s mother or child didn’t die of some horrific human atrocity?
The next argument to consider on the ego trip side of things is that there are those in the world who have the ego to think that they can fix the world. Again this mentality is fantastic, but often arrogant. Never the less, it is this crowd of folks that often use the fear to sell their promise of a better future. Without this formula, we would not have Presidential campaigns. Again, the masses thrive on this because someone is going to take care of them by promising to fix today’s problems – whether or not they knew they had the problem to begin with is entirely irrelevant. The fact that the problems don’t actually get fixed is never the fault of the person selling the possibility of the solution.
We as humans need things to work on, to fix. If we solve the crisis of serious disease, then it will break the “system” someplace else. This will give people a new chance to save humanity in a way that had never been conceived of before. We need heros and pioneers. Humans have an innate need to evolve, we just don’t want to hold ourselves accountable for it.
Personally, I want to live a good life. Be a good husband and parent, make enough money to not worry, and get past the average age of an American man. Once I pass this milestone, I plan on taking up every vice known to man and refrain from ever seeking assistance in longevity (think of the old disco queen in the movie “54”). I don’t want to be a burdon to my kids, I don’t want to run out of money or have to work to 95 to afford to live to 130. And frankly, I don’t ever want to outlive my kids. I can’t imagine how to do that. I am just fine with the natural order of things, thank you very much.
I have taken up enough space on your comment page, so I will end with this. It’s fantastic that you have the perspective that you do, but be patient with the rest of the world – they haven’t caught up with you yet.
It is an interesting point……though there always will be poor among us, and health will always be a bottomless pit of dollars. Research is an expensive business, but none of us now would begrudge the amount of money spent to develop the things we take for granted (antibiotics, vaccines, painkillers, anaesthetics). If we thought about it as “what would someone in 50 years think…”
Maybe we could all make a small sacrifice of HDTV or something to vaccinate one or two kiddies…
Beautiful, artistic post. Who took the photos? Thanks for sharing.
Aahhh, the beast.
We hate it, but we need it. How much preventive care do you think would happen if insurance didn’t pay for it? Medicine would look very different, indeed.
No, we can’t do without the beast. And it is really all about the money. Hopefully some good comes of it as a side effect. Hmm…the health of the nation as a side effect of making money. No wonder it’s so screwed up.
When I get caught up in thoughts like these, I find the only thing that I can do is to focus on my little corner of the planet and try to do some good within my sphere of influence.
Or make some soup.
If it’s all about the money, then you’d think HMOs would return more than five percent profit.
*****
Why is health care so expensive? Well, as others have pointed out, it’s not the individual services; it’s the totality. And most of that is spent in the last few decades of life. Per-capita costs for Americans over 55 are seven times higher than for those under 55. If you eliminate the over-65 population, American per-capita is in line with the rest of the world…
So that’s our problem, is we just spend too much darn money on those inconvenient old people. Why can’t they all just die at age 65 and save us the trouble? Maybe we could have a contest; each year, everyone over 65 gets thrown into a tank full of crocodiles. Whoever makes it out gets to live another year. We could also sell tickets, and the whole operation would pay for itself.
I have enjoyed your post, TBTAM, and the comments. Mostly I am like you and Dr Smak. Guess I will just have to do what little good I can in my little corner. I’ll bring the corn bread if you’ll make the soup.
Bardiac –
PErhaps the Peace Corps hasn;t made any huge changes, but I’m sure the changes you’ve made in individuals lives has been enormous. God bless you for what you’ve dne.
OBS –
You’re right – We want it all. (including good soup…)
Dr Wes –
So the more we have, the more we want. Ther’s the argument for rationing (which of course will never fly here in America…)
Shruggling…. mentions that:
ALL he wants is to make enough money so he doesn’t have to WORRY…
[Wants to] not run out of MONEY. Hello, Shruggling — most of the world doesn’t have the luxury of not worrying, not having enough money to feed their kids.
And frankly, Shruggling doesn’t want to outlive his kids. CAN’T IMAGINE THAT.
And Shruggling wants to you to be patient with the rest of the world — THEY haven’t caught up with you yet.
Shruggling believes that 1) good works are mostly done out of ego and that 2) foundations to do good in a lost family member’s name are a symptom of inability to ACCEPT the loved one’s death — a reality that Shruggling is not willing to even IMAGINE —
Dear Shruggling, since you are clearly not part of the solution, then perhaps your need to be free from worry and the ugly realities you’d rather not imagine, perhaps this attitude makes you part of the problem.
I never thought of it that way- there will always be a number one killer.
Interesting.
Anonymous,
Thanks for your comment. Let me address a few points.
I never make the claim that ALL I want it to make enough money to not worry. You seemed to miss the part where I strive to be a good partner, father, and to live an average age too. Do I try to save money and live a lifestyle that matches my income and desires, yes. Do I currently worry about money, yes. I am, however, very fortunate that I don’t worry about feeding my kids – at least not today. I also, don’t have a car payment, can afford my mortgage, and pay my credit card bill each month in full. Why? Because I spend what I earn. I have an expectation of myself that I should only have things that I can afford. I think I am probably a bit of an anomoly here. So, frankly, good for me. By the way, I contribute to people in need by giving my time, talent and money. My kids have food on the table, it does not mean that I am not understanding of, or lack support for others that don’t have food on the table. Do I personally feed the world with my contribution? Heck no, but it’s something.
My notion of not wanting to outlive my kids is a no brainer, but one that hits close to home. I have witnessed my mother-in-law suffer daily since she burried her 39 year old daughter. Selfishly, I would prefer to not have to experience that pain directly. However, I cannot predict where life will take me.
I do think that good work comes from foundations and individuals who dedicate themselves to a cause. I do think that these acts are not entirely unselfish, and ego plays a role. The effort satisfies all kinds of needs, not just the altrusistic ones. If you think otherwise, that is your perspective, and in my opinion, that would be a naive one. I think it’s great to have these foundations and individual contributions by the way. Great things have been done. My point was that ego is a factor in the human process.
Your judgement of whether or not I am willing to accept or not accept a loved one’s death is simply absurd. You don’t know me at all, so I am not sure where you derived that judgement. I will leave that there.
Your point about me not being part of the solution has serious merits. I do not have the training to cure disease. Do I contribute to a forward looking process to improve people’s quality of life? I hope I do, but I don’t have dilusions that I am a pioneer here. I also don’t have the expecation that others have to do it for me. So my challenge back to you (framing this with the original post in mind) is, what contributions are you expecting from me? Also, which of the worlds problems do you think need to be solved? My guess is that we won’t agree on priority…
Do I think that TBTAM is evolved beyond the average bear? Yes I do – in fact way beyond. I sensed frustration and angst in her post. Hence my response to be patient. Never did I say stop, and never did I imply that solutions were not worth while. I did imply that particular problems that get chosen for solutions have agendas. I stand by that. This is TBTAMs journey, not mine. I don’t share her angst as she has described it here.
So taking things one step further, am I part of the problem? Not sure I know what you are defining as a problem. I don’t think I am contributing to an expectation for others to provide service or solutions for me in particular. At least that is how I live my life today at age 41. We’ll just have to pick this conversation up when I (hopefully) hit 75.
I clearly hit a nerve. My post had a sarcastic/dark twist to it ( humorous one too, I hope, but that was clearly missed – come on, Newton’s 4th law if he had lived longer? Funny!), but that’s me. At least I am authentic and revealed a part of me here. Can’t say that I gleemed anything about you from your post, however. And in my book, that makes you a HUGE part of “the problem”. I am fine with you disagreeing with me, but don’t rip me without offering at least a little bit of your perspective. What exactly are you doing to solve problems? Looks like we are in that pool together.
Shruggling —
Yes, you hit a nerve. You also use the word “absurd” to describe the actions and motivations of others an insulting number of times, considering you are speaking of people you don’t know. Or is that part of your dark, funny sarcasm? Sorry for any assumptions made about your possible reaction to a loved one’s death.
Sofia
http://www.lovehallie.org