The American Way of Dying

November 23 – Last night on CBS’s 60 Minutes, I learned much of what I knew already, most of it obvious.

I learned,

100 percent of Americans will die eventually;

one day in a hospital intensive care unit costs $10,000;

the last two years of life of Medicare recipients costs Medicare $50 billion each year;

it is human natture to want to live yet another day, no matter what the cost as long as it is Medicare money;

Medicare is rapidly growing broke because it never questions paying for what is done;

Americans overwhelmingly want to die at home, but only 15 percent do while 75 percent die in hospitals;

most relatives, dear ones, and significant others of dying patients support dying in the hospital;

many living wills are ignored, and doctors, backed by patients and relatives and significant others, encourage doctors to to everything they can do sustain life;

the mission of doctors, by law, custom, and training, is to prolong life, and they have the technologies to carry out their mission;

profit margins of hospitals, and fee-for-service payment of doctors, encourages hospitals and doctors to support the prolonging of life;

if paying for health care is to be sustainable, it may be necessary to ration care based on age and cost, to set limits based on clinical and cost effectiveness, quality of life, and estimates of how long life is likely to last, and that, figuratively, society may have to “pull the plug” on people destined to die in the near term;

Americans tend to the deny the realities of inevitable death;

it will be extraordinary difficult to cut Medicare spending because of cultural and political backlash;

cutting Medicare spending is a miasma of moral, monetary, cultural, professional, and personal dilemmas;

Slashing medicare benefits is akin to boiling the polital ocean;

what I did not learn is America is maturing in its attitudes towards dying and death, and through its growing use of hospice services, particularly, end of life care is being administered in homes;

home is where the heart is, and ideally home is where more Medicare money is best spent spent for comfort and compassion for the dying.