A while back, my wife got a call from an ultrasound tech, who was shaking, she was so upset. A young individual, in their 20s, who recently had an uncomplicated appendectomy, had presented with abdominal pain. There was gas in the liver and no portal vein was visible on the ultrasound.
CT was not performed with contrast, due to the elevated creatinine. But another “old fashioned study,” a contrast BE, had shown, on separate days, nearly no movement of contrast except through a tiny lumen, suggestive of an intussusception. I was interested in the fact that high tech studies, with high costs and high radiation doses, didn’t make the diagnosis in this woman, but controlling imaging studies and radiation in medicine appears to be another issue where I speak out alone.
The young person died. Yes, people die here in Arizona from appendicitis and uncomplicated appendectomies. I appear to speak out alone when I ask why we aren’t learning from these cases. We should drive the mortality rate from appendicitis to zero.
This person did not live in Saddlebrooke, Cobblestone, one of the country clubs, and have a seven figure income or an eight figure net worth. I am not sure who is going to pay for the costs of care, which were limited by the early death. But how do the young and uninsured, who have appendectomies, or even mesenteric adenitis, pay for the costs of an ED visit with a CT scan? Many are young, gorgeous, and broke, to quote Suze Orman.
I will ask my colleagues again where the money is coming from to pay for care for all Americans, since the young, who think they will live forever, won’t, and they can have catastrophic medical issues, including bad motor vehicle accidents. We have pretty much tried to say vaccines are bad, radiation good, evolution didn’t happen, the Earth is a few thousand years old. I am waiting for the concept that young people don’t get sick and the rest of us don’t really die. I once reviewed a paper for a right-wing medical journal (volunteer, of course), that purported the FDA killed 10,000 people a year by not allowing drugs on the market. The statistics in the paper were awful. And I still remember thalidomide.
As a matter of fact, I wonder what will happen if we do away with social security and Medicare. My wife and I will survive, so long as we don’t have a catastrophic illness, but when insurance companies will have premiums high enough to cover their overhead (read: eight figure salaries), we may become old, not so gorgeous, miserably ill, and broke.
Most people who live to ninety have some degree of dementia. It is a fallacy to think we will live to a ripe old age, and then, just before bad things happen, quietly die in our sleep. Visit a few nursing homes if you wish. Heck, there is a life at any cost group that will keep me alive even if my wife doesn’t want me to suffer. Or keep her alive, when I don’t want her to suffer.
The facts are these: most women over 85 are widowed, and a lot fewer men. Let’s look at the women. Most are not living at La Paloma having nice dinners with their friends at 85. Most are trying to get by, not clear what the bills mean, are subject to scams, can’t get around well, and fear for their safety. Maybe they have children, maybe they don’t. The children have lives of their own. Come on, we all know the picture here.
Suicide by poverty will join suicide by cop as the new America. We aren’t as fortunate as the African Dik-dik, who dies, when his/her mate dies. Some of us just keep on going. That’s fine, until we need to stop keeping on going. I know what that is for me, and I have it in my living will, so clear that even somebody who lives in Arizona can understand it.
But I have left my point: how do we figure out a way to care for people who have catastrophic needs at any age? Is spending $400 billion a year on war (defense is such a nicer word, but it was once–and still should be–the Department of War) really appropriate? After 9/11, I said that we needed covert operations, which would be far more effective, to deal with terrorism. Two wars and a decade later, a small, brave group of men killed Osama bin Laden. He could have been dispatched without the money and lives lost in either war.
In these pages, I have offered a host of solutions, not one of which has been adopted. That is unfortunate, not because I didn’t get the credit, but because those who were in power have not solved the problem. We can and will, as soon as we say, “We can care for everybody in America appropriately, and we can pay for it.”
Then it will fall upon us to figure out a way to do it. Once we make up our mind it will happen, we will find a solution. Heck, I might even come out of retirement to offer a few thoughts of my own. Ten, twenty, and thirty years ago, they were ignored. Maybe now they won’t be.
Boreal B[l]og 
April 26, 2012 at 22:41 |
Although I am no longer in the “young” category, I am a survivor of a catastrophic medical event. June 2008 I began a journey through Viral Meningitis and the sequalae still limiting my life. If it wasn’t for COBRA and President Obama’s efforts to provide continuity of care following major illness, I would not be alive. Also, “current medical practice” eliminates alternative medical interventions and the payment for such. I have significant brain damage and my sister is paying for most of my needs. That just isn’t right. I have worked all my life and paid plenty into the “system”. What efforts are keeping me alive should be included in my Medicare and Medicaid. Many of us are falling thru the holes. In MY opinion.