In every argument I hear against so-called health care rationing, I think of this very well-said piece by the editor of The Week magazine, William Falk, about his own father’s ordeal.
Medicare paid upward of $20,000 for these last days of my father’s life, during which he received little comfort, moments of agonizing pain and fear, and all the medical care in the world, and then some.
When my father went back to the hospital a year ago, he was clearly close to the end: His lungs and liver were barely functioning, his abdomen was filling with fluid, and he could no longer lift himself out of bed. The hospital’s doctors nonetheless treated him aggressively, punching a hole in his chest to insert a drainage tube, which quickly led to uncontrolled bleeding, an infection, and a plunge in blood pressure. Within 12 hours, my father was in a coma, with no chance of recovery, sustained only by a ventilator and a tangle of multiple IV drips. He spent four days in the ICU, until I overcame the resistance of two doctors and had the machines turned off, as per my dad’s living will. Medicare paid upward of $20,000 for these last days of my father’s life, during which he received little comfort, moments of agonizing pain and fear, and all the medical care in the world, and then some.
In the historic debate over health-care reform now beginning in this country, we will hear much talk of “rationing.” If health care is rationed, we’ll be told, we may be denied drugs or surgeries or treatments based on cost, effectiveness, or the patient’s condition or age. It sounds cold and heartless, except when you consider that the only real alternative to rationing is unlimited medical treatment—including a refusal to “lose” the battle with death even when death is near. Unlimited care, of course, requires unlimited spending, which is not viable. Rationing in some form is inevitable; the only question is when we’ll finally be able to admit to ourselves that even in America, there are limits to everything.
My father had a close call about a year and a half ago, and was put on a ventilator for a day. After that, he made my sister and me promise he would never be ventilated again, ever. What worries me is that with the mind-set we see now in health care — to do everything, even when it’s no longer therapeutic but just dragging out the dying process — we might not be able to keep our promise.
So many older people save their whole lives and plan to leave something to their families. Instead, at the very end, in the last few days, every penny is spent on stupid, useless procedures because the loved one was admitted to a hospital instead of signing up with a hospice or just dying suddenly. It shouldn’t be this way. Many of the people who resist changing this system aren’t thinking it through because they haven’t (yet) seen this side of medicine as it’s practiced today. The rest have something to gain from keeping things the way they are, usually a slice of the massive profits.
