After an earnest Google search, I can't find the article. But there was a problem flaring through in the insurance business twenty years ago, despite their sincerest efforts at compassion: Many AIDS patients had purchased something like a reverse mortgage to ease their finances in what was expected to be a roughly two-year decline into death... And suddenly the anti-viral drugs were extending their lives dramatically, and they didn't want to move out of their homes after the equity had been spent.

Every silver lining comes with a thick, dark cloud.

Close paraphrase:

Man: "Life is a swirling, sucking eddy of despair... The only illumination in our ever-blackening Universe is from flashing glimpses of false hope."

Boy: "Good to know, Dad."

This highlights a question resolutely ignored by everyone in medicine and politics: What resources may you command to treat you?

How do you get an abortion if no one near you performs the procedure? How can you tell if there is something wrong in your skull without an MRI? You feel fine, but a test reveals arterial blockage; who is going to clean that passage?

In every case the real answer is the same: unless you are the one paying, you do not get to say how you are treated.

Obamacare is not going to change that. Nothing is going to change that. Now, you can live in a fantasy world where treatment is instant and provides complete relief, or you can face reality, which can and will suck, such suckage arriving with a speed directly proportional to your stupidity plus a random factor or two.

Put my Mom on hospice care a few months ago when she was sick and not eating. The hospital refused to admit her because there was "nothing that they could fix".

After a few weeks she had the nursing home call me. She was pissed that no one would give her solid food (choking hazard for her condition). Funny.

I have medical POA so despite objections I set it up that morning and she's improved back to her "normal".

Point. Hospice takes over all meds/doctors. They (want to) control the patient and make them comfortable as they pass. Meds, whether or not the patient gets certain therapy, doctors, whether to send the patient to the hospital and have them admitted for a specific treatment, or allow them to die.

It has to be that way. A hospital does not have to admit a patient they can not "fix". Meds will be prescribed and off you go back "home". A nursing home can not take that responsibility and neither can a child taking care of a parent at home.

Take off the "hippie" glasses and think about the decisions needed to be made and by whom. Unless you are very wealthy you are screwed if you "do not die quickly enough".

How could it be any other way?

I can't fault the government here. As Rad says, if you aren't paying you don't get to decide how the money gets spent. The reverse mortgages Crid references affect many elderly. But once the deal is done the house is sold. It's not your home anymore. You sold it. You don't get to live in someone else's house.

I can feel compassion for her situation but there is a limit to what you can expect other people to do to take care of you.

In every case the real answer is the same: unless you are the one paying, you do not get to say how you are treated. ~ Radwaste at August 15, 2016 1:04 AM

Yet runaway litigation, malpractice insurance, and a host of other things that scream for reform combine to make medicine nearly impossible for the non-rich to pay for themselves.

And reverse mortgages only help if you own a house and have equity. And not as much as promised even then. If you're a renter or recently purchased your house, then you're on the mercy of society, unless your kids can help.

==============================

"I received a phone call last week: 'We had a meeting. We decided she's stable, and we're pulling hospice,'"

We? Who's "we?" Is "we" that "death panel" of which that woman, Sarah Palin, spoke? That rationed healthcare about which she warned us?

I'm not rich. But I've long had an HMO that doesn't just street you if you live too long. It was affordable before "affordable" care. But they still don't street you if you still haven't croaked at the six months and one day mark:

http://k-p.li/2bszdYB

Some people live longer than expected. If you live longer than 6 months, you can continue with hospice care.

I chose Kaiser based on what I would need in catastrophic circumstances or if I got some horrible disease.

I would like to not have my care run by government bureaucrats; however, yes, I'm well aware that there are many problems in dealing with any healthcare bureaucracy, including the one I'm enrolled in.

More:

http://khn.org/news/021810gleckman/

Medicare has begun cracking down on a handful of hospices that are making big profits by taking on chronically ill, but not terminally ill, patients. While hospice patients are normally expected to have six months or less to live, some hospices have many on their rolls for a year or more.

The problem is having the government all up in our healthcare.

"Yet runaway litigation, malpractice insurance, and a host of other things that scream for reform combine to make medicine nearly impossible for the non-rich to pay for themselves."

Medicare, Medicaid, and Obamacare (and soon, Social Security and government pensions) are all big tragedy-of-the-commons situations. You pay in with the expectation of saving towards the day that you need it. However, the money that you put in towards your future is being spent to provide services to other people now. Some of those people paid in previously, but some of them didn't, and even of the ones who paid in, they probably didn't pay in as much as is being spent on them. If these were insurance programs, the difference would have been covered by investments made by the insurance company to increase the size of the pool to (hopefully) keep ahead of inflation. But in the commons, there is no investment. There is only consumption, rationing and misery.

The bulk of said misery is about to be dumped on Gen X and the surviving Boomers 10-15 years from now, when expenses on these programs exceed income by so much that the government can no longer cover the gap with general revenue and currency inflating. People who have paid in all of their lives will find that, now that they need the services, everything shuts down and they will get nothing. American life expectancy will drop dramatically as services to the elderly are cut off. I expect that by 2050, less than 5% of the population will be over 65. America will have an age-demographic profile resembling that of the mid-19th century.

Ben: Don't read my comments— You're not equipped to understand them.

Dave: I doubt longevity will plunge that far without a collapse of antibiotic effects (which is entirely possible, I'll grant you). But the money for a lot of life-extending treatments (stents/bypasses, aggressive cancer regimens) will indeed have already have been passed to others... And to other purposes.

People are going to be pissed... Which will not help. I can imagine that all sorts of major economic and social slap-backs will have occurred in American governance/service by then.

Americans love being generous with other people's money.

Good lord Crid, what are you whining about now? You think aids patients were the only ones to get reverse mortgages? You think you should get to live in a house you don't own anymore? You're just afraid of criticism?

I would like to not have my care run by government bureaucrats; however, yes, I'm well aware that there are many problems in dealing with any healthcare bureaucracy, including the one I'm enrolled in.

The difference is that if Kaiser screws you, you can sue them.

If the feds screw you, unless they violated the law or the Constitution in doing so, you have to have their permission to sue them.

> Unless you are very wealthy you
> are screwed if you "do not die
> quickly enough".

If you don't die quickly enough, being wealthy can make things even worse, because the family will have resources (for you) to fight even if you're ready to let go. I've seen it happen (not my own family, thank God).

We've discussed this in earlier times here... Our culture is insufficiently stoic about how shitty it is to be an old human being. We aren't conversationally courageous about it. So when the time comes, many people are unnecessarily surprised.

For many years there was a seemingly unending sequence of articles detailing the very distinct end-of-life choices made by doctors, escapes greased by their practical experience. Earlier this summer I was (bitterly) heartened by this piece, affirming the universality of an unpleasant truth.

This outstanding book, though unfit for gift-givers, made the point with handsome clarity: Almost no one experiences a 'death with dignity.'

PS B.I.T.—— Best wishes to all.

"The difference is that if Kaiser screws you, you can sue them."

With Kaiser you have a contract. Everything is spelled out and you both have your obligations. With the government you have a law and a whole bunch of bureaucrat generated rules. If Kaiser wants to change the deal they need to make a new contract and get you to sign it. If the government wants to change the deal they usually just need to change a rule. Just some paperwork a bureaucrat generated. They don't have to get you to agree to the new rule. All the power is in their hands.

Social security is a good example of this. Your 401k is your property. You may spend it poorly but at the end of the day it is yours. Social security benefits are not property. The government could pass a law tomorrow and zero out everyone's benefits. You have no recourse. All those tax dollars you paid in, too bad. Not yours.

Crid, I know it'll piss you off but your 8:36 comment is 100% correct and well written. Take the damn compliment.

My sister is out of that mold. Her death plans were 'Everyone knows my wishes. They'll just figure it out.' Talk about willful stupidity. Without a will and all the related paperwork our wishes don't amount to a hill of beans. We don't have the legal right to enact her wishes even if we knew what they were.

Not to oversimplify things, but to be focused in my response - the change that would most pointedly address the problem of "living too long for hospice care" is what is being called "concurrent care" - an insurance designation that provides insurance coverage for simultaneous

- palliative care (comfort measures/ hospice)

along with

- conventional care (fight the good fight/ don't give up on a cure).

At present, people who are ill have to choose between fighting for a cure, or the expanded comfort measures available to people who have switched their designation to hospice - no longer fighting for a cure but focused on being as comfortable as possible while dying.

Most people do not opt to flip the switch from conventional care to hospice care. I don't know if that is due to the patient's fear of death, or the doctor's fear of failure or death. Some studies have shown that allowing people to choose "concurrent care" - an insurance industry term - increases patient comfort while minimizing procedures and reducing costs.

I haven't read the legislation, but I just read about The Personalize Your Care Act.

From the above link:

"And Congressman Tom Reed (R-NY) talked poignantly about his own mother’s experience with hospice care, and how it inspired him to become a hospice volunteer. Congressman Earl Blumenauer (D-OR) discussed his latest legislative effort, the Personalize Your Care Act, a bill he had introduced just that day to help promote advance care planning and allow for concurrent palliative and conventional care. Senator Susan Collins (R-ME) spoke of her efforts, as Chair of the Senate Aging Committee, to bring more attention to these important issues."