As a healthcare professional I came to some conclusions after listening to each speaker during President Obama’s round table discussion with Democrats and Republicans. Out of everything said, one message stood out in my mind above all the rest and yet will probably go ignored by most Americans and the media.
The Congressional Budget Office reviewed Medicare expenditures and found that 50% of those monies went to the care of the chronically ill during the last year of life. When I heard those statistics I had a flash back to a Master Degree class on ethics I had taken at Loma Linda University.
I was shocked to learn that on average over half of the total dollars spent are during the final months because of aggressive measures to keep the patient alive, even when the odds of complete recovery from the disease and weakened condition are low. The ethics included forced treatment against the wishes of the patient, and application of dollars to prevention programs that reduce healthcare costs.
It was not that long ago the life expectancy was less than 50 years. Now that we can live to be 80, you can easily have multiple organ and system failures that require a high level of care with lower odds of a positive outcome. The same is true for those with chronic disease.
No one wants to talk about it because let’s face it, how many of us want to admit we are going to die. Accepting that 50% of a person’s lifetime health care costs are spent during the last few months of life is a public health fact that needs to be evaluated to improve care for the patient, not deny care.
Educating the patient so they are aware of all treatment options, what is going to be involved with those treatment decisions, and how it will impact their quality of life during the time they have left is always the first priority. All of these are hard decisions to make, but should ultimately be left to the patient as they are the ones who have to endure the pain and suffering that may accompany a treatment option.
Many chronic diseases degrade our mental capabilities and ability to make cognitive decisions that are our own. Everyone deserves the right to participate in this process when they are the most capable of making decisions for themselves, and those of us providing the healthcare, and family members need to respect those decisions.
Recognizing how complicated these kind of cases are to manage, and how easy a patient could get lost in the system, Loma Linda University had already began to implement a patient case management system so that one person was overseeing and keeping track of all aspects of a patient’s care.
I remember thinking how humane it was to have a system that supplied information needed for a patient to choose treatment on their terms. Choices such as whether to have a “Do Not Resuscitate” order can take the burden off loved ones to make those choices for them. We do so many things to protect our loved ones from hurt and pain, yet when it comes to life and death decisions we avoid the responsibility ourselves and instead put it on our children to decide whether we live or die. A burden they have to live with for the rest of their lives.
Even if there is family, a third party can be easier to work with as they don’t bring the emotional baggage to the table, so you as a patient can make decisions more for yourself instead of trying to fulfill the needs of others who love you.
There are many others facing life threatening and debilitating diseases alone with no one to help them. Having a case worker meant you didn’t have to face the road ahead by yourself. It also meant the patient would be monitored so they were not making decisions on their own that could cause more harm than good, such as taking conflicting prescriptions.
Our bodies are complex, and breakdown. Accidents happen with not many of us going through life without having some kind of health problem.
Using healthcare dollars wisely during this time when the greatest amount of dollars is spent can provide more dollars for prevention. With prevention comes more ethics as more people living longer burdens social security will less young people to feed the system.
It has only been in the last 20 years that science has been able to confirm the link between nutrition and chronic disease. Diabetes prevention is a perfect example. There are now over a million people walking around with diabetes or borderline diabetes and don’t know it. If the disease is allowed to progress, the patient could end up in dialysis (at a cost of thousands per week) after the loss of kidney function, need a transplant (over a hundred thousand), medication, amputation (rehabilitation costs), permanent disability (government disability support), and much more that will degrade their quality of life and cost thousands of dollars for one patient when it all could have been avoided.
The link between diabetes and Alzheimer’s is now becoming evident with new statistics showing increasing numbers in the years to come. Alzheimer’s comes with a stiff price tag both in healthcare dollars and quality of life for both the patient and their loved ones that now have to endure the burden of caring for someone that cannot care for themselves.
Type II diabetes, if caught early, can be slowed or reversed through diet and lifestyle.
One premature birth can cost millions. If the child is permanently disabled, you are looking at a lifetime of government financial and medical support. Whereas prenatal treatment, supplementation, and healthy eating could avoid the situation entirely and save enough money to treat thousands of other women with prenatal care and proper nutrition which will save millions of additional healthcare dollars.
The current system feeds on keeping us sick and padding the pockets of insurance companies as they bill the government/taxpayers for one unnecessary or repetitive treatment after another. They dictate who gets insurance and who does not.
People are fearful of the government setting healthcare standards, yet are OK with insurance companies doing so instead. It is because of government guidelines that food companies list nutrition facts on labels and cannot make health claims that contribute to chronic disease. The government is already making healthcare decisions when drugs or various treatments developed by private corporations for profit are approved for use.
Many protections now in place are there because Americans pushed government representatives to make changes. Insurance companies offer no platform for change.
We are human, and not many make it through life without the need for professional healthcare. People are dying because they were denied care by insurance companies. We have to accept that could happen to any of us.
Changing the system, will save lives. How many of us can look in the face of someone that is dying and just walk away, something that is already happening every day.
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