Are you "lucky"if you have a secure retirement?

[houstonscott]

It doesn't change my question. Who gets to decide the cost/benefit? People with terminal cancer can life many months or sometimes years with aggressive treatment. A lot of that time can be almost asymptomatic. But those treatments can be extraordinarily expensive. Who gets to decide when the extra time is not worth the number of dollars it will cost?

Well, what I think happens now is people will ask "is it covered by their insurance?" When the answer is "yes" they say "let's try it". When someone else is paying not much thought to costs comes to mind. That's the problem. HS

 

[JDgreen227]

Come on, I am waiting to get some feedback on Long Term Care here.

 

[ovrszd]

It doesn't change my question. Who gets to decide the cost/benefit?

People with terminal cancer can life many months or sometimes years with aggressive treatment. A lot of that time can be almost asymptomatic. But those treatments can be extraordinarily expensive. Who gets to decide when the extra time is not worth the number of dollars it will cost?

Someone mentioned national level health care earlier as a solution to the insurance problem. If that were enacted the people that will make that decision will not even know your name. And the family will/would have little say in it all.

 

[RedNeckGeek]

The rub is that we're all terminal. So exactly when do you start withholding life-saving or life-sustaining care?

My father had a stroke. My mother had a lot of difficult medical decisions to make when it happened and we (their six children) helped talk her through my father's wishes, the long-term prognosis, etc. In the end, my father lived just long enough for all his children to get into town (a few days). If my mother had made different decisions, he'd have "lived" many months more hooked to machines and oblivious to it all.

But who should get to make that decision for you?

Very similar experience I had with my parents. I had medical power of attorney for both, as well as a Do Not Resuscitate order. Neither wanted to live confined to a hospital bed or past the point where they couldn't lead a normal life, and made that clear in both documents.

Dad suffered a series of strokes over a three year period and the paralysis eventually got to the point that he started choking on his food. His wishes were respected and rather than have an IV or feeding tube installed, he was allowed to starve to death. Heck of a reward for living to just shy of 80.

Mom was recovering well from a stroke when she had another surgery, shortly after which she went into cardiac arrest. The doctors applied heart paddles and proceeded to shock her back to life, but still no pulse after four minutes. Her partner (not married) tried to get them to stop and let her go, but he was forcefully taken from the room (I was not there). After five minutes her heart started again, but when I next saw her it was clear she had suffered severe brain damage. The doctors violated the DNR even in the presence of someone advocating for her wishes that no extraordinary means be used to preserve her life.

So with respect to that aspect of who decides, YOU do, but only if you go to the trouble of making your wishes known to your children and care givers. Just down the hall from my mother's room was an old gentleman who had evidently not made such declarations, and his family was bitterly divided about letting him pass. Eventually it was decided to let him go, but he somehow revived and went home a few days later. But not before his family had done much hand wringing over his fate, all of which could have been avoided by a clear medical power of attorney.

As far as who pays, insurance is supposed to spread the cost of claims over all the members of the insurance pool so that no one person suffers financially. But when insurance companies are able to refuse insurance to those with pre-existing conditions or charge outlandish premiums to those with unfavorable genetic make up or family histories, a growing number of people are left uncovered. As are people that refuse to purchase health insurance, regardless of their ability to pay either the premiums or medical bills. The ACA was supposed to sort all this out, but the central tenant of making the pool as wide as possible to impose the minimum financial burden on everyone has been distorted by political wrangling, we're still a nation where significant numbers of people do not have health insurance.

And as to cost/benefit, some doctors are very frank when asked if the treatment has significant chances of improving the patient's quality of life. Others hide behind their Hippocratic oath and play super hero, causing great pain and suffering as a result. In my parent's case, the super heroes involved succeeded in causing long, lingering, painful deaths that lasted about three years from the onset of the first stroke. All that could have been avoided with sane Death With Dignity options as directed by a Medical Power of Attorney and enforced by a caring family member or advocate.

 

[Parkanzky]

In the context of this discussion, we are most certainly NOT all terminal. So if I cut my hand today in the shop and am ultimately bleeding to death without care am I terminal?? Or would a quick trip to ER change that?? I'm certainly not terminal.

As to who should get to make that decision? The same people that you described in your analogy about your Dad. Sounds like that situation was handled logically and with compassion by the family as it should be. All you and I can do is hope our kids can apply that same mentality.

I agree completely. But HS's point is that we spend a lot of money on care at the end of our lives and those might be "wasted dollars".

I know a couple that are married now. When they met, the young woman had already been diagnosed with terminal cancer and given ~6 months to live. Some might argue that any treatment beyond that diagnosis could be considered a waste of money.

However, that was a couple years ago and they've since been married and are enjoying whatever life they can together. She is still terminally ill and cannot do everything you and I can (she tires quickly, requires frequent blood transfusions, etc) and has to live knowing that at any moment her health is likely to take a negative turn that she won't be able to recover from.

I'd argue that the life they have now is worth whatever it has cost, even if it has been millions of dollars. Does anybody feel differently?

 

[riptides]

I don't think your story fits the model here, you mom was not terminal in her last ten days, your story doesn't apply. HS

Boy, do you shift your arguments accordingly.

Why don't you just come out and say if your not healthy and don't have any money I will not pay for your care?

I am sure that looks like a fit model for your retirement planning scenarios.

 

[Parkanzky]

Someone mentioned national level health care earlier as a solution to the insurance problem. If that were enacted the people that will make that decision will not even know your name. And the family will/would have little say in it all.

That's the political lever that people tried to pull when they were fighting the Affordable Care Act. It was fear-mongering then, and it's fear-mongering now.

There are completely legitimate reasons to oppose a national health care solution, but I don't think that that is one of them. Medicare is a national level health care solution and care decisions for Medicare patients aren't any different than for people with private health insurance. Frankly, people without health insurance have basically the same care options.

 

[Parkanzky]

Well, what I think happens now is people will ask "is it covered by their insurance?" When the answer is "yes" they say "let's try it". When someone else is paying not much thought to costs comes to mind. That's the problem. HS

I've spent some time in a hospital setting. When a loved-one is critically ill, the last thing on most families' minds is "What is this going to cost us?" It's definitely a concern _between_ tough decisions, but it's not how they decide what to do in the moment.

 

[ovrszd]

That's the political lever that people tried to pull when they were fighting the Affordable Care Act. It was fear-mongering then, and it's fear-mongering now.

There are completely legitimate reasons to oppose a national health care solution, but I don't think that that is one of them. Medicare is a national level health care solution and care decisions for Medicare patients aren't any different than for people with private health insurance. Frankly, people without health insurance have basically the same care options.

We'll agree to disagree on that one. In the end, under that plan, someone unknown to the patient or family, will make the decision whether the treatment will be offered/continued or not. That was my point.

 

[Parkanzky]

We'll agree to disagree on that one. In the end, under that plan, someone unknown to the patient or family, will make the decision whether the treatment will be offered/continued or not. That was my point.

Not in the hospitals I've been in...

Physicians make decisions about care. Most of the time, the physician has no idea what kind of insurance a patient has (or if they even have any). They do know that a big percentage of the time they/the hospital won't be payed for the care.

We all agree the system is broken.

I'd argue that the problem is that we all have the potential to really need medical care, and we're all already entitled to get whatever care we need, but that we're not covered equally by insurance so the financial ramifications are very different depending on who it is that gets sick.

The reality is that we already have universal health coverage because nobody can be turned away in an emergency. With that standard of care, treatment for the poor and uninsured is indirectly paid for by the rest of us. That's a really inefficient system. We could just give everybody the care they need from the beginning for less total money.