Medical Wealth Transfer

Something like 50% of Medicare health dollars are spent in the final two years of a person's life. What no one is really talking about is that, in order for the system not to become bankrupt, there must ultimately be a diversion of resources from the elderly to the young.

Unfortunately, this is in stark contrast to the trends of the past several decades, where debt is increasingly being transferred to future generations. Not only have we overspent at the cost of our progeny in things like defense, our trade deficit and our overconsumption of material goods, but we have essentially placed our current health debt burden on subsequent generations.

Unless something is done now, this will undoubtedly worsen as the Baby Boomers age. That generation, unfortunately, has shown some of the least propensity for self-sacrifice of any American generation.

As we watch the health care debate currently going on in Congress, pay close attention to this idea of generational wealth transfer. Currently, in the Senate, there is a proposal to cut some $500 billion from Medicare over 10 years. Despite what Democrats argue, this is ultimately the first phase in cuts to benefits for seniors.

They just can't be honest about that because the elderly vote far more than the young and they almost always vote in their own economic interests.

If, in the final legislation, the Medicare cuts remain, then there is hope for cost control in the future as that will finally set some precedent for further reductions. If, however, the final bill lacks Medicare restraint, then prepare for an even larger economic disaster in the future as the costs of health care will skyrocket even further as our population ages.

A Family Undertaking: POV

I just saw one of the most riveting documentaries in my life. It is called "A Family Undertaking: POV". It is all about dying and the industry of death in this country. It follows a growing movement in this country that emphasizes "home deaths" and "home burials" as opposed to the usual affair that occurs in a funeral home.

A brief history is given of the evolution of embalming and modern funeral procedures that started during the Civil War. Apparently, prior to this, as would be expected, when people died, their families at home often took care of the burial, providing whatever ceremony was consistent with the family's beliefs. Burials often occurred on family property. There was no embalming or embellished caskets and other funeral rites. Rather, it was more of a personal affair. Where families were much more intimate with the death process and the deceased.

I highly recommend this for anyone who has ever given thought to the absurd and often frightening rituals that occur when a loved one dies.

I think we, in this country, need to become more accepting of death. We need less denial. I think one negative byproduct of our modern technical advances in medicine is that physicians, Pharma, hospitals, everyone involved in health care in the US have promoted the idea that life can be extended indefinitely. That we really can push the boundary of aging and death and suffering.

Yes, life expectancy can and should improve.

But, we still will all die. And, being in denial of this does no one any good.

I'm often stunned by how many of my patients, in their 80s and 90s, with chronic illnesses and cancer, often seem shocked that they might die soon. That so many have made little preparation for their death.

We spend so much time and effort thinking about birth. About our jobs and the acquisition of material goods throughout our lives.

It's time we thought a little about the fate that we all share.

Death.

Watch the documentary. It's amazing.

Recharged

It was difficult to return. I suppose this is what most people face as they get older. You get wrapped up in your job, your parenting, your social and religious roles in your community. You "become" someone. You have a persona. There are responsibilities and expectations. Much of this is a really good thing.

But, in some ways, it can be oppressive.

For the past few years, I have fully evolved into the role of an oncologist. I know. After 18 years of schooling/training, you would think that it was about time. But, after all of those years, learning side by side with other fledgling docs, there is a bit of groupthink and herd mentality that occurs.

Only when you are thrust into the "real world", where your day to day is essentially similar to what it will be for the rest of your life that you start to understand the role of your job as the doctor. This is undoubtedly the same in other professions. But medicine is all I know.

I am "Dr. So-and-So". And, although, I eat dinner sometimes in my underwear and caterwaul terrible songs in the shower just like others, my persona at work lends a certain air of responsibility and gravitas to my life, especially in the face of the daily existential crises of my patients.

I love it.

I do.

But, sometimes, I am so immersed in being a physician that I forget that I am no different from anyone else in life. I forget some of the other aspects of my persona. I like to write. I like to loaf around. I like NOT being responsible sometimes. I like to meander for hours in the woods or sit by a body of water.

There is something else to my life then caring for the sick.

For the last week, I was backcountry camping throughout New Mexico and Colorado. For much of it, I beheld ancient Ancestral Puebloan sites. Anasazi sites, they were once referred to.

Often, I was alone. No shower. No cell phone. Just walking, seeing, quietly observing. When I met someone or chatted along the way, my job rarely came up.

I was just "So-and-So". No doctor.

It is humbling and refreshing to see that much, if not most or even all of the world functions so very well WITHOUT you. That you are a very small part of this world and a mere blip on the face of humanity, much less the universe.

It is freeing. It is wonderful.

I forgot that I was a physician so much that, when I came back to work, I realized how lucky I am to do what I do.

Recharged. At least for a moment.