Is Living Longer, Killing Us? A Paradox in Medicine

How would you like to die?  While many of us youth will put forth a response to the tune of “I don’t really care as long as it’s after the new Star Wars trilogy”, this is a paradoxical question that quite frankly isn’t asked enough in hospitals.   It seems to run counter to our now entrenched notion that saving a human life supersedes any expense, especially if that life is one of our own family member or friend.   If someone is on a hospital bed and wishes to live, then it is only reasonable to exhaust every single possible option to ensure that this is the case, correct?

*Squeal*

Not exactly.  At least not when we think about the long term implications of this type of ethic.  There is an internationally recognized problem that is on the rise, and that is the fact that end-of-life care is really expensive and is sometimes wasted on patients that would probably suffer less if they opted for palliative care. Couple this with the fact that our life expectancy seems to keep growing as the time progresses and the truth that a culturally a subtle medical nuance is realized as a major issue down the road.

My point is this: it costs a lot of money to keep us alive when we’re really old, our population is only getting older, if we keep exhausting resources on our older population through federal funding there is little left for the underprivileged youth who need it most.  Quite frankly, if we don’t address this now, then our healthcare ethics simply won’t be sustainable.

The Costs of Living Older 

Let me ask you a question.   As America expands its population and share of the world market, while growing as a superpower, which facet of government spending do you think outpaces the rest in terms of growth?  Most would think military spending, and rightly so given that each year our arms sales continue to grow and contribute significantly to our robust economy.   However, the Congressional Budget Office released in a report on February 2013 forecasts that it is in fact healthcare that will grow larger than it’s current 25% share of our federal spending.  Now that we’re in 2015, thus far the CBO is absolutely right.  In fact, at its current rate, healthcare is expected to double the % of our GDP from 2015 to 2035, 5% to 10% respectively.   Basically, we’re inevitably going to spend more and more on healthcare as our need for new drugs and new medical technology grows.    If you look at that previous link, The Hastings Center, a healthcare think tank, predicts that at this growth rate we will be able to bankrupt Medicare in about 9 years.   Scary stuff.

So where are our Medicare dollars going right now?   The irony of the typical hyper-right wing “the poor are welfare queens” rhetoric, is that it is the elderly Americans that place the largest burden on our federal healthcare spending.   Now if you’ve read my previous posts you know that the Kaiser Family Foundation is my homeboy when it comes to dropping them life changing statistics, yo.  Once again I must call upon their impeccably tasteful infographs to illustrate a point.  So, BOOM:

Effective use of whitespace, clean font, someone just try and tell me this isn’t the second coming of Da’Vinci. I dare you.

Huh, would you look at that, the older you live, the more money it costs annually to keep you alive.   Capping at about 93 years old and dropping rapidly due to the influx of those going into palliative care, which is essentially ceasing life support care and focusing on pain mediation.

Really? More shades of blue? Poor effort here Kaiser, jazz it up some more.

Observe the disparity of this enrollment vs spending.   Notice how those aged 80+ absorb a vast majority of the spending despite being a smaller cohort than those aged 65-79. This data was back in 2011. Now, imagine 30 years down the line when we’re all expected to live much longer on average.  Yikes.

However, let’s get down to brass tax. Why does this phenomenon happen? Of course healthcare costs in general are always on the rise, but in this particular case there has always been a blind eye turned to end-of-life care.   The reasoning behind this was described best by the based healthcare god, Daniel Callahan.  To my older readers, please don’t bother looking into what “based god” is.   You’d just end up finding some rapper out of Oakland that has very little to do with the execution of the term here in this article.  Daniel Callahan is a biomedical philosopher focusing on ethics, and additionally co-founded the Hastings Center in 1960 in between his time authoring 41 novels specifically focused on the state of American healthcare and all its nuances.  If putting a complete hold on my rhetoric isn’t an indication of how much I love this man, then just check out his CV in the previous link and just see for yourself how much this guy has done for the field of public health.

Said based god, from said Oakland area

I digress, Callahan framed the issue best in his novel What Better Health? Hazards of the Research Imperative.  We as a nation just aren’t good at dealing with the elderly and have formed a cultural value to help the old, get even older.  The burden of spending begins to shift unto the younger taxpayers whereas the elderly enjoy freely spending as much money as possible in healthcare resources such as drugs and technology that has only gotten more expensive.   See Japan’s population pyramid to get an idea of what this is like if we didn’t have a decent birth rate.   Callahan even released an op-ed piece for the American Medical Association describing the ethics behind this issue specifically.   If this goes unchecked, he argues, then we’re left with two choices: double taxation or cut the benefits in half.

Dang, Alex.  What do we do?

Now the harsh way of framing this solution would be to look all elderly and ask them to kindly die a little bit earlier, which is in fact completely opposite of the case.  The secret lies in simply educating people about end-of-life care, palliative care, and coming to terms with terminal prognosis.  Believe or not, there is in fact a group of people who are perfectly capable of curbing this issue and changing the entire notion of how we treat death for years to come.  Primary Care Physicians.

don’t even act like you didn’t know this was coming.

Would you look at that, even our American public are very much in favor of not only promoting physician-patient end-of-life discussions, but also want it covered.   Which is incredibly crucial considering that only 17% of those polled claim to have had such conversation with their physician.

Informing a patient in coming to terms with the diversity of options available for end-of-life care helps our cost issue in one really fundamental way.  It curbs fruitless spending of taxpayer dollars, hospital staff hours, and patient beds on individuals who’s prognoses look bleak.  Instead of a patient, only days from death, hooked up to an assortment of machines and being subjected to tests daily (all of which costs money) they could be transferred to a palliative care facility or hospice, where the goal is to allow patients to pass away in the most painless manner possible.   Just to be clear, palliative care can also apply to those very much well and alive but living with a chronic illness such as cancer.

Oh gosh, not another graph…

This kind of informative service is especially crucial considering that, quite frankly, death is a really scary concept.  A good way to look at the elderly view of death can be found in a poll done by the New England Journal of Medicine regarding how poll takers view assisted suicide and whether or not it should be offered to terminally ill people with less than 6 months to live.  Granted, using this as a proxy is a stretch, but seeing as 56% of those age 65+ choose against it, where as those 64 and below fall in 55%-59% for it, you can see signs of evidence that those closest to death fear it most.

This is a crucial mental health service that must be provided to set the standard against our unsustainable dealings with end-of-life care.  It’s another brick in the wall of mounting healthcare costs that simply outpace inflation, wages, and places a burden on the youth.

Okay, I have a short attention span, give me the skinny

Ugh, go back to buzzfeed then you heathen.  I jest, living longer is getting pricier and if the trend of wanting to do everything possible to live as long as possible continues, we’re only shooting ourselves in the societal foot.  There must be a change to counteract this phenomenon that all of these ivy league graduates (Callahan, Kaiser) have been touting about in order to alter our healthcare culture to become sustainable in the next 100 years.  Should we continue down this route, the cost of keeping our elderly alive will be too great, and taxpayers will suffer as a result.   The science I’ve cited has talked exclusively about American healthcare, but I have a hunch this is applicable to other developed nations as well.

This guy? Attention span of a gnat.

Now if you’ll excuse me, I’m going back to not having to think about death until I have kids, good riddance!

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