After reading this excellent diary I decided to put in my two cents on Medicare. My qualifications to pontificate on this are thus: I have a Master's in Nursing Administration, and spent thirty years in nursing, most of them in nursing homes with elderly patients. In addition, I am now disabled and receiving SSDI, so Medicare is my health care plan. I have experience on both sides of the bed, so to speak.
In addition, I am also old enough that I began my nursing career when Medicare was very young in the early '70's. Here is a little history of how Medicare came into being. The whole website is a good read as to the debate that is raging about Medicare at this time.
When Medicare first came in, it pretty much just covered hospital care. Of course, those were the days when you went into the hospital overnight for "tests" that are routinely outpatient these days. And it covered some stupid things. I vividly remember one LOM (little old man) who came to the emergency room in the tiny hospital where I worked on nearly a weekly basis for "constipation." We would give him an enema, clean him out, admit him (just because we could?) and the first thing he would do is order a grilled cheese sandwich, a great recipe for renewed constipation. Lather, rinse repeat. We never could convince him to do anything sensible like take Metamucil or stool softeners, or drink prune juice.
Well of course, after a while Congress began to get frightened by the cost of Medicare, and so we have enured 40 years of things that were supposed to lower costs. The latest thing was DRG's or diagnostic related groups. The idea to pay a hospital $xxx for a certain diagnosis and cover XX days for the same. The idea was that if a hospital could get you over whatever for less than that amount of dollars, and days, they got to keep the extra as a bonus. What resulted was the discharge of patients back to their families or to assisted living or nursing homes "sicker and quicker." Nursing homes became mini-hospitals overnight, only with much less staff and equipment. What happened to nurses was similar to an "I Love Lucy" episode where Lucy and Ethel are working in a factory decorating cakes. All goes well for a while, and then someone speeds up the line of cakes going by. Of course, by the end of the episode, cakes and icing are going everywhere. My memory is that we went from caring for 45 residents who could for the most part walk and talk, and just took their pills when you dumped them into their hand, to caring for 25-35 residents, most of whom needed their pills crushed, and then fed slowly to them. If they didn't spit it out on your uniform. This could take 5-10 minutes per resident, and we were supposed to pass all our meds within two hours. You do the math.
Meanwhile, we are missing opportunities to actually save money because it involves making tough
"end of life" decisions. A case in point. My uncle has had Alzheimer's for several years. He was confused and combative years ago when my cousin moved him away from his wife to her house. Recently he has had a bout of double pneumonia, and sometime in the hospitalization, they installed a shunt for dialysis. One thing I know from working with Alzheimer's patients, it that they won't keep their glasses, hearing aides, dentures, etc. in or on. If they don't recognise it as "part of me", they reject it. This scenario gives me nightmares of best case, my uncle continually undoing is bandage, to worst case, pulling his shunt apart and bleeding to death. And if he is so far gone he isn't picking at everything, why don't we just kiss him goodbye and allow him to go to The Other Side? My uncle was a brilliant man in his day, spent 30 years in the foreign service, and spoke, read and wrote several languages. I believe with Peter Singer that consciousness is what makes us human, not DNA. If we are no longer conscious, ala Terri Schiavo, we are no longer human. People who are in a coma, or anencephalic infant's families should be able to donate their organs, although it doesn't take machinery to maintain their hearts and lungs. I watched my grandmother die with Alzheimer's, and truly believe her soul went to whatever reward there is long before her body died.
So, what the point here? Or do I even have a point? Yes, I do. If we are going to rein in the cost of Medicare, we are going to have to make difficult decisions about end of life care. It is insane to tube-feed someone like Terri Shiavo for 15 years while children go without health care. Basic nursing home care runs $3-4,000 a month, with the cost of the tube feeding and supplies on top of that. It is insane to pour units of blood into a 95 year old cancer patient that might be needed for a child that's been in an auto accident. And, OK, I'll be a meany and say it, it is insane to spend thousands of dollars to save very tiny premature infants, who then are severely disabled.
For the record here, I do not ever want to live like my uncle or Terri Schiavo. Undoubtedly, some will accuse me of being ableist for this sentiment. However, I have promised to come back and haunt my family if they disregard the wishes in my Living Will.