Wednesday, August 5, 2009

Healthcare, living well and letting go

Last week I was going through the mail during my few days at home and, among the many pieces were a few bills for a medical appointment I had in the spring. The total out-of-pocket expenses for this one appointment: nearly $1000. Granted, this includes the $750 deductible, but given the salary I make, it's still alot (considering that on top of this there is an additional $60/month for the co-pays of medication). As I perused the bills, I looked through the labwork that was done and it was filled with things I have no clue about.

At the same time, I was listening to the radio and the on-going debate about healthcare. No doubt we have a broken healthcare system and we need to do more to see that people have access to healthcare, especially preventive medicine. But looking through my own bills, and reflecting on my own recent interactions with my doctor (whose biggest concern seemed to be that I was rejecting the idea of pursuing elective cosmetic surgery to fill out my cheeks that have thinned out as a result of the HIV-progression or treatment).

What I am noticing that seems to be completely absent from the debate about healthcare is that not only should all people have access to healthcare, but perhaps we should also be having a national dialog about what we expect from healthcare and why. I suspect, based on my own bills, that my MD is milking me for billable services. I know that he needs to be monitoring certain things because of new medications, but I also know that in some cases, if something were off, the prescribed course of action is more medication. Do I really need to know that certain levels of something are off, if I am going to refuse the treatment?

That very week, the woman (Hilda) whose house I am living in died. She was in a nursing home for the past 2 years and had not been out of bed for that time, but on Sunday night she got out of bed and fell, breaking her leg and hitting her head. My friend Marilyn (the woman's guardian) got a call at 6:30 in the morning asking whether she wanted to have brain surgery performed on Hilda. She was told she needed to make the decision immediately, not for the patient's sake, but because this was when the operating room was available. Marilyn was told that the surgery was to remove a clot (for a woman who had been basically comatose for a few months). Marilyn was not told about the broken leg. It all smacked of a healthcare decision trying to milk this woman's estate before she died.

Basically, I think we need to open up the national dialog to include a frank discussion that, yes, we are all on the same train progressing to one common end result. We want to use healthcare to help us get there as safely, happily, healthily and productively as possible. But we perhaps should depend less on healthcare for the quality of life things, and focus on some of the basics, while we also commit to healthier living. I don't know that statistics, but have heard about the high proportion of healthcare dollars spent on the last month of life. A part of this makes sense - trying to extend lives is costly. But we should know that all we are doing is extending life, not saving it.

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