We Can't Afford Everything for Everybody

The debate in Congress over health care insurance is making me crazy – and nervous.

Listening to the blow-by-blow daily reports is like reading a suspense novel or watching a serial mystery. How is it all going to turn out? Who’s going to win and who’s going to lose? Which proposals are going to live and which will die? And when it’s all over, are we going to understand what happened and what we have created?

Some days I just wish it would all go away, so I can’t imagine how the legislators working on the grand plan must feel. But I know it can’t go away because we’ve got to come up with a solution to the lack of health insurance for 47 million people and how to pay for it all. One thing is for sure: The trajectory of increasing costs is unsustainable.

Perhaps at the heart of the issue is whether you believe that health care is a right or a privilege.

I’ve come to believe it’s a right from the time you come into the world.

It’s also citizens’ responsibilities to contribute to the cost of insurance based on their ability to pay, to stay as healthy as possible, and to decide how best to use our limited public resources, because – well, they are limited, and as of now, our spending is out of whack.

According to the Centers for Medicare and Medicaid, Medicare spends almost six times as much on patients in their last year of life as it spends for those not in the last year of life. Out-of-pocket spending for those with less than a year to live is three-and-a-half times as much as it is for non-terminal patients, and private health insurance spends three times as much. The spending actually peaks in the last month of life when we spend 20 times as much money on terminally ill patients than we do for those who are not terminally ill.

I found this shocking and sad, and reflective, I suppose, of our attitudes about death. It also speaks to the misconceptions about end-of-life treatment that some people have. This was brought to my attention today in a conversation I had with a family member about the morality of pulling out all the stops to provide medical care for someone who has no chance for recovery.

He was under the mistaken impression that there were only two choices for the terminally ill: to treat or not to treat. I had to explain that deciding to discontinue expensive treatment doesn’t mean abandoning patients and spending nothing; it means providing quality palliative care – doing all that we can to make people's last days the best they can be.

Nurses in and out of the palliative care field can do a lot of educating about this option.

The awareness of palliative care has been growing, but with 76,000 aging baby boomers coming down the pike, the need for this education and awareness is greater than ever. We can’t pay for everything for everybody, but this doesn’t mean that anyone has to suffer. We also need to raise the collective consciousness about the morality of spending millions of dollars for care that will have little or no benefit.