America has by far the most expensive health care system in the world. We spend $2 trillion annually on health care or an average of over $6,300 per person. This amounts to 16 percent of the nation’s economy. Spiraling increases in the cost of health insurance now impose an almost unbearable burden on employers and employees alike. And it’s all about the denial of death.
Out of control health care costs are propelled primarily by philosophical considerations rather than by economic, political, or technological factors. The demand for health care services is driven by the fear of death and the supply by the greed of providers, hospitals, pharmaceutical companies, and health insurance companies. When human greed exploits the fear of death, the sky is the limit in terms of health care prices. “You deserve to live forever,” is the not so subtle message from health care professionals and pharmaceutical company television advertisements.
To be quite blunt, the problem of the American health care system is that most Americans neither know how nor when to die. Furthermore, not only do physicians offer little assistance in dealing with these weighty issues, but they often exacerbate the situation.
Arguably the United States is one of the most Christian nations in the entire world. Ninety percent of Americans believe in God and seventy-five percent expect to go to heaven when they die. If that is really true, why are so many Americans so inordinately afraid of dying? Why are they prepared to go to such extremes to prolong life just a little while longer?
Those who can afford good health insurance have access to a plethora of very expensive, high-tech medical services including magnetic resonance imaging, ultrasound, nuclear diagnostics, complex multi-organ transplants, coronary bypass surgery, artificial kidney machines, death-defying prenatal procedures, genetic enhancements, and gene splicing. Anti-aging clinics offer everything from yoga, meditation, and mind-body medicine to growth hormones, sec hormones, melatonin, herbs potions, and elixirs to delay the aging process, but to little avail. Joel Garreau’s book Radical Evolution reports on a new breed of scientists who believe that advances in genetics, robotics, information technology, and nano technology will allow us to improve our intelligence, reinvent our bodies, and even become immortal.
There are dozens of drugs and high-tech medical devices and procedures claiming to prolong life. We have become accustomed to an endless series of announcements on the evening television news reporting major breakthroughs in the cure of this ailment or that, only to be followed by a retraction six months later warning of risky side effects of questions on the efficacy of the drug or procedure.
By widening the boundaries of illness and lowering the threshold for treatment, pharmaceutical companies have created millions of new patients and billions of dollars in profits. By exploiting our fear of disease and death, pharmaceutical companies have redefined mild problems and common complaints to serious illness and medical conditions requiring drug treatments.
So strong is the fear of death that it’s not unusual for the wealthy who are terminally ill to spend their last months either on the Internet or flying from one medical center to another in search of a physician, a medical school, an unproven drug or medical procedure, or a high-tech silver bullet which will forestall the grim reaper for a few more months. The problem is that the number of options available to the terminally ill patient is often completely overwhelming. How does one cope with so many alternatives? Is this any way to live or die? Vermont writer Garret Keizer refers to this phenomenon as “physician-assisted eternal life: the desire of the old to avoid death at any cost, especially if the cost can be passed on to another generation.” But at the lower end of the income level, it’s quite a different story.
The problem with health insurance is what I call the “I’ve got mine, Jack” syndrome. Elderly patients who have paid their monthly premiums feel they are entitled to the best health care money can buy. They never think about the effect which a $100,000 hospital stay will have on other people’s premiums. What it’s all about is looking out for number one. Indeed, it’s not uncommon for a senior citizen to boast after receiving notice of a large hospital bill paid by Medicare, “I’m really getting my money’s worth.” No wonder Medicare is almost broke.
Eighty-six-year-old Martha was admitted to the hospital with internal bleeding which turned out to have been caused by an anti-inflammatory medicine. The bleeding subsided within forty-eight hours after she arrived in the hospital and the medication was discontinued. In spite of the fact that the bleeding had stopped, she was then subjected to two very traumatic and highly intrusive tests at $1,500 per test—a colonoscopy and an endoscopy. In addition, she was given an MRI and a spinal injection.
On the fifth day I the hospital, Martha suffered the first of two heart attacks, spent two days in the cardiac intensive care unit, and was finally released at the end of her second week there. When she left the hospital, Martha had little to show for the $40,000 outlay paid by Medicare and her private insurance company. She was much weaker than when she entered the hospital and less self-sufficient.
To promote its cause the Alzheimer’s Association recently issued a press release with the provocative headline, “10 Million U.S. Baby Boomers Will Develop Alzheimer’s Disease.” Virtually all of the attention bestowed on AD by the medical profession, academic researchers, and the National Institute of Health treats the problem as though it were purely a medical problem. All we need do to cure AD is identify the gene causing the problem and then find a chemical compound to allay the effects of the troublemaking gene. Apparently it has never occurred to anyone that AD may simply be the body’s way of protecting those whose lives have become meaningless from the despair associated with prolonged life. AD may, in fact, be a way of taking them out of their misery. Not only may there be no cure for AD, but even if there were a cure, what would be the psychological, social, and moral consequences of administering it?
Notwithstanding the predominance of Christianity in America with its adherence to the belief in life after death, out culture promotes a Darwinian, survival of the fittest attitude with regard to the extremes to which we are prepared to go to prolong our own individual lives. Ad kind of macho, Old West attitude seems to come over us as death approaches. It matters not how much of society’s scarce health care resources are consumed by prolonging my life for a few more months or years. I am the center of the universe. The rest of the world be damned!
Ostensibly our religion should prepare us for death by teaching us how to live. The only thing we can count on when we die is that our soul—our very being—will survive on this earth through the personal relationships we have experienced, the creations we have left behind, the communities in which we have lived, the joy and sorrow to which we have given birth, and the rebellion we have fomented. Our soul is the sum of our deeds, our work, our creations, our experiences, our love, our joy, our pain, and our suffering. Throughout our entire life, our soul is continuously in the process of becoming whether we like it or not. Our soul is who we are.
For those who want to live forever, the only game in town is the survival of your soul long after you have bid this earth adieu. If this is important to you, then you will no doubt want to devote a lot of time to the care and nurturing of your soul. It’s your only hope for achieving immortality.
Even though no cosmic source of meaning has been revealed to us, I find myself drawn to French existentialist Albert Camus’ idea that the purpose of life is to die happy. One of the reasons so few of us die happy is that we refuse to plan for the one event in our life that is absolutely certain—our own death.
Although we have no formula that will guarantee a happy death, it’s hard to imagine dying happy alone in an impersonal, sterile, high-tech hospital with all sorts of wires and tubes attached to your body. It is also hard to envision dying happy if you spend your last days engaged in the frantic search for a silver bullet which will enable you to live forever.
Consider the case of a friend of mine who, when he was diagnosed with lung cancer, moved with his wife from their lovely home in Vermont to an apartment in New Jersey so he could be near the Sloan Kettering Hospital in New York City. He spent his final months making weekly trips to the City in a futile attempt to find an experimental treatment program that would cure his cancer. Another friend made similar trips to Sloan Kettering from Richmond, Virginia, but to no avail. In both cases the medical bills were staggering and the patients’ families were subjected to enormous stress and inconvenience. In the former case, the patient’s widow now lives alone in scenic New Jersey. What a way to go!
Rebél
Thomas H. Naylor
November 15, 2008