Tuesday, September 25, 2012

A death benefit or the last two weeks of life

It should come as no surprise that humans are uncomfortable with death and mortality.  American culture is obsessed with youth.  We don't want to admit to aging or dying.  I would be happy to show anyone the rows of aging creams in any pharmacy.

I listened recently to this great podcast
from This American Life about loopholes.  In it, a lawyer had read the small print and figured out an investment opportunity with annuities (sadly the loophole has been closed).  He contacted someone who was terminally ill.  I will over-simplify it, but if they agreed to sign forms, an unrelated investor would receive their entire original investment plus interest (even if there was a loss) upon the original person's demise.  The investor didn't have to be related in any way to the terminally ill patient.  For this agreement, the patient would receive thousands of dollars in cash. 

One daughter (in the program) explained that her mom really appreciated the money before she passed on.  When she went to the  mall with her grandson, she could buy him the things he wanted; she wouldn't have been able to afford them before.  The daughter said it meant a lot to her mom during her last days.

There are many issues with funding medicare.  Medicare costs keep spiraling.  And it's a sobering statistic that 80% of of the spending occurs in the last two weeks of life*.  That fact is shocking to me.  I know we are uncomfortable with death.  We hate it, we rage against it.  People are especially uncomfortable with losing parents and loved ones.

But we are bankrupting our country because we can't admit the truth, that we are dying and our loved ones will die.  (How does the cliche go?  The things that won't change - death and taxes). 

The pragmatist in me pondered the annuity idea and this medicare fact.  What if, like in the podcast, we gave terminally ill people a choice.  The government would give a portion of the money ($20,000, $50,000) cash to a family in the above situation.  The person/family then agreed that they would get only palliative care - do not resuscitate, manage pain, etc.

If I were terminally ill and near death - I would much rather have that money to spend at the end of my life.  I would want my children to have that money after I'm gone.  I would rather they have a nice vacation or pay down debt than have that money go to doctors and hospitals.

Money is such a driving force in our culture.  At times, it seems like we are selling our souls (what makes us human, what makes us unique).  But the profit motive cannot be denied. 

Most people make decisions based on finances, at least partially based on finances.  There are many other factors, but finances are often key. 

 People wouldn't be forced to take the money.  But it seems to me that when there is a financial incentive, people are much more willing to make a tough choice. 

Some may say (like the above lawyer's actions) that this is immoral or unethical.  It's true that issues of life and death are incredibly complex.   But we as a country are already steeply involved in these issues. We are keeping people on feeding tubes and ventilators because we can't bear to let their bodies go.  And some of these people were frugal during their lives.  Maybe they would take the sugar packets from restaurants.  Maybe they would drive five extra miles to save $.10 in gas.   They would be shocked and saddened to find out that their children and the government had spent $200,000, $500,000 or more in their last two weeks.

I support medicare - I support caring for our aging and infirm elderly.  But I also support making the hard choices and decisions; in recognizing what we are really paying for. 

Just because we can keep someone's body alive, doesn't always mean we should. 

*I searched for the original reference to this statistic, and I can't find it.  But it's clear from the news link, we (the government) spend(s) a lot of money during the last few months of life, and often in the ICU (which is very expensive). 


Anonymous said...

Hi Aerin:

This is Cowboy from Wheat&Tares. I have been in involved in group benefits, and healthcare financing for a number of years. I enjoyed your article on the subject of Medicare spending. I liked that you are willing to take a sensible postion that cut's through the emotional response to just throw money down the tube for a realistically hopeless cause.

I'm not so certain about the option idea, as I don't want to see money thrown towards other bad causes. Still, there needs to be a re-evaluation on where medical expenses and procedures are necessary, and where to just come to terms with the fact that Mom's had a good life.

These are difficult issues, but my suspicion is that like it or not, we will be tackling them in the five years. Healthcare and insurance premium inflation are set to outpace wages in the next fifteen years, at which point there will be no other option than to face the hard realities that we have been too altruistically opposed to up to this point.

Nice article.

Freckle Face Girl said...

I agree. I have been trying to find the documentary that I saw that demonstrated some of the crazy spending to prolong the inevitable. I finally gave up & decided to comment.

It made me sick thinking about what people would put themselves & their loved ones through for a few more days or months of life. I saw glimpses of the possibilities when my dad was dying of cancer as well as my former mother-in-law. I don’t happen to be afraid of death, so I wonder if that taints my view. I guess I think quality over quantity. All of my family members have decided that easing the pain is fine, but mostly just let nature take its course.