Sunday, March 03, 2013

Should a retiree take responsibility for his own Medicare costs by demanding less, and maybe not living as long?


Even on the Sunday morning news shows, I hear talk that the federal sequestration is driven by the fact that it is so difficult to cut “entitlements” and therefore the meat of government services (defense and infrastructure) gets cut. 
  
There was vague mention of means testing again, and a reminder that the Supreme Court views “entitlements” as “benefits”, not as property rights, so Congress can still change them.  The debt ceiling can come up again as soon as mid May. Social Security, because the trust fund is a Treasury bondholder, is safer from the debt ceiling problem in the short term than we had previously thought.
  
There has been a particular complaint that Medicare patients go into doctors and demand everything.  I am afraid that my own mother (who passed away in 2010) tended to do that. In my own case, I’m trying to do as little as possible.  My own primary care physician has gone along with that, but I noticed a remarks about “concern” on my charts. 
  
I do have a heart arrhythmia, but do delve into it would require “doing everything”.  The same could be true about the consequences of doing the expected colonoscopy. 
  
Once you go down a diagnostic path, it is very difficult for our medical system let up on trying to do every possible test and treatment. 
  
A half-century ago, we let problems like mine slide.  We understood and accepted that everyone dies of something, and once you retire, your days are finite, perhaps even “numbered”.  You remained productive and active as long as possible, which might be two or three decades if you were healthy, even with very little intervention.  Once something happened, however, it was essentially over.  Once people developed major illnesses, their life expectancies were low and the periods of disability and need for custodial care were short.
  
I’m comfortable with that.  That is the world I grew up in.  Today's world, of emotional indulgence in some families, is not.  Instead, a lot can be done today, but typically people need social support systems, some of which I don’ have.  As Dr. Mehmet Oz said, “you love someone, and they love you back”, despite all the dependence and disability.  That didn’t seem to be expected in old age when I was growing up, but it has grown with time.  
As to specifics, I can see the case for some treatments, which have sometimes grown less invasive.  Even some heart surgery can be done with laproscopes or "keyholes".  That would require some "preparation" but could be feasible, some day.  But I cannot see how someone "like me" could ever be a reasonable patient for, say, a transplant.   

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