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Gas Pains

Tom grew up in Milwaukee, bartended in Wauwatosa in the '70s and moved here in 1984.

Commentary, observations and musings about the outdoors, life in general and maybe Tosa politics and personalities will be the order of the day. He savors a lively debate as much as terrific cooking.

It Don't Come Easy

Family, Girlfriend, Healthcare, Random Musings and Idle Chit Chat

If you're old like I am you might remember this song by Ringo Starr from the summer of 1971.

The last of my father's final expenses are finally getting accounted-for and settled.

For the last number of years I handled his personal finances - mostly routine bill-paying, filling insurance for medical expenses and paying taxes.

A couple of weekends ago (perhaps) one of the last Medicare EOBs arrived in the mail.  Out of curiosity I fetched his medical bill file and toted-up the cost of hospice care during his last months here on earth.

It was roughly $43,500. 

That was just the hospice care.  Physician, pharmacy and other medical expenses amounted to a couple of thousand additional dollars. 

My impression of dad's end of life care was that it was exceedingly dignified. 

And while forty-three grand is a pile of money it really does get lost in the grand scheme of modern-day health care costs. 

I would also guess that it was not anywhere near as expensive as it might have been if I had exercised my power as Health Care Agent to insist upon maybe a feeding tube, or a hospitalization along with heroic efforts to extend his life.

Even if there wasn't any quality left.

 Photo by Gary Porter

Dad wanted it to end the way that it did.  Not President Obama.  But my dad. 

So in a manner of speaking I was the Death Panel. 

(Truthfully it was my brother and I - but I was the official decider.) 

Just in case any of you weren't aware of this - Medicare covers the cost of hospice care at one hundred percent.

That's right.  No out-of-pocket expense.

You can die with dignity and it won't cost you a thing.  Of course, you have to be on Medicare for that send-off. 

I happen to be of the opinion that a dignified and comfortable exit from this earthly world is not a bad deal.

Therefore, I want to go on public record and inform the Governor of Alaska that the next time she cracks wise about Death Panels she can shove it where the sun doesn't shine. 

This is serious business.   Playing fast and loose with this subject for cheap political points does not contribute in any meaningful way to a rational debate.

I also just happened to have sprung my faithful hunting companion loose from an expensive hospital stay.

Girlfriend ended-up in the canine ICU for treatment of a rather serious kidney infection.

The bills currently stand at roughly $2,539 with the cost of follow-up care yet to be incurred.

Just in case any of you weren't aware of this - my MasterCard covered the cost of her care at one hundred percent.

What is interesting is that upon admitting the pooch to the hospital I had to initial and sign-off on what was the canine equivalent of a Healthcare Agent document.  Including all that stuff about resuscitation and heroic attempts at prolonging life.  Moreover, the doctor had a serious discussion with Jill and I about the costs to be incurred.

We had to make a $1,100 deposit too.

And as the bills mounted the discussion was revisited.

How comfortable are you with the expenses so far? - she would politely inquire.

I was thinking - When was the last time your doctor did that with you before you made a treatment decision?

Girlfriend has potentially a number of good bird hunting years ahead of her including a decent quality of life.  We therefore checked Option Number Two for her.

We now have a slobbering, bouncing Lab hurtling through the fields and woods.

On the other hand - if she was advanced in her years, poor of sight, lame in the hips and had already lived a rich and full life my wife and I would have likely agreed upon humane euthanasia.

The dog would want it that way. 

A dignified and comfortable exit from this earthly world.

Simple economics AND quality of life would have entered the decision-making process. 

This is a difficult decision for anyone to make about their dog. 

It is an almost impossible decision to make for a family member of the human persuasion.  

The reason I bring this up is that all of this end of life medical decision-making is complicated, expensive and fraught with emotion. 

It don't come easy.

Furthermore, you cannot distill it down to a simple parable about my father and my hunting dog. 

Let there be no misunderstanding - the lives of people and dogs are not equal.

My take-away from these recent events is that we as a country have to have a very serious and difficult discussion about health care and to what extent we prolong lives and at what cost.

Who shall take responsibility for what portion of the cost of care and who shall be the decider?

Should we leave it to brutal market forces and defer to family members proffering a MasterCard to present themselves with the sick, the lame and the dying? 

Or will there be Sara Palin's self-imagined Death Panels?

Or do we exercise complete discretion to profligately expend whatever resources we want, to prolong lives without regard to quality of life or the predestined outcome?

Or is there some sort of middle ground?

This is complicated stuff and the answers don't come easy.

Business, particularly small businesses, are struggling under the burden of benefits costs.  Retiree healthcare costs are choking local government budgets.  And with an aging population of baby boomers entering an already strained Medicare system the government's MasterCard does not have a credit limit sufficient to finance what everyone wants. 

Who is going to have the intestinal fortitude to tackle this subject without trivializing or demeaning it by means of cheesy sound bites for short-term political gain?

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