A Viable Procedure

Harry Talbot grumbled as he was wheeled from his hospital room down a chilly hallway to, he was told, yet another test. Harry grumbled often, a definite fit for a curmudgeon. At 82 his skin was parchment white in the cool fluorescent lights of the hospital and wrinkled like a Shar Pei. His red rimmed eyes had lost their clarity some time ago and had a kind of milky look to them. He was skinny and balding, his scull freckled as the rest of him with liver spots. Scant and thin white hairs defied gravity, seeming to go their own way. His hearing was bad, his vision was bad, his digestion was bad and he thought he’d have a stroke with each bowel movement he tried to make. Wafting from him was the odor of geriatry and urine.

In and out of an elevator, he knew he’d been brought into one of the basement floors of the hospital. Which one he didn’t know and didn’t care. He just knew he wanted to go back to his room and watch television, but for the life of him he couldn’t recall what was on. The orderly rolled him into a room and parked him next to an examination table. A nurse swept into the room asking how he was feeling today. He was going to answer but she cut him off saying “A little poke…” and pressed a needle into his arm. Harry felt a moment of vertigo and then fell asleep so he didn’t see the doctor come in and pull his stethoscope from his neck. The doctor listened as Harry’s heart stopped, waited a moment to make sure it didn’t beat again and then ‘called it,’ giving the time of death to the nurse who entered it into Harry’s chart.

Earlier that morning, Harry’s name had been added to the list of patients whose allocation of life extending treatment had reached the maximum plateau permitted. Rather than cast him out to expire homeless, penniless, frightened and uncomfortable, he was, as law dictated, permitted to pass away with dignity.

Following the first decade of the new millenium the medical system was in shambles. Health care costs had skyrocketed and hundreds of thousands of Americans couldn’t afford health insurance and even more couldn’t afford the medical costs of profound illness or injury. The government had attempted to create a single payer system, where the government acted as the sole insurer as was done in neighboring Canada and other nations but politics, driven by a heavy lobbying action failed to get any traction for the idea. The government was though, able to come up with legislation that brought down the costs of health insurance and get it enacted into law, but conservative factions within congress and the senate hammered against it until it slowly disintegrated. Hospitals and clinics became overloaded with patients unable to pay and health care in the Most Prosperous Nation became a nightmare. Those who could afford it went offshore to get their care in countries with better facilities, more highly qualified medical professionals, and lower costs.

Something had to be done and so the studies began and moved forward in earnest. A number of facts were brought to light, many of which were unfavorable to certain elements of the business realms of society. America had high incidence of contamination and pollution, high incidence of obesity and stress, and America has a large proportion of elderly in its population. Contamination, pollution, obesity and stress were responsible for a third of the load on the medical system. What accounted for two thirds of the dollars spent on medical care was spent keeping the elderly alive in the last five years of their lives. The biggest problem with the medical system was people trying to extend their lives as their mortality loomed large before them. Fear of death in the elderly was sucking up the lion’s share of medical resources. This was made worse by the huge percentage of those elderly who relied on government subsidy and usually perished with huge owing balances that would never be satisfied because the government’s payments stopped at the death of the recipient.

Thus emerged the Comfortable Death Act of 2016. The Act mandated a specific amount of money that could be spent on life extending measures. Not life saving measures, but life extending measures which would not add to the quality of a person’s life, but merely postpone the inevitable without improvement in a person’s quality of life. People like Harry Talbot came to an unexpected yet comfortable end when the expenses to maintain life reached a specific dollar value. That value was not standard, save for the algorithm which weighed certain individual criterion like age, energy, depression level, impairment and other factors that presented a quality of life index. That index translated itself into the magic number of maximum expense.

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Of course this is fiction, but there’s truth in it as well and that is that two thirds of the dollars spent on health care are spent in the last five years of people’s lives. We have a tremendous fear of death and go to great expense to fend it off. Granted there are those who come to accept their demise when it appears inevitable. I myself had come to the conclusion that it was all over for me at one point. The doctors involved in my case concluded that I would perish within six months and gave me the grim prognosis. Involved in a therapy that was particularly hard on me, it was easy for me to believe that my death was at hand and because of the extreme pain I was in and because of the unending nausea and other physical discomforts I was experiencing, death held out a hope of relief. But it took serious discomfort for me to come to that conclusion, and had the situation continued, I might have sought a death with dignity on my own. My home state of Washington passed a Death With Dignity act, making it one of a very few that managed to overcome the hysterical predictions of wholesale abuse of the Act and passed it. To date, you can count on one hand the number of people who have taken advantage of the law. I applaud their actions but then I can understand how all of the quality of life can be drained leaving no good reason to suffer excruciating pain; the end will be the same no matter what, so what’s the sense of masochistically enduring the unendurable? But more, what gives others the right to demand that those in agony continue to suffer when they would be the first to step up to euthanize an injured animal with no hope of survival? Are people less deserving of compassion than a dog or cat?

I’m not saying the country should engage in some version of Logan’s Run.  I don’t believe in the concept of economics determining the viability of a person’s life. Because of that, I find myself favoring the the solution that would permit the nation to provide quality care to all, regardless of financial status, age or any other factor. That is the two fold approach of flat taxes and a single payer system. Flat taxes would eliminate the reams of regulatory loopholes that permit Americans to dodge their fair share of the costs of supporting the nation’s needs, among them health care. I favor a tax rate of approximately 9 percent of individual income and twenty percent of business income because it would even the burden out across the population, regardless of their situation. I believe in a single payer system because that’s the best way, (volume pricing) to reduce the costs of care workers, procedures ad medications while radically increasing the quality of that care. Look at health car in Canada, France, Germany, the Netherlands and others and you find a population with great admiration for their care system. As it is, when the more affluent among us go offshore to attain higher quality care, the care they receive is the same care that a bus driver or manual laborer receives, and that care exceeds by profound measure the the level of care our overburdened american system of scattered payers and unrepresented factions has to content with,  But I also believe that we, as a nation, should grasp the realities of extending life for no positive purpose, only adding tenure to the preview of hell a forced continuation of existence exerts on those who deserve better.

It is a concept that we all must give though to, and objective and serious thought at than we have so far. Let some day we might find ourselves for that one final yet unannounced test and we have cosrrd a threshold that now adds suffering tho the others of our elderly ilk.