Felicia Nimue Ackerman: Broken ribs worse than... - Anne Bouey

"In a New York Times column last summer, the late Dudley Clendinen, who suffered from Lou Gehrig's disease, wrote that Americans "don't talk about how to die." We don't? For years, Americans have been discussing how to die. Most of this discussion exalts hospice care and deplores aggressive life-prolonging medical treatment - often in a manner reminiscent of the "Four legs good, two legs bad" slogan of Orwell's "Animal Farm." Consider "The Long Goodbye," Joe Klein's cover story in the June 11 issue of Time. The cover says: "How to Die: What I Learned from the Last Days of My Mom and Dad." You can learn plenty from Klein's story. You can learn about the opposition faced by sick old people who want to prolong their lives. Klein decries "unnecessary expenditures." Here is his account of one expenditure that he considers unnecessary. "At the age of 80, my mother insisted on having a heart-valve operation to fix a murmur she'd had since birth. 'It's getting worse,' she said. ''I'm feeling more tired than I used to.' " Klein says the operation cost over $100,000. He says Medicare paid for it. He does not say whether it relieved his mother's symptoms or prolonged her life, although elsewhere his article indicates that she lived into her 90s. Klein's omission suggests that he considers the medical effect of the operation irrelevant to whether it was worth the expense. But should we begrudge an operation that offers significant benefits? Aren't there more humane ways to alleviate our country's financial woes? Like most writers addressing this subject, Klein blames his mother's "unnecessary" operation on fee-for-service medicine. He extols the system of Pennsylvania's Geisinger medical organization, where "doctors are paid salaries and outcomes-based performance bonuses rather than by the services they perform." Moreover, if Geisinger doctors "can improve service while cutting Medicare costs, [they] get to keep a portion of the savings." This arrangement obviously provides a... more... - Anne Bouey from Bookmarklet