Brief Notes From a Travelling Panda

(I am on vacation and we have made the 1200 mile trek from frozen Yankeeland to Louisiana to visit the family.  Please accept some short observations hastily typed on borrowed computers, apropos of nothing in particular and perhaps not really related to anything you want to read about. -PB)

A Modest Proposal

Although you wouldn’t believe it from the casino billboards that become more numerous the closer you get to Vicksburg, the typical gambler in one of the many riverboat casinos that have docked at the river ports of Mississippi and Louisiana is not a suave, bon vivant dressed to the nines in elegant casual clothes or dapper evening wear.  Nor are they young, fit, tan, and pretty.  In fact, the clientele of a riverboat casino look suspiciously like nursing home patients on holiday, complete with motorized scooters and portable oxygen tanks.  Either that or a cross-section of people who couldn’t get tickets for the tractor pull.  It’s not even the slightest bit glamorous. There are no James Bond characters casually dropping a couple of grand with cultivated indifference but instead mostly just a collection of middle and lower class Americans sweating and smoking as they desperately try to recoup the grocery money that they lost at the blackjack table.

I am ambivalent to gambling. It is, after all, a free country and how people spend their own money, within reason, is their own business.  Even so, there are huge legislative and public relation fights whenever the casinos want to set up shop, usually pitting those with moral objections to gambling against those lured by promises of free money to offset state budget deficits and provide for the economic development of decaying downtown river fronts.  I have a hard time getting excited about protesting gambling even if I know that, despite the promises of money for the sacred public schools or other bloated but still underfunded state activities, as casinos are usually owned by consortia with no ties to the city or the state, any rational person would suspect that the net flow of money is going to be out of the community and not in. The lure of easy money however, of something for nothing, is too appealing to both the gamblers and the government for any group of citizens, even those who have economic and non-religious objections, to prevent the casinos from arriving.

It’s hardly worth fighting as the outcome is almost preordained.

The typical script used to assuage public fears is that, as the gamblers will be mostly from out-of-town or out-of-state, the negative effects on the local economy will be slight or non-existent.  And yet, I have for curiosity’s sake wandered through some of the opulent casinos in Shreveport and I can’t help noticing that most of the gamblers look local.  I mean, they ain’t coming from Iowa but probably from no farther than the neighboring Louisiana parishes or Texas counties. (Shreveport is on the Red River in the Northwest corner of Louisiana and only about fifteen miles from the Texas state line.)  Most of them look like they really shouldn’t be throwing away large amounts of their disposable income in such frivolous pursuits, perhaps instead reserving some of it to pay their medical care, especially seeing how health care is the biggest concern of the electorate and our heads will explode if we don’t get everybody free health care as soon as possible.  I don’t have the statistics to back this up, just intuition, but I have a sneaking suspicion that many of the people I have seen feverishly pulling at the slot machines or rolling the dice with glazed expressions are even part of the Holy 47-million-uninsured.  Either that or they are sucking, literally and metaphorically, on Medicare oxygen as they wheel themselves from the buffet to the blackjack tables.

In short, there’s a lot of money being dropped by people who can’t afford it.  Consider then the problem of getting people to pay for their health care.  Gambling and other vices will always take priority, especially if medical care is free or quasi-free as it is today for the legions of those who know that no Emergency Department can turn them away for any reason regardless of their ability or intention to pay. Under the dual maxims that first, there’s no fighting human nature, and second, if you can’t beat ’em, you may as well join ’em, I propose we open up casinos in our charity hospitals.  That way not only will we save on ambulance costs when an elderly patient living on a fixed income codes in front of a slot machine but the house’s cut, usually fairly substantial, can help defray the costs of providing free care.

It’s win-win, I tell you.

10,000 BC

Social welfare, at least how it has been implemented in the wishy-washy West where we don’t have the gonads to throw troublemakers into a gulag, would have worked a lot better in 10,000 BC, at the dawn of human history when mastodons still trampled the occasional Neanderthal who came a little bit too late to take advantage of early Bronze-age affirmative action. It would have been great. They could have picked some arbitrary age, say 50, after which the rest of the tribe supplied you with bison meat and berries and everybody would have hunted and gathered in security, feeling pretty darn good about themselves, even though nobody, but nobody ever lived that long. Not only could a disease always be counted on to finish what a couple of bad winters started but, as being an active senior meant being able to flee from the saber-tooth cats with the rest of the clan, the odds were against anybody even living to forty. This is how it went for most of human history and, with slight variations, what is necessary on the graveyard end for any system of cradle-to-grave socialism to be sustainable.

The problem today, and surely FDR must be rolling in his grave, is that people refuse to oblige the state by dying at a reasonable age. Where once people routinely expired long before they could collect a single dime of government benefits , now the selfish bastards live many years beyond the time when a good citizen, if he really cared about the financial solvency of his nation, would sheepishly shuffle off his mortal coil to avoid offending anyone. In the United States, most of our socialism is for the elderly and they are voracious consumers of it, everything from Medicare to Social Security, the rich bounty of which many reap in excess to the contributions they have made when they were productive citizens back when Nixon was President. It’s a serious problem. The projected cost of supplying just medical care to the elderly is estimated to be around 40 trillion dollars in the next fifteen years. That’s 40 trillion dollars, most of which we do not have and yet are legally obliged to pay as Medicare, like Jehovah, lives in the Holy of Holies and death will strike down the blasphemer who dares suggest that we cut back on the burnt offerings.

Cut back we must. There is no way to pay this huge and rapidly growing sum. No way at all. Socialism in the United States (and everywhere else), as it is depends on a large pool of young workers paying the benefits for a small group or beneficiaries who play shuffleboard, totter around the house, and then obliging die before they can make too many demands on the system, is unsustainable.   People are just living too long with too many medical problems all of which need to be carefully managed at great expense to ensure their ability to continue to use finite resources.  A bit of a Catch-22 situation, I mean looking at it from a cold-blooded economic perspective.

It’s not that I am against taking care of the elderly.  I’m all for it.  I am just pointing out that shortly, very shortly, the decision not only to do it but to what extent is going to be taken out of our hands by two of the major principles of economics, first that nobody works for free and second, that you can’t pay for things forever with money you don’t have.  You can borrow for a while but eventually your creditors will catch on that you cannot possibly pay them and the ride on the artificial prosperity train is over.  One way or another we are heading for extreme rationing of medical care, either overtly or covertly, because there is no money to pay for unlimited access to all the health care you can eat.  Surely our elected leaders know this but still not only promise to maintain the current levels of medical care to those already eating from the public trough but to extend similar benefits to everyone else.  There is no money.  We cannot add another 40 trillion to the projected deficit  with impunity.  The government does have other obligations, you know.  Like defense, infrastructure, and the other traditional roles of government in free societies.

28 thoughts on “Brief Notes From a Travelling Panda

  1. Your thought-provoking thoughts about social welfare, aging, the elderly, taking care of the elderly, the healthcare of the elderly, the economy, and the delicate and yet destructive dance between the healthcare of the elderly and the economy, reminded me of a joke.
    After Dick Cheney shot his hunting buddy in the face, some comedian said, “We’re going to have to make tough decisions regarding the healthcare of the elderly.”
    Actually, I wish that was a direct quote, I can’t remember exactly what the guy said. Guess you had to be there, sorry.

  2. K, I just found the joke I was referring to above. It was #2 on a Letterman Top 10 list called “Top Ten Dick Cheney Excuses”: Until Democrats approve medicare reform, we have to make some tough choices regarding the elderly.
    Just to clarify, and because I hate to leave a punchline hanging.

  3. Oh, but ending the war in Iraq will give us all the money we need for unlimited healthcare for everyone forever! >) If you can believe it, I interviewed with a physician who really believed this during a medical school interview last year.

  4. I’m in favor of licensing those motorized senior carts. That way we could at least make ’em pay for the cost of the medical care of the people they keep running down.

    You ever get between a bunch of those things and a Buffet restaurant? Brutal!!

  5. THat sounds about right.

    When Social Security was instituted, IIRC, the retirement age was just a few years (2?) less than the average life expectancy.

    Now it’s, what, 15?

    Tie SS retirement to life expectancy and the problem goes away.

    (Yep, able bodied old people gotta work longer to support themselves.

    See this? This is me not caring very much about that – since disability benefits are unrelated to age-based retirement, those who are actually unable to work shouldn’t be affected.

    I don’t see any reason that old folks should get free livin’ for a decade and change on my tab, while they’re able to work. Wanna retire earlier? Make more money. That’s my plan, since I’m damned sure that SS will collapse or be utterly reformed by the time I’m 62.)

  6. i grew up in vicksburg, and i remember when the casinos came into town. i hated them, and still do because every time my mom would drag our family to eat at one i would always see the folks with their iv poles and oxygen tanks creeping around wasting all their money. it’s just ridiculous.

  7. i grew up in vicksburg, and i remember when the casinos came into town. i hated them, and still do because every time my mom would drag our family to eat at one i would always see the folks with their iv poles and oxygen tanks creeping around wasting all their money in the smokey casinos. it’s just ridiculous. so my tax money goes to let these people waste their dollars AND pay for their medical care that they shouldn’t be getting since they don’t deserve it! lovely!

  8. Firstly, please write a book.

    Secondly, in some older posts, you glorify our current leaders and the current administration but now you are condemning the current trend in the economics of healthcare. Shouldn’t they, the Bush administration, have seen this epidemic, shall we say, coming, and not have spent so much on this current war but instead have invested in other aspects of the budget so that we would be in decent shape financially?

    (Our war on terrorism supersedes all other concerns.  Like I said in previous posts, there are more important things to me than medical care.  “Health care” is not even really my big political issue.  Besides, we could cut defense spending, even eliminate the military and we’d still be going bankrupt paying for entitlements.  It’s that big of a problem.  Positing that if we only stopped paying for defense or scrapped a couple of carrier battle groups then everything would be all right is ridiculous.  How about looking at it like this:  The voracious appetite for free money by our citizens is robbing us of our ability to finance defense, infrastructure, and other legitimate functions of government.  -PB)


  9. Hey PB! I grew up in Louisiana, a couple of hours away from Shreveport. I miss it terribly, but can’t afford to take the fam there on the 24+ hour journey, by car. My grandparents lived pretty near Vicksburg, but in Louisiana. Talk about a welfare state though. When Katrina came and people were demanding the billions of government entitlements to “fix” things, I knew exactly what would happen to it. Politicians there are so absolutely corrupt. My parents do like Bobby Jindal though.

  10. I don’t object to slots in the ED, hell it would give the crowd something to do in triage.

  11. Very deep article– just my thoughts on gambling, I infuriated my senior citizen mother by showing her a video from a psych class of rats pulling bars for treats and then one that I took on my cell phone of people in sweat suits and tennis shoes in a casino at some slot machines.

  12. Enjoyed the post – thought provoking! Hey…you might be onto something…casino in the hospital and they get a cut. Ha! They’d probably operate in the green. 🙂

    I always say that while social issues, education, health care IS important…if we don’t have a strong military to provide defense (be a deterrent) then nothing else will matter in the end because we wouldn’t exist as we do now and I don’t believe it would be for the better. Just go back through history to learn about that.

    So it’s a matter of trying to balance the eagle but don’t ever forget why it has to be a priority.

    Whether it is with local law enforcement or something global…unfortunately there will always be a need to have the means and attitude walk tall with a big stick.

  13. Deep? Laughably, foolishly, simplistic with an understanding of economics derived from economics 1a in his freshman year of college.

  14. AND he missed the important points such as if you are not on the production-possibility frontier then you can get a free lunch. Guess what? US healthcare is not efficient.

  15. Another perspective: I am a forty seven year old female, currently unemployed and uninsured by choice (well, sort of) in order to stay home 24/7 to care for my bedbound elderly parents who, at 86 and 84, have exhausted all their investments and retirement savings. My days consist of trying to ensure that they eat healthily enough that they don’t dehydrate or lose too much more weight, changing diapers, transferring, bathing, listening to one’s hallucinatory rants and calming irrational fears and trying to decipher the aphasiac’s unintelligible attempts at conversation. And, just so my brain doesn’t turn to mush, I mull the options of dealing with the never-ending, no-possible-hope-for-solvency, how-much-longer-can-I-afford-to-feed-AND-medicate-them financial and medical care crises. Talk about stress! Yes, they have lived far longer than either anticipated living. What am I to do? There are no plugs to pull – not yet anyway. They spent several years post-retirement paying an EXHORBITANT amount of money to one of the bigger insurance companies to continue their pre-medicare- eligible benefits cum secondary insurance providers. In a year when my dad experienced his massive stroke and spent almost three months in ICU and eventually rehab, and my mom had three hospitalizations of her own, the secondary provider collected in premiums over eight thousand dollars yet paid out on their behalf less than 2000. So, quickly realizing that this made no sense, I switched them to a medicare HMO which, while considerably less expensive on a monthly basis, has caused me excessive amounts of stress trying to wheedle, cajole, negotiate, beg, plead, demand, or manipulate appropriate and, in my estimation, cost-saving services. For example, 82 y.o. female who is walking unaided admitted to hospital by internist to do a “quick” balancing of electrolytes. Overnight stay at most. Except, while she’s there, she’s choked and aspirated and now requires additional treatment and stay days to address pneumonia. Night before planned discharge, she codes and is revived, necessitating placement of a pacemaker, extending stay two more days. Returns home and takes to bed. Good, in that she is not sneaking out of the house in the middle of the night BUT, bad because she has for some reason become afraid to ambulate. Muscles begin to atrophy. She’s soon unable to bear weight. After several attempts to convince MHMO that it would be cost-effective to provide PT via home health they allow five, count them FIVE visits for PT. 82 y.o. woman who has been on her back for over a month and they think five pt visits is all it takes to get her back up and walking? Yeah, right! They might as well have taken that money and used it to wipe and flush. I tried to explain to them, just in case they weren’t familiar with what happens to skinny, old, bed bound women with diabetes, that it would be much, much less expensive for them to help me get her back on her feet but, they’d not have it. So, now they have to pay to have skilled care home health nurses to address bed sores, because now that she’s not mobile, she is in diapers. Now that she’s not mobile, she’s prone to pressure sores. Now that she’s not mobile, she’s virtually impossible to transfer into the car so whenever she has to go to the doctor or hospital, she requires ambulance transport. Oh, and unless she requires skilled care, she cannot have a bath aide who bills at a much cheaper rate than an RN. The bath aide would go a long way toward preventing the need for skilled care to address bed sores but, that would make entirely too much sense. We can’t get the least expensive service unless we also get the more expensive service. What the @#$%%^? She’s not had a bed sore since they d/c’d home health because I work my ass off trying to prevent them. I’d get more services if I took worse care of her.

    Did I create this situation? NO. Did my parents? Well, I guess one could argue that they imprudently lived beyond their life expectancy and probably should have made their kids pay their own college tuition to ensure they had enough money to live on in their golden (due to incontinence) years. And, probably my dad could have worked another few years after he retired at seventy but, holy cow, he had been working since he was six years old, and that is not an exaggeration. However, because I love them, and partly because I don’t want them to be or feel like they are a “drain on the system” I will keep them at home til they die rather than subject them to the inhumanity that is nursing home “care.” Alternatively, I could dump them in the nursing home to the tune of $8700 per month minimum, compliments of the U.S. government. Yeah, they live off Social Security because it’s all they have left. Although, I hardly think most people would consider what they are doing “living.” I’ve spent every penny of my retirement and liquidated all my assets in attempt to pay down their debt. They have no more assets. There’s no more money. We are one expensive antibiotic away from the final frontier. It is humiliating beyond belief to have to tell the hospital social worker that my dad cannot be discharged to home until the beginning of the month because there is simply NO MONEY with which to fill all the discharge scripts, so I guess I have failed, and please find him a skilled care bed at the nursing facility for a short term stay. Let’s just go ahead and run up the MHMO tab even more because I don’t have the cash to buy the meds he needs and he can get ’em “for free” at the nursing home. See my dilemma? Intelligent people sometimes can’t make intelligent decisions. Here’s another plan: stop paying the MHMO premiums and go with straight medicare and make sure all the docs and facilities take assignment. That way I could use the premiums toward paying for the meds. That would probably not reduce the quality of care they receive, would it? Sure, we might have to put up with the attitude that we are just two, or three more drains on the system when we show up in the ER with legitimate emergent issues but, hell, I’m not proud. Not anymore at least. And, God forbid I should “get sick” because then we’ll all be paying for my care as well. What’s a person to do?

    Sorry for the rant. Maybe I should get my own blog but, who’d want to read it? Hell, maybe I’ll spend a buck on the lottery. That seems as good a plan as any.

    (Thank you for your comment.  But look, your mother coded in the hospital, was resuscitated, and needed a pacemaker after that. Do you have advance directives for your parents?   I realize that nobody wants to consider that their parents will die but everybody eventually does. As it sounds like your parents currently have a very low quality of life, if you’ll pardon my asking and I don’t mean to sound cruel, how long do you intend to “do everything possible” for them?

    On another issue, I bet your parents are on twenty medications, most of which they no longer need and which could be discontinued for all the good they are doing.  This is also going to sound cruel but if you think about it, what long-term medications do they really need?  This and other issues comes back to the question of futile care, family expectations, and money, particularly the high cost of medicine at the margins.

    I assure you, by the way, that in Europe or one of the other countries with “free” medical care, your mother would never have been resuscitated. -PB)


  16. Oh dear. I seem to have stumbled upon a skeptical conservative site. It’s so interesting to see how other skeptical people view the world… I’m surprised by how many skeptics turn out to be Ayn Rand fans or libertarans…

    (By their nature, conservatives tend to be skeptics.  So “skeptical conservative” is redundant.  We are particularly skeptical of government intervention and I believe you can find plenty of examples where this skepticism is justified.  Being skeptical, however, of Reiki, homeopathy, acupuncture, and the other snake oil transcends the liberal or conservative label.  As for Ayn Rand, her works are unreadable and I don’t think too many conservatives advocate the kind of nineteenth century predatory capitalism which she seemed to favor. -PB)

    I understand the need for a national defense, and why it should be a priority, but when it comes right down to it, how much is too much? Is it possible to spend too much on defense? What metric should we use? Should we lower costs by expecting higher casualties and spend less on technological gizmos? What is the economic interests, and how much are they worth? I don’t think we’re in any danger of being invaded by Mexico or Canada… that leaves, what, realistically? A missile assault by China and Russia? And how do we defend against that? MAD? Missile Shield, which either doesn’t work or is easily confounded? Some defense spending is justifiable, some isn’t. There’s nothing sacred about it. So is some public health care spending. Whither that dollar should go depends on what specific defense program or specific medical program.

    But it’s good, I think, that we at least agree that health care and defense spending are the two biggest expenses.

    (The difference is that defense spending is not legally protected and can be cut (or increased) as the situation warrants.  If you think the only real threat is a missile attack from China or Russia you need to read up on defense issues. -PB) 

    Maggie – Sorry you’re going through such a difficult time. I’m a big fat liberal and think we need to have universal healthcare, paid for by the government. But I also think we need to, as a society, have a reasonable discussion about end-of-life. People die. We can extend life at great cost and with little benefit. I don’t think I would let anyone die if it was my decision, but it’s now a position that we are almost all going to be placed in, because we do have the power to extend life, even if it’s not really living.

    And I’m really not clear on why you were trying to pay down your parents debt. The standard thing to do in these situations is find a way to transfer your assets to your children so you can qualify for federal assistance. But good luck getting your life on track and caring for your parents.

    (Oh, I see.  Even though you believe in government solutions to problems placing your full faith and confidence in the same you are advising Maggie to scam the system, trying to hold on to money that belongs to the mighty and all-powerful gubbmint’. -PB)

  17. I think that entitlements take up something like 70% of the federal budget, so defense spending really doesn’t begin to match what we throw away on social welfare programs.

  18. Oops…here are some figures from the Christian Science Monitor:

    Certain trends have been favoring the left for the past several decades. In the early 1960s, transfer payments (entitlements and welfare) constituted less than a third of the federal government’s budget. Now they constitute almost 60 percent of the budget, or about $1.4 trillion per year. Measured according to this, the US government’s main function now is redistribution: taking money from one segment of the population and giving it to another segment. In a few decades, transfer payments are expected to make up more than 75 percent of federal government spending.

  19. Maggie,
    I am a practicing internist. Many (most) of my patients are elderly. I am a social liberal. But I heartily second Panda’s comments to your post. You are perpetuating your own living hell by not having advanced directives for your incapacitated parents in their 80s. I’ll bet that if they both had their faculties, they would be horrified that you have exhausted yourself emotionally, physically and financially to extend their poor quality of life. Almost no person over 75 with whom I have ever had the “end of life/resuscitation” talk wants to be “brought back” to be a burden on their children. I am not a fundamentalist Christian, but many of my patients and their families are. One way that has hit home in some family discussions is the concept that “Sometimes a severe infection is God’s way of calling someone home – most people don’t just die peacefully in their sleep.” Or, “If Jesus wanted to do a miracle and keep your Dad alive, do you really think he would require a ventilator to do it?” That gets people thinking, and actually has opened the door to some good discussions. A lot of adult children and grandchildren of multiply comorbid demented parents/grandparents feel very guilty about not doing enough, and talking openly about these things often gives them “permission” to make other choices. Maggie, it sounds like your parents were very generous to you – paying for college, etc. I would imagine that they would not be the type of people who want you to have to sacrifice yourself so much to extend their end-of-life care by a few months. Hope you can see through some of the pain to start taking care of yourself.

  20. Panda, Panda, Panda…..
    You scoff at sheep spleen water, but you throw around horseshit, bullshit, and snake oil like a believer.
    Would you take a horseshit pill if it were backed up by empirical evidence? Or, in that case, would you consider other decision making metrics? just wondering.

    (Listen, I don’t often do this but unless you start demonstrating a little more…I don’t know…let’s call it “credibility” I’m going to stop approving your comments.  I already have one village idiot here (who is a chiropractor) and don’t need another.  If you have a legitimate comment or question just post it but you have passed into the realm of “trolling.” -PB)

  21. Oh, let me back up a bit.

    My parents both do have advance directives. My mother was a no code when she coded but, for some reason, the order wasn’t in her chart. It was middle of the night and I was home with my father so, not available to give any instrux. We’ve not been in a position, except for that one time, to have to make any decisions like this. Neither required any “heroic” effort to “recover” from their CVAs. Yes, they did receive care. My mom is now down to four meds: digoxin, metoprolol, aspirin and a very, very small dose of seroquel. All but the seroquel I can get cheaper than the copays. She has atrial fib. Her bp shoots up sometimes really, really high. She gets an occasional UTI which we treat with antibiotics if we catch it. Maybe two or three UTIs in the past three years or so. She has complained of chest pain on occasion and I’ve taken her to ER to address it. I don’t know if that’s prudent or not. Should I just ignore it? It’s not like she’s a surgical candidate or anything but, what’s a person to do? She developed a lump on her upper right chest. I wasn’t sure if I’d cracked a rib transferring her or what so, I took her to her doctor who made an appointment to have an ultrasound done. Should I say skip it? Is it worth doing just to know what we might be dealing with?

    My dad is more difficult. Among other things, he’s got a suprapubic catheter which causes no end of UTIs. We don’t treat all of them. He gets his meds from the VA but, when he needs an antibiotic, we have to pay out of pocket because we can’t wait to go through the process of getting it from the VA. One antibiotic can cost more than our grocery budget for the entire month. Now, I used to take him to the urologist every three or four weeks to have his catheter changed. That seemed ridiculous to me so I asked the doctor if I could learn how to change the catheter myself. He taught me how to do it and I did it myself at home for over a year. The HMO decided that when he no longer was eligible for or required PT at home, he had to lose his bath aide. You must require a “skill” and have “skilled nursing” to also get a bath aide even though it costs much less to just have a bath aide. So, in effort to avoid prematurely wearing out my back and necessitating more expensive nursing home care, the doctor ordered “skilled care” to change the catheter every two weeks just so the bath aide could return. Does that sound like I’m scamming the system? Yep. But, what else was I going to do? They make it virtually impossible to use only what you need. I AM NOT HAPPY at how much money we must waste in order to get what we need. The reality is though that it would cost much, much more money to put them in a nursing home. I’ve been there and done that with another relative and also with my dad for what were supposed to be “short term” stays but on both occasions, he deteriorated so rapidly that I brought him home. It is not acceptable to me to leave them at someone else’s mercy. They are MY parents and MY responsibility and I’ll not relinquish that responsibility, nor will I subject them to what I consider, based on experience, to be substandard, if not inhumane care. I fully recognize that nursing home care would hasten their deaths. That is not a “problem-solving” option of which I will avail myself.

    Now, if I took my dad off his meds (plavix, aspirin, metoprolol, simvastatin, zoloft, seroquel, risperdal, B 12 and prn urispas) would it hasten his death? Are any of these meds necessary? From my perspective, the zoloft, seroquel and risperdal have made it much easier to manage his dementia behaviors at home but, I worry about the potential negative side effects I read about every time I turn around. Should they stay or go? What about the heart/blood pressure/cholesterol drugs? Do they do any good? How would I know? What would happen if we d/c’d them? Is the care they get unreasonable?

    I’m not actively trying to prolong their lives (am I?) Neither am I actively trying to hasten their deaths. I know they’re going to die. Given my druthers, I’d have liked them each to die quick and painless deaths while in the midst of some activity they were enjoying immensely. That possibility no longer exists. Are they happy? Relatively speaking, I guess. The thing is, I know, because we did talk about it, that they want to be allowed to die in their own home. Can I honor that wish? I hope to. Every time I do seek ER care, I have to wonder if they might be so ill that we’ll get there and get “stuck.” I don’t want that to happen. I don’t want them to be in pain, or scared. Is that too much to ask? I’m just trying to do my part. And I am thoroughly frustrated at all the hoops I have to jump through to try to get them what I think is reasonable. It’s all or nothing. I can either turn over all their care to the nursing home and let the government pay for the whole shebang for as long as they can last or I can keep them at home and expect nothing in terms of help. See how that sounds? God, I know I am not “entitled!” We are too poor but, not poor enough.

    And, ArkyDoc, you are right, my parents would not want me to sacrifice anything for their sakes but, they raised me to understand what it means to love and care for each other and so sacrifice I will. Really though I don’t consider this a sacrifice. It’s a choice I made and I’d do it all again. I just wish my headlong crash into reality didn’t require me to focus so much on “cost of care.” I just cannot accept that my parents have become too expensive to take care of. I CAN care for them and I CAN do it better and cheaper than the nursing home can but, Medicare won’t pay me to make sure I can afford to do it, now will they? They’d rather pay the nursing home a ton of money than help me keep them here with a tiny bit of monetary help. So, why do I bother being concerned about preserving precious resources? I could be running them to ER probably ten or twelve times in any given month and demanding care. I don’t do that. Am I being hard-headed? Is the nursing home the answer? I cannot believe it is. Honestly, I cannot see it. It’s not good for them and it’s not good for Medicare. It’s expensive. It doesn’t make them better or keep them from getting sicker. It’s just another place to go to die.

    We’re not out playing the slots or blackjack but, don’t think for a second that we’re not gambling every single day. I’m not liking the games or the odds.

  22. Maggie:

    Agreeing with what others have said. make your parents DNR. Put them on hospice if you can. It is OK. It is the humane, caring, right thing to do. No more trips to the ER. No ICU stays. No more resuscitations. Those are cruel and unusual punishments. Individuals, and the nation as awhole gave to come to grips with this.

  23. Since you’re travelling to Louisiana, what do you and your family hope for (or expect) from Bobby Jindal? I know little about him, but he seems a decent man.

  24. Eh.
    I had been lurking on your website long enough to be sufficiently aggravated by your CAM bashing to de-lurk.
    I’ve got a test in high school tomorrow to study for, anyways. (It’s my Biology for Social Scientists class. I took it because I don’t even have to do any lab.)

  25. Wait wait wait, let me get this straight. You’re still in high school and you’re going to come lecture us about medicine? Simply stunning.

  26. (Richter is banned. Sorry. She’s trolling and I’m sorry I let it go on so long. This is my blog and the comments, believe it or not, are very important to it. Some people check in just to read them.

    With this in mind I’m not going to tolerate whatever Richter thinks she’s doing. Her comments are asinine. I allow asinine comments, of course, but they have to have some charm or interesting point of view. -PB)

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