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It is said that in England death is pressing, in Canada inevitable and in
California optional Small wonder. Americans' life expectancy has nearly doubled
over the past century. Failing hips can be replaced, clinical depression
controlled, cataracts removed in a 30-minuts surgical procedure. Such advances
offer the aging population a quality of life that was unimaginable when I
entered medicine 50 years ago. But not even a great health-care system can cure
death—and our failure to confront that reality now threatens this greatness of
ours.
Death is normal; we are genetically programmed to disintegrate and perish,
even under ideal conditions. We all understand that at some level, yet as
medical consumers we treat death as a problem to be solved. Shielded by
third-party payers from the cost of our care, we demand everything that can
possibly be done for us, even if it's useless. The most obvious example is
late-stage cancer care. Physicians—frustrated by their inability to cure the
disease and fearing loss of hope in the patient—too often offer aggressive
treatment far beyond what is scientifically justified.
In 1950, the U.S. spent 7 billion on health care. In 2002, the cost will be
one hundred billion. Anyone can see this trend is unsustainable. Yet few seem
willing to try to reverse it. Some scholars conclude that a government with
finite resources should simply stop paying for medical care that sustains life
beyond a certain age—say 83 or so. Former Colorado governor Richard Lamm has
been quoted as saying that the old and infirm "have a duty to die and get out of
the way", so that younger, healthier people can realize their potential.
I would not go that far. Energetic people now routinely work through their
60s and beyond, and remain dazzlingly productive. At 78, Viacom chairman Sumner
Redstone jokingly claims to be 53. Supreme Court Justice Sandra Day O'Connor is
in her 70s, and former surgeon general C.Everett Koop chairs an Internet
start-up in his 80s. These leaders are living proof that prevention works and
that we can manage the health problems that come naturally with age. As a mere
68-year-old, I wish to age as productively as they have.
Yet there are limits to what a society can spend in this pursuit. Ask a
physician, I know the most costly and dramatic measures may be ineffective and
painful. I also know that people in Japan and Sweden, countries that spend far
less on medical care, have achieved longer, healthier lives than we have. As a
nation, we may be overfunding the quest for unlikely cures while underfunding
research on humbler therapies that could improve people's lives. |
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发表于 2017-8-6 14:03:56