An HMO takes a flat yearly fee and makes its money by not doing things to you. Sometimes they don’t do things that you want or may really need.
If you or someone else pays for each thing you get, fee for service, doctors and hospitals get paid for doing things to you. Sometimes they do things you don’t really need and wouldn’t want if you took the time and effort to consider it carefully.
With the exception of amounts owed, no doctor, hospital, or medical provider of any sort gets money from you once you are dead. So there is a huge incentive to keep you alive as long as possible and you or someone else will pay for it.
They have an interest in promoting the idea that you don’t want to die, no matter what. Realistically, it makes no sense to fear, or not want, what you are going to get anyway. If you have lived a full life, do you really want to spend all or most of your money for a few months or years of intensive medical procedures instead leaving it to the beneficiaries of your will?
When you are relatively young, radical procedures like transplants may make sense. If they work, you get to enjoy the benefits for a reasonable amount of time. They can be worth the risk. This is not the case for the elderly.
Most insurance plans pay the full cost of hospice care. Instead of trying to make you live longer, they concern themselves with keeping you comfortable.
Get Catheterized
I recently had the experience of being the primary caregiver for a person in hospice care dying from cancer. I learned something that may be useful to you sometime in the future. If you should ever become incontinent, get catheterized right away. The human body makes too much urine to deal with any other way. Adult diapers and pads can't keep up with it. The patient and the care givers are much more comfortable after catheterization.
The hospice folks waited for me to figure it out. They didn’t suggest catheterization right away or explain why it is advisable. I wish they had.
False Information
Justice Ginsberg's pancreatic cancer has not spread, according to news reports. No test can possibly assure a person that they don't have spread of the disease. The most that these tests can do is find a cancer that is big enough or active enough to be found. A positive result only means that cancer, if present, is too little to be dectected.
The Right to Die in Comfort
Modern medicine has discovered how to relieve even the most severe pain. Yet the law may be used to sentence defenseless patients to agony, by withholding those drugs that can eliminate suffering. A dying person should be able to experience the end of life in comfort, without the interference of right wing religious fanatics. If they think that it is more holy to suffer, let them. But, by God, leave the rest of us in peace and in accord with our own beliefs and conscience.
How Should We Think of Death?
When we die, our consciousness goes on in some form or we have the most perfect rest. Either is a fine outcome.
Scientists tell us that the universe is 13.7 billion years old. If you are a middle aged person, 40 perhaps, you were unconscious during the previous 13,699,999,960 years. You hadn't been born yet. You missed out on those years entirely. You are unaware of everything that happened during that very long time.
Do you care? Of course you don't. Does it make you feel bad that you weren't alive then? Of course it doesn't. Then why should you care if after you die you won't be aware of the next 13,699,999,960 years? It's the same oblivion. There isn't anything particular that distinguishes the vast time before life from the vast time after it.
An Epidemic of Ignorance
AIDS is caused by a virus, but it is an epidemic of ignorance. It was not vigorously attacked at the beginning, because it was foolishly thought to be a disease of homosexuals. It was allowed to spread unchecked because of hatred and bigotry. Although Gay men have shown that it can be controlled through education about safer sex practices and other hygienic means, in some quarters these have been foolishly rejected.
Abortion
The pro life assassins should instead work to reduce the need for abortions. A person’s right of control over his or her own body, including a woman’s right to end a pregnancy, must be given the highest priority. Even so, reducing abortions to the minimum possible is a good idea for many reasons. Varied and simultaneous approaches would be most effective at accomplishing this objective.
Abstinence is fine for those it suits. But there are many options between that and unprotected, heterosexual, vaginal intercourse. Masturbation, that activity the Republicans forced a U.S. Surgeon General out of office for mentioning, alone or with someone, is one such class of available (and safe) alternatives. Oral and anal sex (protected) are possible choices. No unwanted pregnancy has ever been produced by homosexual activity. The wide availability of contraception, both information and devices, would be useful.
But the right wing isn’t interested in any of these solutions because they don’t fit with the religious convictions that they fully intend to force on everyone else, if the rest of us let them get away with it. Now the anti abortion terrorists have struck by twice sending envelopes with white powder and letters threatening anthrax to family planning clinics around the country. The sender, apparently a fundamentalist cult, perhaps Christian, calls itself “The Army of God.”
Why So Many People Don’t Go to the Dentist
Well, it’s the money. For some it is because they don’t have it. For many others it’s because they think dentists are money grubbers and vary in honesty from not very to worse.
Some will only supply first class, top of the line, treatment when the patient wants second class. They push two caps and bridge for a missing tooth when one can get along quite well without a tooth or two. This is particularly the case when the tooth doesn’t show. They tell you that if you don’t fill in the gap the other teeth could float. That is about as likely as the dentist floating off into the air. Then they rip it all out when you lose one of the anchoring teeth.
They push root canals that usually lead to even more expensive procedures later when the tooth turns black and then breaks off. Then they want to put in a post and a cap. There’s still money to be made off of that root.
They sell expensive treatments for an ailing tooth. The dentist says that after the operation the bone will regenerate. You agree, and set up the appointment. It’s when you arrive for the procedure that he tells you the bone “may” regenerate. This is about as likely as the dentist growing another head.
They push periodontal treatments for gum disease. If you resist, the dentist says, “Would you like to have them all pulled now?” A few years later they tell you that you need to have it done again. Then you start loosing your teeth anyway.
Why do you suppose that most regular heath insurance plans, Medicare and Medicaid don’t cover dental expenses? Well, it’s because a large part of those expenses aren’t medically necessary. And what is really necessary is affordable. That is, if you can find an honest dentist who puts your interests as a whole person, not just a mouth, ahead of his bank account. Good luck.
Food
Most folk eat far too much. It's bad for their health and a waste of money.
For more of Juan’s comments go to Juan comments on the news .