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Considering Everything – Except What We Should…

July 5th, 2017 | No comments

Periodic random thoughts on growing older but hopefully wiser… 

First, I’ve actually been negligent in keeping my blog up-to-date – probably much to the delight of some of my readers 🙂  In large measure, the negligence was due to our family’s preoccupation with Mom’s worsening Alzheimer’s.  So, I apologize for missing blogs in recent weeks during some of the most important discussions on health care since the passage of the Affordable Care Act during the formative period of the Obama Administration.  My attention was diverted from my normal obsession about all-things-health-care-and-Washington to a more normal obsession that is faced by millions of families across the nation on the next steps they need to consider in providing care for Mom or Dad or other elders in their lives.

And, while I missed sharing thoughts on events over the last month, you no doubt noticed that there was an abundance of thoughts and perspectives on the issues of the day shared by many of my health care colleagues.  It seems that everywhere I turned over the last several weeks there was an ample supply of pundits sharing thoughts on the tenor of our times – both health care and non-health care related.  Our nation seems to be obsessed with the ongoing soap opera which unfolds daily on the small screens in our hands and the larger screens which light up our living rooms.  But, as we follow the whims and whispers of “party politics” in our nation’s capital, it seems to me that there is a much larger “people politics” issue befalling our nation.  While I don’t disagree that the machinations of Washington require our worthy attention, we should not forget the equally important and looming issues that will shape our society for decades to come.  Decisions being made in the near term over the next several years will affect our nation for years to come.  The GenXers, the Millennials and those who come after them will be the recipients of our decisions.  It’s all about people…and, the people are getting the short end of the stick – from my perspective.

Which brings me back to health care.  I’m increasingly concerned like others that the demographics of our society is a huge problem (i.e. we are getting considerably older as a society than previous generations).  The demographics hang around the neck of the USA like a lingering albatross!  Why?  Because if we do not fix our health care system – the health care system will be the singular issue that bankrupts the nation!  I realize that I’ve said this before and that it is a bit provocative but – it is true.  Each quarter the percentage of GDP consumed by health care inches up.  In fact, unless something is done, we are clearly reaching for 20% of GDP consumed by health care – on the conservative side.  As one who has been around for a while, I remember the cries from the pundits when we reached 10% of GDP, then 12%, then 15%…  Each of these hurdles were described as “…not sustainable.”  But, while we have sustained ourselves in the short term, it seems that our nation is digging a deeper and deeper financial hole for itself due to the large amount of resources we invest in health care to the exclusion of other important societal needs. It cannot continue and we need to solve the problem – Now!!  ObamaCare – as passed – did not fix the problem.  ObamaCare with changes could set the right course.

But, lest I make it theoretical, I would like to be more personal.  All of these thoughts are shared in the context of the much larger, more socially important phenomenon – the aging demographic of our society.  The aging of the boomers (i.e. my generation) are beginning to stress the system – just as we have for each era through which we passed.  Now, instead of Schwinn bicycles for every kid, or marching in the streets, or finding jobs for every Boomer, or raising families, or paying college tuitions – we are now faced with caring for family members.  Such has been my dilemma for the past number of weeks.  And, while there are many diseases that are painful, protracted and difficult such as cancer, or debilitating neurologic problems, or severe heart disease – the plight of a person afflicted with Alzheimer’s is like a blackening abyss from which there is no escape.  While there are displays of thought, they are random at best, mostly about isolated and unconnected events; or offered only as snippets left behind and reflecting the personality of the person behind the mask.

The heartening part is that the snippets which come through often convey the essence of the person.  My Mom still loves coffee and asks for “a cup of good coffee” every couple of minutes.  While she is easily distracted, her personality comes through in bursts of commentary about keeping the house clean or washing the dishes or some other every day domestic task.  It’s probably why – except for my desk and office – I really do try to keep things picked up around the house.  After all, I wouldn’t want her to show up and chastise me for being a slacker…

But, while there are lighter moments and interludes of banter, there is also the pain of watching the person that guided you throughout your entire life – whether you wanted the guidance or not – wither away like a flower who receives no water on an unseasonably hot day in Arizona.  It’s difficult.  Then, there are the hard decisions that accompany Alzheimer’s about which medical interventions seem appropriate and which are not?  Where should the family draw the line?  And – while I’m a physician who has faced these situations many times when I was in active practice – it’s a whole other matter when the people you are advising are your brother and his family, let alone the weight you feel on yourself.  Are we making the right decisions?  What would Mom want?  These are the experiences of every family, everywhere about everything related to Mom, or Dad or whoever we happen to be providing care for at the closing of their life…  Since there seems to be insufficient “talk” about these familial decisions – perhaps including them in a blog is the next best thing one could do.

And just as important as the personal side is the societal side of these questions.  How we will care for the aging demographic in a period of flattening resources is increasingly the tenor of our times.  As a society, we are no longer the only economic engine in the world.  So, what does that have to do with Mom?  Well, Mom is the canary in the coal mine.  As the boomer generation comes fully of age, the experiences Mom is facing will increase from 5.4 million to 7.1 million afflicted individuals by 2025 or, a 40% increase.  So, one of the questions we should be asking ourselves is: What can we learn from caring for the current generation to pass along to the next generations?  And, learn we must!!  For – unless something changes – we boomers will be responsible for bankrupting the nation if not because of demand but because of sheer size.  It’s not just about Alzheimer’s.  Pick your favorite problem.  The percent of increase is comparable for all diseases.  The resources that will be consumed over the next couple of decades make that last century look like a cakewalk for society.  Yet, we are consumed about outbursts on Twitter, the who-knew-what-when questions, investigations of importance such as the potential Russian meddling in American elections; and, investigations of naught such as the one on election fraud by Americans.  So much ado about so little.  And, while all of these temporary flights of focus capture our energy, the back channel is filled with warning signs about real problems like the looming crisis in health care, the need to consider how best to support education for the next generation, the aging infrastructure of our cities, and…I could go on but will not bore you with the litany of problems.  Which is why I decided to start by sharing my personal thoughts.  We are Considering Everything – Except What We Should…  Let’s get back on track and demand the right focus on the right problems.

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