They say there are two certainties in life: death and taxes. But we sure do work hard to avoid both.
When it comes to taxes I'm with Mitt Romney. I want to pay what I owe and not a penny more. It's just that, unlike Mitt, I think I should owe more. But that's a topic for another time.
Let's talk about death. I just finished an excellent book on that topic by Dr. Atul Gawande, Being Mortal: Medicine and What Matters in the End. Gawande writes that doctors are not trained -- and our entire medical system is not prepared -- to deal honestly with end-of-life issues. Doctors are trained to fix things, not to help us manage the compounding losses on our way to an inevitable end.
And trying to fix what cannot be mended is expensive. Gawande reports that in the United States 25% of all Medicare spending is for the 5% of patients who are in their last year of life, and most of that spending happens in the final two months, when very little is being accomplished.
But there is evidence that if we just thought about it, we would make better choices. Gawande writes about La Crosse, Wis., where, in their final six months, elderly patients spend half as many days in the hospital as the national average. End-of-life costs are consequently also half the national average, and yet life expectancy is longer than the average.
The reason seems to be that patients and their providers simply think things through. Starting in the early 1990s, medical providers in La Crosse initiated a campaign to systematically get their patients to think about end-of-life issues. It became routine for patients admitted to a hospital, nursing home or assisted living facility to have a conversation with a health care professional built around four simple questions regarding how they wanted to be treated near the end of their lives.
By 1996, 85% of La Crosse residents who died that year had a written advanced directive, up from only 15% when the project started.
And chances are that their final days were of better quality with more time to meaningfully engage with their family and friends and appreciate their surroundings. As Gawande writes: "Technological society has forgotten what scholars call the 'dying role' and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with (their) God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms."
What we need to get to work on is a system that allows us to do just that. Like most people my age -- I'm 55 -- I'm starting to witness the health care system as it struggles to deal with aging and I can report that it doesn't do well at all. Gawande's book resonated with my own experiences, and it offered hope for something better.
It can be a tough read sometimes, and it's not for everybody, but for most of us aging baby boomers I highly recommend Being Mortal, because we all are.