Dr. J, Royal Surgeon, took ‘Puter up on his offer to respond to ‘Puter’s post regarding grandma killing.

Without further ado, here’s Dr. J:

Erudite Puter, the Philosopher-King of the Gormogons:

I have read with fascination your missive, along with that of the Volgi and GorT with regard to end of life planning, care and the obligations of the family and government.

Dr. J. has stated on multiple occasions that government financing of healthcare through medicare, and medicaid, it’s subsidization of health-care through the wage control acts in the 40s, HMO acts in the 70s, corporate welfare and propagandizing to constituents that ‘health-care is a right’ have resulted in a population with a perception that for the amount taken out of their paycheck (ignorant of the amount out of the employer’s pocket) plus a $15 co-pay should buy them the world. This is completely unrealistic. By short-circuiting the consumer/producer relationship the demand for services increases and as a consequence cost spirals out of control.

It also produces false expectations. For example, if a person has a heart attack and has angioplasty and stenting, their likelihood of surviving the heart attack is certainly greater than if they just rode it out. In that situation, the coronary needs to be fixed. If they’re doing it for stable coronary disease, it will make the exertional chest pain go away faster than can be done with pills, but opening that artery does not make you live longer.

Furthermore, the bulk of medicare spending occurs in the last 1-2 years of life. As physicians we don’t necessarily know when someone comes in to the hospital with an acute illness if things are going to get worse or get better until they either get worse, or get better. Figuring that out sucks up a big chunk of change. Indeed, just today, Dr. J. is taking care of someone who came into the hospital, took a turn for the worse, was stabilized, and it’s not clear yet whether he’s going to get better or get worse. Obviously, our plan is to keep chugging along so long as he isn’t going in the wrong direction. If he gets worse, we will revisit our previous conversations with his family.

Again because medicare is the big payer in these sorts of situations families will usually want ‘everything done,’ but more and more there is an element of, ‘daddy always said he didn’t want to be hooked up to machines to live’ as well. This makes our lives easier, because the good doctors will frame these situations in terms of reversible and irreversible conditions.

The reality is that the patient, their next of kin and the doctor providing care should be driving the conversation regarding end-of-life issues. Everytime a patient comes in to Dr. J.’s clinic after their first hospitalization for congestive heart failure, we begin the discussion that this is a chronic illness that will likely be the one to take them from this earth SEVERAL YEARS FROM NOW (unless they’re a transplant candidate). I tell them this so they have no illusions about their new chronic illness, and that they will know that there will come a time in the hopefully distant future (5-10 years) where I will have to tell them we’ve done all that we can to manage things and it’s time to think about comfort care. It makes that second conversation go much smoother.

The patient and their family is best served having the FREEDOM to decide how much or how little care they want when the time comes that things are looking grim. The best way to do that is for them not be burdened with worrying about the dollars and cents of the situation. The government doesn’t need to be part of that solution, it just has been since 1965 resulting in a lot of expense because of doing things that daddy may never have wanted.

Dr. J. has rambled enough, so he needs to get back on track with policy.

Dr. J’s solution involves the government getting out of our healthcare decisions and trust us with our own money. They control the purse strings so they have a seat at the table so to speak.

What the government should do:

1. Allow pretax Health Savings Accounts to be rolled over, and even potentially invested in some form of interest bearing account.

2. Decrease the regulations on health insurance as to what has to be included in a given policy.

3. Tort Reform.

4. Medicare Reform – It’s a Ponzi scheme waiting to collapse anyway. Take care of everyone over 55, cause it’s too late for a course correction for them, and make sure those under 55 can buy a product that is affordable until death.

5. Cut our fricking taxes. The amount we had over for BS programs is better spent on charities and saving for our future.

What the public should do:

1. SAVE and PLAN – We are all going to die. When you are 22 and fresh out of college working your first job, you should be saving for the future with a plan to have what you need rather than buying the fanciest car you can afford AND a 55″ LED TV with 500 channels and the latest greatest iPhone. Financial planners are great, and many of them don’t charge you, except through fees related to your investments with them. A small price to pay for a lot of sound advice. Dr. J. is slowly converting his term-life to whole life, in part to parlay that into long term care when the time is right. If he goes quick, it’s a windfall for the little med student and little resident. Whole life is not for everyone, talk to your financial planner and see what’s right for you.

2. Don’t wait until you’re married to follow step 1. You will be several years behind.

3. If you are older, talk to your adult children about your plans and wishes. Dr. J.’s mom gave him the scoop on everything before she had a minor orthopedic operation. She’s a planner. She is the ant of ant and grasshopper fame.

4. Adult Children, figure out what the best plan for you and your parents are. We’re making arrangements so that Mama J. or the J-In-Laws can be accommodated in our home should we need to do so. Dr. J’s grandmother spent her last two years of her fight with cancer living with Dr. J. and his parents when he was a yout’. So, it’s totally doable for most, but not all. But families have to be frank about these things. It has been easier to discuss these issues with Mama J. (a silent generation individual) than the J-In-Laws who are boomers, andd thus immortal.

So, in summary, end of life issues are sticky. They should be handled by families talking to each other and planning ahead. The doctors can give advice and council, we know the outcomes of chronic illnesses, but we can’t predict the future until the very end. The government can best serve us by giving us the freedom (and letting us keep more of our $$$) so as to let us address these issues ourselves. But we need to be responsible and do so.

Best,

Dr. J

That’s some good advice. ‘Puter’s got a fever, and the only prescription is MORE DR. J!

'Puter

Always right, unless he isn’t, the infallible Ghettoputer F. X. Gormogons claims to be an in-law of the Volgi, although no one really believes this.

’Puter carefully follows economic and financial trends, legal affairs, and serves as the Gormogons’ financial and legal advisor. He successfully defended us against a lawsuit from a liquor distributor worth hundreds of thousands of dollars in unpaid deliveries of bootleg shandies.

The Geep has an IQ so high it is untestable and attempts to measure it have resulted in dangerously unstable results as well as injuries to researchers. Coincidentally, he publishes intelligence tests as a side gig.

His sarcasm is so highly developed it borders on the psychic, and he is often able to insult a person even before meeting them. ’Puter enjoys hunting small game with 000 slugs and punt guns, correcting homilies in real time at Mass, and undermining unions. ’Puter likes to wear a hockey mask and carry an axe into public campgrounds, where he bursts into people’s tents and screams. As you might expect, he has been shot several times but remains completely undeterred.

He assures us that his obsessive fawning over news stories involving women teachers sleeping with young students is not Freudian in any way, although he admits something similar once happened to him. Uniquely, ’Puter is unable to speak, read, or write Russian, but he is able to sing it fluently.

Geep joined the order in the mid-1980s. He arrived at the Castle door with dozens of steamer trunks and an inarticulate hissing creature of astonishingly low intelligence he calls “Sleestak.” Ghettoputer appears to make his wishes known to Sleestak, although no one is sure whether this is the result of complex sign language, expert body posture reading, or simply beating Sleestak with a rubber mallet.

‘Puter suggests the Czar suck it.