Wednesday, April 1, 2009

At what price?

Over a decade ago when my mother was hospitalized to have her lung cancer diagnosed I was somewhat chagrined to see the name of a 74 year old heart transplant patient listed in a room down the hall. The health information privacy act was not in effect yet and I happen to glance at this man's age, post operative diagnosis and profession as I walked past the nursing desk one day. My mother was six years younger, probably much more frail and had retired thirty eight years before when I was born. As America enters the debate over health care yet again, I think back to the questions that I had when I noticed that bit of information about a random patient in 1991.

You see, until the moment that I saw the patient's age, I believed that organ transplantation was offered only to those 60 years old and under. Well maybe, I thought, he was able to buy out of the system. That was only a fleeting idea as I noticed he was a retired minister. We were in a denominational, not of profit hospital so he probably had some influence. Again, no problem. Except that health care is a pie, even if it is one that America has tried to expand, someone paid all the expenses that went with the cost of the heart transplant surgery, recovery and on-going care.

My mother's condition was terminal. I have shared before that I had that realization the moment I saw her fingers some weeks before. Her palliative treatment also had a price tag. The radiation alone she received cost thirty five thousand dollars. All this was paid by a health policy that my father's former employer paid for as a part of my father's retirement benefits package.

Looking back I feel that the care my mother received was worth the cost. I believe it would have been worth the price if I had paid it out of my pocket, which I am not sure my parents would have allowed if this was the way our scenario played out. We had five months to prepare for her death. My mother had some good days and actually stopped her treatments when she determined they were more painful than she felt they were worth. Hospice, which Medicare covered, was extremely helpful in the last few weeks of her life and afterwards as my father began to deal with life without my mother.

Yet, I have always wondered about a heart transplant in a 74 year old. Perhaps if it were less of a mystery. Did the recipient believe it was worth it in terms of the suffering? What was his quality of life? How long did he live? What were his families thoughts. If I knew the answers to these questions I could better measure them against the 40% of children who did not receive immunizations in our county that year or the women who had to wait all day for each visit in their obstetrical care so they went to work instead unable to lose a day's paid to receive their "free" care.

I hate to be the bearer of such tidings. I venture to guess that all of us glancing at this blog can do the math. The toughest part of the health care debate will be the rationing of health care. Patients, physicians, hospitals, third party payers all need to get use to that fact and move on to making choices.
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