Robert Sachs

Many of you my be scratching or shaking your head about the furor created by Sarah Palin and a host of other right-wing Republican leaders, media pundits, and their minions over what they call Obama's death panels - where, they claim, the fate of our seniors will be presided over by government officials. Of course, most of us know that this is just a distortion on the issue of Living Wills. Worked on by both compassionate Republican and Democrat lawmakers, the language might not be perfect, but the goal is simple to give people the choice to chose the scope and aggressiveness of treatment at the end of life.

But, there actually IS an issue here - an issue that goes beyond moral outrage. It has to do with a schism in the medical community itself. This schism is, at one level, about the concepts and philosophy on what constitutes health care in elder years and in times of terminal illness. But, in the end, this debate comes down to the thorniest of issues - DOLLARS.

Backing up for a moment...Most of you are familiar with Hospice. But, most of you probably don't know the hell people like Elizabeth Kubler-Ross went through to present and bring into existence a compassionate, palliative approach to an end of life.

Allopathic medicine holds as one of its tenets that disease and whatever brings us closer to death must be challenged at the least, but most often fought. Although we philosophically know that we shall all die, somehow there is a disconnect in allopathy that compels some clinicians to fight terminal illness all the way to the end - no matter what the cost to the quality of life of the patient. I am reminded on a saying that was told to me years back..."The operation was a success, even though the patient died."

It is commonly known that most of our health care costs go to tending to the elderly and that the lion's share of the cost that is incurred in attending to their health needs escalates dramatically in the last year of life. Translated - there are big bucks to be made in using aggressive therapies and heroic measures.

Some docs, like Kubler-Ross, saw that such an approach was costly - especially to the physical and mental wellbeing of patients. Patient's families could be easily talked into doing whatever it was to save granny, mom, dad, or little Jimmy. But, was this really in the interest of the patient if the intervention caused more pain or was - percentage wise - not very likely to save life anyway?

And so, there emerged Living Wills and the Hospice alternative - palliative care to easy pain and suffering and create a gentler, peaceful way to exit this life.

The problem is - palliative care is cheap. It is low tech, low on medication, low on intervention. Doctors and hospitals don't make much on palliative care. And so, as this option gathered momentum, hospitals, insurance companies, and HMOs decided that it was OK for those who elected palliative care to go home and for social workers, nurses, and volunteers to be with them in their final days. Translated again, Hospice was cheap. It is not because hospitals, HMOs, and insurance companies became enlightened. They just couldn't make money if people made this choice. In other words, Hospice is UNINTENTIONAL compassion. The fact is that if push came to shove, most insurance companies, HMOs, and hospitals would like you use lots of drugs, use big costly machines, and run up a big, fat bill.

So, per usual, money is at the heart of the debate, fueled by the allopathic "disease-care" model.

And then we come to the issue of a "public option." Here we have people all over the map; thinking that their right to chose their own health care will be eliminated, the cost of the option itself, etc...

It is truly sad if the best Congress can up with is a public option. But, it may be the necessary inter-mediary step to go in the direction our entire healthcare system needs to go - towards prevention. Until this is REALLY on the table - where there are homeopaths, chiropractors, acupuncturists and the like an their services factored into the equation - allopathic health care will remain expensive and inevitably drain whatever options people can chose from.