Dorothy Del Favero’s 100th Birthday

[from billlifka, posted with his permission]
Dorothy Del Favero has achieved every woman’s dream. She’s reached an age where all listen to her talk, but she can’t hear them.

A balanced diet and strenuous exercise routine are the secrets to her longevity.

She eats sweet rolls, cookies, chocolate candy, mountain dew, deep fried onions and baked potatoes with a stick of butter and three ounces of salt. Each of these foods provides an antidote to some particular pill prescribed by her doctor.

As for exercise, can you bend from your waist to use a hand broom and dust pan on the floor?

Dorothy does a lot of walking; from her nap on the sofa to her nap on the recliner to her nap in bed. She carries her four-point cane at shoulder level so as not to impede her passage. She still clears the dinner dishes. The juggling of dishes from table to sink is an entertainment highlight. She still empties the dishwasher. We hope to find most of the dishes some day.

To be honest, Alice [her daughter, billlifka's wife] is the drill sergeant in charge of food and exercise and deserves the credit for Dorothy’s survival. Of course, Dorothy wasn’t always a senior senior.

She was born in the Friesland province of Holland, birthplace of old English. Her maiden name was Bijvoets which means, “by foot”. This suggests her ancestors walked into the Low Countries at the time family names were assumed. Her Bijvoets side is traced back 500 years to a tinsmith in Antwerp. In her early grammar school years, Dorothy’s family nearly starved during World War I. Her father was an archetypical entrepreneurial immigrant to America. After the war, it took him three tries before he finally established himself making sinks for Pullman railroad cars on Chicago’s south side. Then he brought his entire family to live with him in the new world. Dorothy was 17 at the time, the 6th of 12 children.

He started a business tinning implements for the Chicago stock yards. In time, this broadened its scope in plating processes. When Dorothy’s father died, the business was willed to his 4 sons and continues in the Bijvoets family. The 8 daughters were bequeathed the family home and, before that, encouragement to find good husbands. About a year after her arrival, Dorothy met a hunky young man at a Lake Michigan beach. Mario Del Favero had emigrated from Northern Italy in his teens to join an older brother successfully employed as a carpenter in Chicago. Photographs at the time suggest he was the kind of guy who attracts bathing beauties. As luck would have it, Dorothy qualified as a bathing beauty. I’m guessing they didn’t really share a language when they met. That may have contributed to their 58 year marriage. Mario died in 1987.

Mario and Dorothy produced Alice, Tom, John and Richard. Present count is 9 grandchildren, 16 great grandchildren and 1 & 8/9 great-great grandchildren. None are in jail and all are gainfully employed or doing well in school. Until recently, Dorothy could speak knowledgeably about each of them without being prompted. She still can with a little help in getting started.

I think she’s had a satisfying life far beyond her expectations when she left her mother country as a girl, full of apprehension. Hers has been a classic American immigrant story similar to most of our family stories. In celebrating Dorothy’s life, in a way we celebrate the America that was and the America that shall come again. Happy 100 years, Dorothy!

Motivation and PASSION

The photo shows my water aerobics friends (I only wish!)

Joel is having trouble keeping motivated and wonders "is it worth the effort?" (See 1 and 2.)

He writes "I know that Ira's bicycling group ends their ride with a stop at Panera's for coffee, danish and conversation. Is this what gets them on their bikes from a cozy bed on a chilly morning?"

I thought about it while bicycling to water aerobics this past Saturday morning, again at Paneras with my bike club friends, and yet again at Chumach (Bible) Study at the synagogue that morning. Yes, the coffee and snacks are a definite draw, but it is mostly the people, my set schedule, and naps that keep me motivated.

As I turned the pedals, and watched the world go by, "People/Set Schedule/Naps" became "PSSN". That acronym, with the addition of vowels, morphed into "PASSION".

MOTIVATION IS EASY WITH A YOUNG FAMILY

When young, motivation is easier. A close-knit, loving family had high expectations for me. My mom worked at my grandma's knitting shop. I was surrounded by women who doted on me. In those innocent days, it was considered safe even for young children to play outside. I had a nice nap every early afternoon. My dad, a letter-carrier, was up and out on schedule early every morning, but he also came home early and we spent quality time talking, working carpentry projects, and playing.

I walked to school on a set schedule with friends. In those days we had all-day kindergarden that included a noontime nap. The naps ended with first grade, but the set schedule, and a sense of duty to family and teachers went on through high school. I worked part-time at a shoe store and selling ice cream on the beach and in an office during those years and that motivated me to go to college so I could qualfy for non-menial employment.

Work as an engineer was challenging and often involved long hours of (unpaid) overtime and travel, but I was motivated by obligations to wife and children. Again it was the people in my family and at work and in the clubs and synagogue that kept me motivated. My wife and I had a full schedule of work, attendance at our daughter's school events, square dancing, and so on. I had bike and ski and kayak club friends. My employer paid for me to get my Masters and then my PhD and that kept me busy and intellectually alert.

Then, the children went away to college and had families of their own, ... and we retired!

HOW TO KEEP MOTIVATED IN RETIREMENT?

There is a danger of "vegging out" in retirement if you are financially secure. Pension and Social Security checks come regularly, investments grow, and so do your waistlines! There is a temptation to sit and watch mindless TV programs, eat rich food and "enjoy life - you earned it!"

Fortunately, my life before retirement gave me the foundation for the PASSION (People, Activities, Set Schedule, Interests, Optimism, and, eventually Naps) that keep me motivated.

People - Particularly loved ones - your wife and family, but also friends, neighbors, co-workers and other acquaintances.

People are far and away the best motivators. Spouse and family provide a firm foundation. If you show up they have to let you in! Beyond that, what gets me up and out almost every morning are the people who are waiting for me.

As I bicycle down the street, people call out my name and I say theirs. Others nod to me - we don't know names but we shout "good morning!" as I bike and they walk their dogs or jog along. At the sports pool they (mostly women :^) are happy to see me. We exchange pleasantries, ask about travels, and kid around about who can hold his or her legs up higher and longer and so on. No better way to start a day than exercising in a heated pool. (My wife, Vi, goes to some of the same water aerobics classes, but she travels by golf cart, most often with a neighbor.)

If I'm meeting friends for a bike ride we are happy to see each other. Bicycling is probably the best form of transportation ever invented. You go fast enough to get someplace miles away, yet slow enough to talk, enjoy the sights and sounds, and "smell the roses". And, bicycles run on peanut butter sandwiches - "green" energy!

We eat out with other couples, go to parties and entertainment events, and enjoy life. It is my wife and all those other people who make it worthwhile!

Activities - Athletic and otherwise

The key to living a nice long life is to keep moving! It may be "sour grapes" but I don't think strenuous running or competitive sports are good for the body, particularly not an aging body. That is why I do "soft' exercises such as bicycling, water aerobics, kayaking, walking, and so on.

I try to put in at least an hour a day, but, I keep the civil service worker attitude in mind: "I'm paid by the hour, not by the mile!"

Set Schedule - Something to get you up early and out of the house almost every day.

When we retired we thought we were leaving set schedules behind. However, it turned out that our calendar is far more complicated than ever. Without scheduled events it would be so easy to stay in our cozy bed all morning, reading or watching TV, perhaps taking turns preparing breakfast in bed. To help prevent that, our alarm is set for 6:30AM every morning and we have no TV in our bedroom.

My morning schedule is set in stone: get the newspaper, feed the fish in the koi pond, read the paper over a light breakfast, and get outside! Monday, Wednesday, and Friday it is bicycling to regular water aerobics. Tuesdays I lead an easy neighborhood bike ride and end up at a different sports pool for deep-water aerobics. Thursdays I bike with a neighbor to a men's breakfast at Perkins and then to deep-water aerobics. Saturdays it is early deep-water aerobics and then a bike ride to Paneras. After bicycling home, it is into the hot-tub with a cup of ice cream and a magazine. Then, it is time for a nice nap!

The rest of the day is free, except for lunch or dinner with friends, shopping trips, volunteering at the synagogue office Thursday afternons, Friday evening services, and other odds and ends. My wife and I each teach an online grad course for the University of Maryland, so that takes a few hours every other day or so. I also have email to keep up with, my Blogs (The Virtual Philosophy Club, Curb Your Enthusiasm - Fantasy Episodes, 2052-The Hawking Plan, and 2052 Life, Liberty, and Technology), my Google Knols, websites I follow including The Drudge Report, Watts up With That, Reality Prime and several others. There are TV programs I watch regularly, some automatically recorded on our DVR. That keeps me busy and involved!

Interests - Intellectual and otherwise.

My interests are wide and varied. We get lots of magazines, mostly from trading in unusable airline miles. My wife buys me books, in a so far unsuccessful attempt to change my social and political views. (My father taught me to be frugal. therefore, any book or magazine we have paid for, including those from airline miles, and idiotic political screeds, has to be read.)

Optimism - Open outlook welcoming variety.

Take to heart Max Ehrmann's beautiful words of Desiderata "Go placidly amid the noise and the haste, ... be on good terms with all persons. ... the world is full of trickery. But let this not blind you to what virtue there is ... everywhere life is full of heroism. ... Take kindly the counsel of the years, gracefully surrendering the things of youth. ... You are a child of the universe no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be. And whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery, and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy."

Naps - Noontime slumbers to refresh body and soul.

This has been a protracted posting. Time for a nice long nap!

Ira Glickstein

Is it worth the effort Part 2

A joke that we've seen many times in film and TV, is a situation in which a overly serious actor says to the director "What's my motivation?" The situation generally involves no motivation or obvious motivation such as slipping on a banana peel or falling out of an airplane.

Motivation can come from within or without and is therefore one of the great practical philosophical questions. It is the practical embodiment of "What is the meaning of life?" In solving my own problem of lack of motivation, I'm wondering whether it's possible to use ideas from those who motivate others to motivate one's self. For example, there are those who sell their motivational ability to corporations to motivate the sales staff. There are also books like "Who moved my cheese?" There are religious leaders who motivate people to act more morally. These miss my target in that they are centered on gain in some form or another (reward, reputation, competition or heaven). An example of transferring these notions to the self might be when I promise myself a piece of pie after I complete a chore. The trouble with this is that I'll weigh 300 pounds and become a diabetic, if I use this motivational technique too much. (I know that Ira's bicycling group ends their ride with a stop at Panera's for coffee, danish and conversation. Is this what gets them on their bikes from a cozy bed on a chilly morning?)

Community organizing is another well documented form of motivation. I went to a summary of Saul Alinsky's theories about motivating the masses. It's fascinating reading.

http://www.frontpagemag.com/readArticle.aspx?ARTID=30778

"But it is not enough for the organizer to be in solidarity with the people. He must also, said Alinsky, cultivate unity against a clearly identifiable enemy; he must specifically name this foe, and “singl[e] out”[44] precisely who is to blame for the “particular evil” that is the source of the people’s angst.[45] In other words, there must be a face associated with the people’s discontent. That face, Alinsky taught, “must be a personification, not something general and abstract like a corporation or City Hall.”[46] Rather, it should be an individual such as a CEO, a mayor, or a president."

Can I motivate myself to get out my oil paints and finish the painting that's been sitting half finished for a year, using Alinsky's methods? Can I fool myself into believing that the ghost of Picasso is preventing me from succeeding? Should I hang his picture on the wall of the garage with a knife in his heart? Maybe. Maybe I can get back to my ukulele by targeting the great Ota-san as my enemy. In some psychological sense he is. In Hawaii, I was shopping for an ukulele when Ota-san walked into the shop and started strumming. His masterful playing of this humble instrument was daunting. It was obvious that no matter how much I might practice, I would never reach his level. Alinsky has a lesson concerning that situation. You must motivate the group toward projects in which the probability of success is nearly certain in order to build confidence. (Using Ira again, he is virtually certain of finishing his morning ride and there is no competition involved.)

I'd appreciate any ideas you may have concerning how to move from theory (or daydreaming) to action. Here in my trailer out in the woods of Michigan I have my paints, my violin, my ukulele, my Spanish lessons, my Italian lessons and my book about Einstein. However, all I managed to accomplish yesterday was lay some traps for the trespassing mouse who's stealing my food. Perhaps I was able to do that, because I could visualize him as my enemy! -Joel

WIRED: The Villages Golf Carts Featured

The latest issue of WIRED Magazine features Tricked-Out Golf Carts Swarm Florida Communities, with special emphasis on The Villages, FL, where we live.

They make the point that golf carts might just be the future of energy-efficient and safe transpotation, at least for the growing numbers of senior citizens.

The photo to the left was taken by my wife, Vi, at a golf-cart parade here in The Villages. Yes, there is a golf cart somewhere under that Christmas tree!

There are several interesting photos in the linked story in WIRED.

The story makes it appear that most golf carts here are "tricked-out" and sell for $10,000 or more. The photos in the magazine show carts that look like classic cars or are illegally geared to go above the legal limit of 20 MPH. The truth is that most of us drive pretty-much "plain vanilla" golf carts. Ours for example, is a 2001 that served a year or two at a golf course and was rebuilt for us in 2003, with an added rear seat, and cost us about $4,500.

Here is a selection from the WIRED story:

It's 9 am in the Villages—practically midday for the chipper residents who often rise at four—as I drive my LC3 down to the Colony Cottage. I'm due for a quick primer in pickleball—sort of a Ping-Pong/tennis hybrid. I arrive to find dozens of fit retirees dashing around the courts, the ubiquitous row of shiny EVs [Electric Vehicles] parked outside.

There will be more carts fighting for space here soon. While the rest of the country wallows in the recession, homes are still being built and sold in the Villages at a rapid clip. The population of the community is expected to hit 100,000 by 2014.

The Villages embodies what environmentalists have been waiting decades for—a glossy future powered by electric vehicles. The slightly messy reality, though, is that it's not powered by pristine futuremobiles but by gaudy, overclocked golf carts.

But the lesson of the Villages isn't just about the vehicles we're driving—it's about where we're driving them. The future of transportation should be focused on the quick jaunts that make up most of our day-to-day driving.

The Villages is for people who've lived long enough to know that what they want now is a warm breeze in a quiet, open ride—going fast enough to hit both the golf course and the Walmart in the same afternoon but slow enough to take in the scenery along the way.

As my octogenarian opponent deftly whacks the pickleball past my reach, I look up to catch a glimpse of the future on the horizon. It's a gray-haired guy with a backward cap, cruising in his cart past a brand-new community center. A golden retriever stands on the passenger seat, tail wagging, and an American flag is displayed proudly right where the gas tank should be.

Ira Glickstein

Health Care

[from John] We’ve talked about various aspects of a Universal Health Care System; however, we’ve never addressed the mechanics of writing such a bill. We know that HB 3200 is more than 1000 pages long. Who wrote that bill? Staff members? Doubtful. What are the qualifications of those who wrote the bill? Were any lobbyists involved? Writing such a bill must be expensive, see the sample bill below. Where does the money come from?

I’m curious!

A Universal Health Care System

Section 1. Introduction
Section 2. Funding
Section 3. Transition (from Medicare Medicaid to the new system)
Section 4. Tort Reform
Section 2a. Registered medical practitioners.
Section 2b. Hospitals and clinics
Section 5. Standardized Electronic Accounting System
Section 6. Corporate/University/Government R&D programs
Section 6a. Medicines
Section 6b. Equipment
Section 6c. Procedures
Section 7. Re-apportion duties between Doctors, Nurse Practitioners and Nurses.
(allow NPs and RNs to perform routine medical duties now required of doctors.)
Section 8. Establish clinical system to relieve emergency rooms work load.
Section 9. Catastrophic Insurance
Section 10. Health Maintenance Accounts
Section 10a. Fund maintenance and accountability
Section 10b. Personal accounts
Section 10c. Functions and procedures
Section 11. Procedures not covered by Sections 9 and 10
Section 11a. Private health Insurance
Section 11b. Indigenous personnel

Filtering

[from Joel] I'm fascinated by the recent events concerning ACORN. A courageous young couple used the hidden camera style originally developed by shows like 60 Minutes to catch ACORN employees in illegal and immoral behavior. Demands for investigation of ACORN have fallen on deaf ears for years. The appearance of damning videos everywhere on the web (as well as on Fox News) finally forced action by the Congress despite the neglect by the mainstream media. The web seems to be fast becoming the mainstream, while the old news media have placed themselves in the fringe by overly filtering the news.

I attended a teaparty near Detroit a few days before the main demonstratio on September 12. The local media underestimated the turnout by a factor of ten. The coverage by the media was negligible considering over a million people showed up. As you can see from the photo, the protestors were mature and the signs weree grassroot sloppy. -Joel

END-OF-LIFE: Honest Brokers (not Death Panels :^)

President Obama, in a moment of unusual candor, expresses his views on end-of-life health care for those with chronic or terminal illness, published in the New York Times Magazine in April 2009 (full text from NY Times website, see section V).

DIRECT OBAMA QUOTES
“… government can … be an honest broker in assessing and evaluating treatment options. … when it comes to Medicare and Medicade, where the taxpayers are footing the bill …

“… using comparative-effectiveness studies as a way of reining in costs, …

“… the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here. …

“…there is going to have to be a conversation that is guided by doctors, scientists, ethicists. … you have to have some independent group that can give you guidance.”



WHO WILL THE GOVERNMENT "HONEST BROKERS" BE?
The government funded "honest brokers" envisioned by Obama will be doctors, scientists, ethicists, and bureaucrats who will use actuarial data to compare alternative treatment options, and, based on cost-effectiveness, provide national guidance as to which should be used when public money is funding the treatment, such as Medicare.

As a case-in-point, the President brought up the hip replacement received by his terminally-ill grandmother mere weeks before she passed away. During his campaign, she was diagnosed with terminal cancer and then, probably due to a mild stroke, she fell and broke her hip. Her condition was analyzed by her doctors who told her she had three to nine months to live due to the cancer. They also told her that a weak heart posed risks for the invasive surgery hip replacement.

In the absence of cost-effectiveness data or guidelines to the contrary, she chose the hip replacement, which was approved by Medicare and done mostly at public expense. She passed away two weeks later, sadly just days before Obama won. It appears the stress of the operation may have shortened her life by several months.


I don't know if Obama's grandmother got approval for the hip replacement because she was related to a prominent person. That would be bad enough, but it would be even worse if we are giving hip replacements and other stressful and expensive treatments to all terminally ill grandmothers and grandfathers.
QUOTING THE PRESIDENT AGAIN
"... in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. ... So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here."

A STORY MY FATHER TOLD ME

Once upon a time, there was a boy in China and he saw his father carrying a large basket on his shoulders. "What do you have in the basket?" he asked.

"Well," said the father, "It is your grandfather."

"What are you doing with grandpa?" asked the boy.

"Well," he replied sadly, "Your grandfather is quite old and he is so sick that we cannot take care of him anymore, so I am going to dump him in the river."

The boy thought about it awhile, and then he said: "OK, Dad, ... But remember to bring back the basket!"

Of course the point of the story is that the boy will learn from his father's actions and will, when the time comes, uses that same basket to dispatch his father.

When my mom's cancer roared up after a year of chemo and radiation, she decided to accept only palliative care. Our family travelled to San Francisco where they lived and said goodby. Hospice provided morphene and a hospital bed for their apartment. We spoke by phone every evening for about a month until she passed away.

My dad made it clear that was what he wanted when the time came.

About five years later he had a stroke and fell and was taken to the hospital where an MRI confirmed a major bleeding in his brain that was terminal. He could not speak or hear or see and was being kept alive with IV hydration and nutrition and oxygen to help his breathing. My brother and I asked the doctors to remove all artificial life support, including the IV and oxygen, and he passed away a few days later.

I have asked my children to do the same for me when the time comes. "Remember to bring back the basket!"
CONCLUSIONS

Although I did not vote for him, and oppose much of his economic policy, I agree with President Obama's remarks on end-of-life treatment.

I wish he and his Democratic allies would be similarly honest in more recent remarks and I wish the Republicans who are characterizing the issue as "pulling the plug on granny" would be more thoughtful and helpful and honest as well.

I do not like to hear people call these "honest broker" government medical and ethical tribunals "death panels". However, the 'honest broker" guidelines, when imposed on Medicare and other public-funded medical decisions, will, in effect, cause many of the terminally and chronically ill to be given palliative treatments that will undoubtedly shorten their lives.

Whatever you call them, I believe we need ethical end-of-life guidelines to prevent doctors and hospitals from ordering expensive treatments that are not cost-effective (and that may be done more for reasons of fear of malpractice suits and/or simple greed to increase their incomes).

I am not if favor of further nationalization of US health care. However, with Medicare the primary payer for nearly all of us over 65, we need national guidelines to prevent the program from going bankrupt. (See this and this for more details on my views of what we really need in cost-effective health care reform.)

Ira Glickstein

PS: For the record, and in case the NY Times takes the page linked above out of their free access, here is the full text of the applicable section of the document from which I quoted Pressident Obama's words.

V. Post-Reform Health careYou have suggested that health care is now the No. 1 legislative priority. It seems to me this is only a small generalization — to say that the way the medical system works now is, people go to the doctor; the doctor tells them what treatments they need; they get those treatments, regardless of cost or, frankly, regardless of whether they’re effective. I wonder if you could talk to people about how going to the doctor will be different in the future; how they will experience medical care differently on the other side of health care reform.THE PRESIDENT: First of all, I do think consumers have gotten more active in their own treatments in a way that’s very useful. And I think that should continue to be encouraged, to the extent that we can provide consumers with more information about their own well-being — that, I think, can be helpful.
I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.
And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.
And right now we’re footing the bill for a lot of things that don’t make people healthier.
THE PRESIDENT: That don’t make people healthier. So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies (see note below) as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship. It is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.
Won’t that be hard, because of the trust that people put in their doctors, just as you said? Won’t people say, Wait a second, my doctor is telling me to take the red pill, and the government is saving money by saying take the blue —THE PRESIDENT: Let me put it this way: I actually think that most doctors want to do right by their patients. And if they’ve got good information, I think they will act on that good information.
Now, there are distortions in the system, everything from the drug salesmen and junkets to how reimbursements occur. Some of those things government has control over; some of those things are just more embedded in our medical culture. But the doctors I know — both ones who treat me as well as friends of mine — I think take their job very seriously and are thinking in terms of what’s best for the patient. They operate within particular incentive structures, like anybody else, and particular habits, like anybody else.
And so if it turns out that doctors in Florida are spending 25 percent more on treating their patients as doctors in Minnesota, and the doctors in Minnesota are getting outcomes that are just as good — then us going down to Florida and pointing out that this is how folks in Minnesota are doing it and they seem to be getting pretty good outcomes, and are there particular reasons why you’re doing what you’re doing? — I think that conversation will ultimately yield some significant savings and some significant benefits.
Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —
Yes, where it’s $20,000 for an extra week of life.THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.
So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.
And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.
I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.
And it’s going to be hard for people who don’t have the option of paying for it.
THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
So how do you — how do we deal with it?THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
Note: Comparative-effective studies — which are now done by academic researchers, but not systematically across the medical system — review data to determine which widely used treatments do not improve outcomes and which effective treatments are not used often enough.