Since my stepfather's death in Florida a few weeks ago, I've realized that it's much easier to die in America than it is to live.
While millions of Americans do without any health insurance at all, and seniors cut their necessary daily medication in half to stretch the bill, and some wait until a simple problem has grown serious enough to require emergency room attention because doctors' fees are too high, dying
- like running a prison - has become a American growth industry.
Specifically, we have developed a booming for-profit hospice industry.
This may come as a shock to those of us who think of hospice as a group of tender-hearted volunteers who sit with the dying and aid the family at a time of frightening and powerful transition. In Vermont, for example, all volunteer (non-medical) and medical hospices (involving doctors, hospitals and nurses) are non-profit.
If you use a volunteer service here, you can have counseling, respite care, and perhaps someone to sit with you during an all-night vigil.
But Florida actually has competing for-profit hospice companies, if you can imagine such a thing. The concept of making money on dying people may sound slightly ghoulish, but I need to say that every person connected with the hospice service we used - Vitas Healthcare Corp. - was warm, caring, thoughtful, respectful, supportive and professional.
Once Harold, 88, was diagnosed with terminal progressive Parkinson's disease, wheels began to spin. Suddenly, a hospital bed, an air mattress, a wheelchair, a commode, catheters, latex gloves, a table, an oxygen tank, a doctor, a nurse and a social worker materialized. The chaplain dropped by. Necessary medication was whizzed in - by FedEx! - from the local pharmacy. We didn't need it, but we could have had homemakers doing light chores like laundry and cooking. A certified home health aide gave Harold baths, massages and skin care. A private 24-hour-a-day emergency number was provided.
Harold looked around and asked, "Who's paying for all these people?"
The answer: we all are. Medicare for pays 80 percent of hospice care, private insurance 12 percent, and Medicaid 5 percent. "Since Vitas accepts Medicare and Medicaid as 100 percent of coverage for its services, there are no out-of-pocket expenses to patients and/or their loved ones," Vitas says in its handbook.
Harold lay at home, dying, for about two weeks. By rough estimate, the care he received - and at the end, he had round-the-clock nurses - could have tipped the scales at $30,000. But thanks to Medicare, there was no bill.
Vitas, it turned out, is the nation's largest provider of hospice care. Founded in 1978 by a minister and a nurse, its headquarters are in Miami but it operates in eight states: California, Florida, Illinois, New Jersey, Ohio, Pennsylvania, Texas and Wisconsin. It employees 5,700 professionals who care for more than 7,900 patients daily, primarily in the patients' homes but also in the company's 17 hospice inpatient units, as well as in hospitals, nursing homes and assisted living facilities.
And here's something you're not expecting: since December 2003, Vitas has been owned by Roto-Rooter, Inc., which paid over $406 million for the company. Call in Vitas "and away goes trouble down the drain."
While Harold was dying, my mother, who is only slightly younger, was also having medical problems. And she couldn't get a doctor to save her life.
One weekend she called her primary care doctor about her problem. He did not have an answering service. He did not have someone covering his patients for him. The best this supposedly caring physician could do was a phone message: "If this is an emergency, call 911."
On Monday she called her gynecologist. The message on his machine was longer and offered nine options, including: "If you are a doctor or a hospital, or have a true medical emergency, or are in labor, please press 1."
When we finally broke through the machine barrier and explained to a secretary that a) mother had a serious medical problem,
b) her husband was dying in the dining room, and c) she was facing a trip north to bury him, the earliest appointment we could get her was a week away.
While her doctors couldn't care less that Mom was suffering, Harold was surrounded with a United Nations of care, with nurses from Jamaica, Haiti, Latin America and Romania.
Hospice is not only a great service, but a cost-effective one. According to some research, $1.56 is saved for every $1.00 spent in hospice care, due to the decreased use of hospitals, expensive diagnostic tests and life-prolonging treatments.
At the moment, about 78 percent of American hospices are nonprofit and 17 percent are for-profit. Several studies have been done comparing services, and the results are usually that the nonprofits provide better care. For example, a Yale School of Medicine study done this year concluded that, "The pattern of care differs... As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive."
Physicians for a National Health Program oppose all "for-profit, investor-owned corporate entities in health care." They say that, "Diverting huge sums away from health care and to private investors does not provide health care value... Let's establish our own public health insurance program and thereby take control of our health care system. Let's send Roto-Rooter back to the sewers where they can continue to do what they do well."
They have a point. The minister who founded Vitas took away over $200 million when he cashed in, while the nurses around Harold's bed were not paid very much at all.
Although I favor a universal health care system as being a lot more cost effective (FedEx from the local pharmacy?), I can't deny that Harold received excellent care which was a relief and a blessing to his distraught family.
Still, aren't companies like Vitas the essence of socialized medicine? Isn't the community - as a whole - paying for them through our Medicare and Medicaid taxes?
One thing, however, is certain. If I was in labor, I wouldn't want to wait for the end of a message on a machine. If we could just provide caring service for our living as well as our dying, we'd all be a lot better off.
Joyce Marcel (email@example.com) is a free-lance journalist who lives in Vermont and writes about culture, politics, economics and travel.