During the many discussions of the healthcare crisis I rarely hear mentioned the real causes of the massive budget shortfalls: too many people need healthcare too often and for too long a time. Tens of millions of people, starting in early or middle adulthood, have to visit their doctors every 6 months to get one or several expensive prescriptions for conditions (like high blood pressure and cholesterol) which could be more easily, cheaply and safely controlled/prevented by healthy diets and lifestyles.

This story does not have a happy ending. Eventually those pills are no longer effective and pill takers need hospitalization and expensive rescue care, such as kidney dialysis, heart surgery, organ transplants, chemotherapy and lung ventilators. All these medical miracles are doled out by multiple medical specialists. Seniors love to go to specialists and get all their latest tests and procedures.

Many eventually end up in acute care hospitals where bills run into the tens of $1000s daily. ASAP they’re sent to convalescent hospitals where they may stay permanently if their care is too complex for the family to handle. My last 12 years as a doctor was spent caring for these folks. Those 12 years were the most stressful and demanding of all my 50 years as a doctor.

You can walk into any one of 1000s of nursing homes all over America and find this scenario: There’s Momma, in full arm and leg restraints so she won’t climb over the guard rails and fall, and so she won’t pull out that feeding tube taped in her nose. It has been weeks since she has voluntarily eaten anything. She has a bed sore on her lower back the size of a small frying pan and her left foot has been partially amputated. The smells in that room would make a spy talk! Momma screams a lot which p….s off her 3 roommates, but is pretty much ignored by the very busy/overworked nurses, most of whom are from the Philippines. They were the most caring and patient nurses I have ever known in all my 50 years as a doctor. And believe me, it takes all the patience and caring they could muster up to deal with a unit full of patients like that.

Momma’s bed is often surrounded by weeping family whom she does not recognize. When she was first admitted, her son brought in 3 plastic shopping bags of pill bottles, some full, some empty, some mislabeled and some duplicates. He seemed embarrassed about the family’s confusion and non-compliance with her multiple medications. I reassured him that was pretty common. Keeping track of a bunch of pills is hard enough even if it’s for yourself. He said it was always a struggle to get them down her, “because she thought we were all poisoning her so she’d die and we’d get all her money”. He teared up a bit and said “it was really, really painful to watch your own mother suffering so much and accusing you of things like that”. I reassured him that was pretty common too.

Growing old in America is definitely not for sissies.