The Spirituality of the Budget Crisis

David Brooks over at the New York Times wrote an interesting opinion piece on the current budget crisis and how it relates to our fear of death and our faith in science and medical technology to delay death. Here’s a few provocative snippets:

This fiscal crisis is about many things, but one of them is our inability to face death — our willingness to spend our nation into bankruptcy to extend life for a few more sickly months. … As Daniel Callahan and Sherwin B. Nuland point out in an essay in The New Republic called The Quagmire, our health care spending and innovation are not leading us toward a limitless extension of a good life. … “We have arrived at a moment,” Callahan and Nuland conclude, “where we are making little headway in defeating various kinds of diseases. Instead, our main achievements today consist of devising ways to marginally extend the lives of the very sick.”

As the parent of a seriously ill child, I agree with everything he’s saying, and yet I have no idea how we parse out quality of life and making the decision to let go (and let hospice). It’s my understanding that Americans wait too long to enter (or enter their loved ones) into hospice care. It seems that we do a great job at fighting disease (even if we’re bankrupting ourselves in the process), but a pretty lousy job at welcoming the dying process.

What would it look like if we made our healthcare decisions (both individually and as a society) based on something other than the fear of death?

You can read Brooks’ article here: Death and Budgets

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  • http://alisonleighlilly.com Alison Leigh Lilly

    Eh. I’m getting stuck on his claim that, “The fiscal crisis is driven largely by health care costs.”

    As far as I’m aware, that’s just not true. While it’s true that we spend more on health care than other nations, most of those costs go not to patient care itself, but to the insurance and pharmaceutical industries – both of which have helped to drive up the cost of patient care while ensuring that we don’t get the quality care we need. This is pretty obvious when you think about it: Insurance companies make their profits by figuring out loop-holes out of paying for care. Pharmaceutical companies make their profits by selling patented on-going treatments for symptoms rather than permanent cures for underlying causes. By pouring our resources into insurance and pharmaceuticals rather than patient care directly, we pretty much encourage a system where we have to pay more and more money for less and less effective care. It’s actually in the interest of both insurance and pharmaceutical companies to “marginally extend the lives of the very sick” rather than make headway on curing – not to mention preventing! – disease. But this has less to do with our fear of death, than our love (or someone’s love, anyway) of profits.

    All of that aside, health care is most definitely not the main cause of our current fiscal crisis. We spend far more on our military, for instance, by many times over, and our tax rates – especially on the top 2% – are wildly out whack.

    Of course, I think you can argue that these underlying issues also go back, in the end, to our fear of uncertainty and loss of control. The consolidation of power through brute military strength and our willingness to bribe big businesses with tax-breaks and bail-outs for the super-wealthy – these are rooted in the same fear that leads us to cling to what structures of security we have, even when those structures have failed to protect us or provide for us… just as people cling to the promise of a magical medical cure to stave off the decline and death of a loved one, except on a far broader scale.

    So let’s put the focus where it needs to be. I doubt we can save our economy by having a stiff upper lip as we watch our parents and grandparents (or our siblings or children) suffer from disease and death. I don’t think it’s right or just to suggest that doing our best to keep our loved ones from suffering has somehow driven the economy into the ground. Closer to the truth, I think, is that we have not worked hard enough for the social and cultural shifts that would invest in peace instead of war, and measure happiness in terms of health and quality of life instead of quantity of possessions and their security at all costs.

  • http://www.patheos.com/blogs/carlmccolman/ Carl McColman

    Preach it, sister! :-)

    I’m with you on pretty much all counts. Given Brooks’ politics, it’s no surprise that he ignores the issues you raise. But I would agree with Brooks to the extent that the reason why we are so willing to let big-insurance and big-pharm call the shots goes back to the fact that we are afraid of death (even more so than we fear suffering). The fact that those who love profits are able to get away with it is symbiotically enabled by our societal fear of death.

    “I doubt we can save our economy by having a stiff upper lip as we watch our parents and grandparents (or our siblings or children) suffer from disease and death.”
    I certainly hope you don’t think that’s what I’m saying! My point that we should be more proactive about hospice is not to let those who are sick suffer needlessly, but precisely to alleviate their suffering, through appropriate palliative care.

  • http://Google Barbara Wells

    I agree that too much time, money, and suffering are spent on lives that people would probably like to escape. However, how does one get out of this life with dignity? Hospice is only a partial answer it seems to me. We have outlawed the Dr. Kavorkians of our world. Could it be that merciful, dignified dying should be allowed as an alternative to years in a nursing home? And how amazing if this could also influence our budget crisis. In my opinion this would be a very spiritual option.

  • http://alisonleighlilly.com Alison Leigh Lilly

    “I certainly hope you don’t think that’s what I’m saying! My point that we should be more proactive about hospice is not to let those who are sick suffer needlessly, but precisely to alleviate their suffering, through appropriate palliative care.”

    No, that’s definitely not what I thought you were saying. :) Brooks… not as sure, though I know it’s a pretty hefty accusation to throw. I guess I was more just guarding against the conclusions that an argument like Brooks’ might lead to if we’re not watching where we’re going.

    And I think you’re completely right about our societal fear of death. I think one reason we struggle with that question of quality of life is that sometimes we’re far too eager to mistake quantity for quality, or assume that they are in all cases one and the same thing. You could even argue – based on how some conservative politicians seem bent on undermining family planning education and birth control options – that mistaking quality of life for “quantity” of life also plays a role in our cultural obsession with reproduction and this debate about whether or not offspring should be the foundation for a “marriage.” Though I realize that, for a Catholic, that might be getting into some sticky territory. ;)

  • http://gravatar.com/2breathe2 2breathe2s

    Quality of life ,each and every day. Why do we wait to say the things( nice ones) until it is too late? Why do we wait to spend time with people who truly support us until time feels like a rich commodity? The more we lose, the more we gain. This budget crisis is about personal budgeting of time and quality time. That may be the only “justice” in it appearance in our lives now. May more of us, see and feel the urgency in re evaluation of our priority and resources, namely time and connections. Thank for the post.


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