Should We Accept Kidney Donations from our Children?

I’ve been looking into the phenomenon of organ donation from children to parents. Since I believe our national approach to Medicare injures future generations on behalf of us in the over 65 cohort, I wanted to see how we’re dealing with the most tangible form of intergenerational transfer – organ donation. Continue reading…

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The Passing of the Generations

Probably like everyone else, the older I get the more conscious I become that I am part of a generation whose time came – and is going. My parents died some years ago as did my uncles and aunts. The “greatest generation” is rapidly dying off. The tears and memories of parents whose children died in World War II have now been erased. I realize as well that by the time my 16-year-old granddaughter is my age, some 67 years from now, I will be long gone and her parents as well. Continue reading…

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Magical Thinking, Overtreatment, and Neglect of Patient and Family Values

My friend and college classmate Ted Marmor (see his recent post here) and Jonathan Oberlander have a short but illuminating article in a recent issue of the Journal of General Internal Medicine – “From HMOs to ACOs: The Quest for the Holy Grail in U.S. Health Policy.”  They offer a chastening analysis of our almost theological belief in the existence of a “‘Big Fix,’ a reform that will decisively rein in spending and simultaneously improve the coordination and quality of medical care.” Continue reading…

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Trying to Practice What I Preached: Helping my Parents at the End of Their Lives

Once again, the challenge of how to constrain rising health care expenditures has caught the public interest, stimulated by concerns over rising federal debt and limited ability to generate tax revenues. I recently chronicled my unsuccessful efforts at stimulating medical cost containment from both academic and foundation positions (1971–2002) in the April 23, 2011 issue of the Archives of Internal Medicine. What I did not relate was how hard it was to put into practice for my own family the principles I had been espousing all those years. Continue reading…

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Medicare and Social Security: Conjoined Twins

Although I grew up in a middle class family in Washington, D.C., my father, one of the pioneers in the early days of radio, was in and out of jobs over the years, usually fired. We went from elegant parties with small orchestras in our home one year to taking in a boarder the next. The stress on my mother from those economic roller coaster rides was enormous, and as children my brother and I felt the pressure. Although I have a good retirement income now, and no rational reason to worry about money, I still do. It is the kind of trauma that gets stamped forever in one’s psyche. Continue reading…

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A Lesson in How to Die and How to Live

In the summer of 2005, my mother was 82 and had been in frail health for a while. Angina, hypertension, and chronic congestive heart failure were under control following an aortic valve replacement six years previously. Upon her return to Boston from a trip to New York for our daughter’s wedding, we noticed that her appetite had diminished and she was losing weight. She was severely anemic and was admitted to the hospital for evaluation and blood transfusions. Clearly something was going on, but her doctors did not know what. Continue reading…

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