[00:05.80]2003 Text4

[00:08.08]It is said that in England death is pressing,

[00:11.41]in Canada inevitable and in California optional.

[00:16.91]Small wonder.

[00:18.32]Americans' life expectancy has nearly doubled

[00:21.43]over the past century.

[00:24.06]Failing hips can be replaced,

[00:26.28]clinical depression controlled,

[00:28.80]cataracts removed in a 30-minuts surgical procedure.

[00:32.73]Such advances offer the aging population a quality of life

[00:36.80]that was unimaginable when I entered medicine 50 years ago.

[00:41.84]But not even a great health-care system

[00:44.22]can cure death--and our failure to confront

[00:47.45]that reality now threatens this greatness of ours.

[00:52.29]Death is normal;

[00:53.49]we are genetically programmed to disintegrate and perish,

[00:57.32]even under ideal conditions.

[01:00.34]We all understand that at some level,

[01:03.37]yet as medical consumers we treat death

[01:05.99]as a problem to be solved.

[01:08.21]Shielded by third-party payers from the cost of our care,

[01:12.75]we demand everything that can possibly be done for us,

[01:16.28]even if it's useless.

[01:18.19]The most obvious example is late-stage cancer care.

[01:22.83]Physicians--frustrated by their inability

[01:25.56]to cure the disease and fearing

[01:27.67]loss of hope in the patient

[01:29.89]--too often offer aggressive treatment far beyond

[01:33.71]what is scientifically justified.

[01:36.84]In 1950, the U.S. spent $12.7 billion on health care.

[01:42.91]In 2002, the cost will be $1,540 billion.

[01:50.27]Anyone can see this trend is unsustainable.

[01:53.80]Yet few seem willing to try to reverse it.

[01:57.12]Some scholars conclude that a government

[01:59.65]with finite resources should simply

[02:01.70]stop paying for medical care

[02:03.91]that sustains life beyond a certain age--say 83 or so.

[02:09.56]Former Colorado governor Richard Lamm

[02:12.21]has been quoted as saying

[02:14.33]that the old and infirm

[02:16.24]"have a duty to die and get out of the way"

[02:19.26]so that younger, healthier people can

[02:21.28]realize their potential.

[02:23.80]I would not go that far.

[02:26.31]Energetic people now routinely work

[02:28.80]through their 60s and beyond,

[02:31.02]and remain dazzlingly productive.

[02:33.84]At 78, Viacom chairman Sumner Redstone jokingly

[02:37.98]claims to be 53.

[02:40.60]Supreme Court Justice Sandra Day O'Connor

[02:44.02]is in her 70s,

[02:45.43]and former surgeon general C. Everett Koop chairs

[02:49.03]an Internet start-up in his 80s.

[02:52.16]These leaders are living proof

[02:54.25]that prevention works and

[02:56.08]that we can manage the health problems

[02:58.19]that come naturally with age.

[03:00.51]As a mere 68-year-old, I wish to age

[03:03.74]as productively as they have.

[03:07.05]Yet there are limits to

[03:08.31]what a society can spend in this pursuit.

[03:11.73]As a physician,

[03:12.94]I know the most costly and dramatic measures

[03:16.16]may be ineffective and painful.

[03:19.50]I also know that people in Japan and Sweden,

[03:22.92]countries that spend far less on medical care,

[03:25.84]have achieved longer, healthier lives than we have.

[03:30.18]As a nation,

[03:31.31]we may be overfunding the quest for unlikely cures

[03:34.95]while underfunding research on humbler therapies

[03:38.48]that could improve people's lives.