Thursday, April 21, 2011

Life and Death - USA and Thailand


An Old Man Walking In Tahsang Village
In America the Federal budget disagreements continue with outrageous allegations being hurled by both sides making the possibility of compromise all that more remote.  It appears to me that the art of civil debate and social discourse has been lost to and in favor of the cheap alternatives of character assassination and the instant gratification of labeling your opponent.

Besides the strategy of "winning" an argument by out shouting those who disagree with you, the standard procedure seems to be sticking a nefarious label on those who disagree with you; with the objective being to completely discredit your opponent and diminish any of the facts that they contribute to the discussion.

Egged on by the media, the participants in our government do not seek and identify those areas where they agree or can compromise.  Rather they seek to focus on the areas where they disagree with each other and how they occupy a much higher moral ground than their opponents.  Establishing class or a racial basis to defend your position and to attack your opponent's positon seems to earn bonus points in the tawdry game being played out across this land.

A big component of US public spending is related to health care.  Medicare and the implementation of Obamacare have significant impact upon the quality of services to patients as well as the costs to taxpayers.  There has been some and undoubtedly there will be much more argument regarding the scope and costs related to these programs.

One of the great promises of the Internet, especially sites like Facebook, is the ability and opportunity for people of varying backgrounds and experiences to exchange information.  Through Facebook I am well aware that having left the USA to work and live in other countries I have developed very different views than most of the people that I grew up with.  That is OK and does not mean that they are "bad" or that I am "bad".  We just disagree - there is nothing wrong with that.  It is just a natural phenomenon of people reacting, experiencing unique lives and adapting to different environments.  Ideally we would all benefit from sharing and considering the diverse perspectives.

I am fortunate that I have friends on the Internet that I can disagree with.  The important thing is that we can communicate why we disagree and in the ensuing discussion provide information with which we can each reconsider our individual positions.  Most importantly, so far, we have been able to still respect each other. 

Recently on Facebook there was a posting of an article from the AARP which called on people to contact their representatives to vote "No" on Rep Paul Ryan's budget which according to them would "effectively end Medicare as we know it and put the health of millions of older Americans at risk."

Someone responded to the posting by stating "Along with Medicare cuts, Medicaid benefits will be denied long term nursing home care for seniors.  Middle class families as well as low income families rely on Medicaid to help them afford nursing home care for their parents ..."

I felt compelled to respond and posed the following question.  "Whatever happened to taking care of your family rather than putting them in homes?  It works in Thailand.  It used to work here."

A friend of mine pointed out the following life expectancies for Thai and American people - Thai Male - 71.4 years versus US Male - 76.08 years; Thai female - 76.08 years versus 81.5 years for US female.  My friend also made the comment that this is what happened with taking care of your family, they die earlier.

Personally I was surprised at how little difference there is in the life expectancies between Thailand and the USA.  Those of you who follow this blog may have read several entries that I have written on health care in Thailand.  In Thailand you can have world class health care if you know where to go and you are able to pay for it.  In general the sophistication of health care for the average Thai is not comparable to that available to the average American.  Facetiously I also remarked that I did not know the extent that Thai driving practices had on the lower life expectancies in Thailand.

I have written about seeing a local doctor and paying $13 for the office visit and medication that was dispensed.  Thirteen US dollars for a doctor visit and prescriptions is extremely cheap for most Americans however it is a burden for the vast majority of people in Isaan.  The ousted former Prime Minister of Thailand, Sinirat Thaksin, instituted a national health care program in Thailand for poor people.  Poor people register and receive a card from the government.  The card allows the person to pay a fee of 30 baht ($1.20 USD) for medicine.  However the program is limited only to payments for medicine and does not cover procedures, doctors, or hospitalization.  This program is one of the reasons that he remains popular with the poor people of Northeast Thailand; but that is a whole different story that I am not writing about today nor do I choose to write about.  Just as I do not appreciate foreigners telling me what we should do in our country, I will not be a foreigner telling people what they should do in their country - it just makes life easier and more pleasant for everyone.

I have been told and I have heard people tell my parents that they are very lucky to have a son like me and a daughter-in-law like Duang who will travel 8,000 miles to care for them.  It is very nice to receive such compliments but for Duang like all other children in Thailand these are very strange statements.  In Thailand children are expected and accept the responsibility to care for their older relatives in their advanced years.  Typically it is the youngest daughter who bears the responsibility but extenuating circumstances can change that.  Some grandchildren or even nieces or nephews will care for an elderly relative.  It is ingrained in the Lao Loum culture to care for the elderly.  It is the way that America cared for its elderly in the past.  It was a duty and a responsibility of the younger generations - a social compact that for many today no longer exists.

My parents often apologize for "messing up" my and Duang's life.  I tell them and I really mean it that we prefer to not be here but it is our duty as well as responsibility to take care of them.  They need us and we are capable of helping them.  We are able to ensure that they can remain in their home where they are most comfortable.  Putting them in a nursing home at this time would not improve the quality of their life in any way. As to "messing up our life" - this is our life.  Living back in the USA and taking care of my parents is not necessarily the life that we planned but it is the life that we have.  It is the life that we have to deal with as best we can.  It is a life that we still enjoy.

In the exchange over Facebook, another friend wrote "In Thailand I suspect there's a basic respect for the elderly, rather than a basic fear of being elderly that seems to permeate the stay-young-forever society we have." I very much agree with that statement.  In addition to the fear of being elderly, I believe that in America, the elderly are considered somewhat of an embarrassment and I suspect that for some people they are too painful reminders of the fate that awaits all of us.  In our materialistic society there is not much value in being old. Other than medical care we are not great consumers of goods and services.  We also do not pay a high amount of income taxes or contribute to payroll deductions such as Unemployment Insurance, Social Security Hospitalization Insurance, or Social Security Old Age programs.  To the contary we are consumers of the government entitlement programs.

In Isaan caring for elderly has religious conotations.  A person earns merit in the Buddhist religion by caring for those who can not care for themselves.  Earning merit in this lifetime assists a person to return in a higher status in their next life.

No matter the case of how we consider the old, the fact remains that:


Funeral Rites In Isaan

We will all die some day of something.

The only speculation exists is how we will die and when we will die.




When I contemplate life and death issues, be it in Isaan or the USA, I am often reminded of a wonderful quote from National Geographic contributor, Wade Davis, a renowned Canadian Anthropologist.  In his documentary series "Light At the End of the World" regarding the Buddhist attitude towards death ... "The Buddhists spend all their lives getting ready for a moment that we spend most of our lives pretending does not exist, which is the moment of our death".

In Isaan death is a milestone of life which is familiar to and accepted by all people from a very early age. The conclusion of this life, which for many has been very difficult, presents the hope as well as opportunity for a better and easier life in the future - another step towards eventual enlightenment.

As I witness the pain and suffering of people in the USA as they artificially struggle to delay the inevitable, I have pause to contemplate the best way to live and die.

In Isaan, death comes quicker and sooner due to a lack of money and facilities. Yes the expectancies show that; roughly five years sooner than in the USA.

However as I shared with my Facebook friends, in Thailand it is not about how long that you live; it is about how you live which really matters.

At what point should we allow ourselves or others to let go and conclude the suffering?

If a person wants to spend their money in a futile attempt to attain immortality, it is none of my business.  However if public funds, my tax dollars, are going to be spent in this quixotic quest to avoid death then I am involved by default.

There were allegations last year regarding Obamacare establishing "Death Panels".  I do not want a panel of bureaucrats determining what procedures and medicines that I will receive.  I want the freedom to determine what the extent of my healthcare will be even if it means that I may not receive certain procedures because I can not afford them.  However the practical determination of how public funds are to be spent is entirely justified and in my opinion - expected and a duty.

However if public funds are to be used to finance anyone's health care, I think that it is entirely reasonable to have limits upon procedures and medications dependent upon one's circumstances.  What may be deemed appropriate to save the life of a 35 year old person may not be calculated to be appropriate for a 90 year old person. To me it does not make financial sense to pay $93,000 for a new drug treatment regimen for prostate cancer that extends the life expectancy of a man by 4 months versus chemotherapy which extends it by 2 months.


Is it the best use of Medicare or other public funds to pay for colonoscopy examinations of 87 year old people? 

Discussing who should receive what treatments is repulsive, distasteful and best left to the people directly involved - the patient and the physician.  However when the treatments are paid for by public funds, that discussion needs to take place in a more public forum and especially from the perspective of what is best for the overall collective good.  It is dirty and nasty to boil a person's future down to actuary tables and calculated value, but this is what we invite when we subbrogate our freedom of health choices to the government.


People die 5 years younger in Thailand than in the USA but at what cost do Americans live those five extra years.  More importantly, what is the quality of those five extra years that Americans live?

We are all going to die of something some day; there is no denying or escaping this fate.

I would rather die earlier and be happy at the time of my death than to live longer and either be miserable or suffer for the additional years. 

How you choose to live out your final years is up to you ... until, in my opinion,  your choices are paid for with public funds.  At that time your choices no longer become strictly yours.

As I was taught - You can have anything that you want as long as YOU can pay for it.  When you expect others to pay your bills, you give up a great deal of your freedom.

A true indication of how mature and sophisticated a society we are will be demonstrated in how the issues of personal freedoms, personal responsibilities, social responsibities, ethics, morality, accountability and common sense are resolved in regards to health care in America.


Two Souls Departing In Isaan


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