A bedside view of Medicare.

• Author: Douglas, Susan

I spent the last two months watching my father die. This is the hardest thing I have ever done. Like millions of Americans, my brother and I were pulled between our jobs, our families, and a desperately needy parent, with our utmost priority being our father's comfort and, secondly, family finances. Simply put, we could not have gotten through this without Medicare.

For those of us of all ages going through this struggle, the recent "debate" about proposed cuts in Medicare seems surreal. While we stroked foreheads, rubbed dry lips with ice chips, emptied bedside commodes, felt for pulses, and cried, we heard a discussion about caring for the elderly that was bloodless, abstracted, and idiotic.

I don't doubt that in short order this system is going to be under real strain, and that changes must occur. But it's as if politicians and pundits alike are viewing the situation from the vantage point of a dirigible instead of from the edge of a bed.

There was lots of vague talk of budgetary "bloat," but precious little talk about what, exactly, would or should be cut. Only Jack Germond, rousing himself from his usually somnolent state on The McLaughlin Group, countered Fred Barnes's assertion that Medicare would be "rescued" by the Republicans. Germond asked questions rarely heard elsewhere. Will the deductible that the elderly pay go up? Will there be a cut in the number of days of coverage? Win there be higher copayments? He got no response.

My father wanted to die at home instead of in a hospital or nursing home, and this was our choice, too. For two-and-a-half months he needed someone in the house, 'round-the-clock. Medicare provided a nurse's aide twenty hours a week. My brother and I, who both work full time and have small children, got coverage for the equivalent of two-and-a-half work days, and no nights. Wherever the "bloat" is, it ain't here. The other four-and-a-half days, and all the nights, had to be covered by my brother and me, and by private nurse's aides, who cost $150 a day in New Jersey.

Medicare's policy seems predicated on the notion that there is already an in-home provider - e.g., a wife - to make up the difference. When there isn't, the children better have time, money, or both. And they had better live nearby or be ready to do a lot of commuting, and they had better have understanding employers. Such mundane details - the real stuff of caring for the sick and dying - never make it into pundits' pontifications about "managed...