The United States views health care as a commodity, a product with market value. As long as health care is treated as merchandise to be bought and sold, both the bleeding hearts and the supply-side conservatives should recognize that there will always be some kind of allocation. If profit is involved, there will never be enough to go around.
There will be rationing – inevitably by wealth.
The U.S. already spends more than twice as much on health care for each of its citizens as any other country in the world. Yet, every industrialized nation delivers better care to more of its people. The frightening fact is that U.S. health care is not only the most expensive in the world; it is also the least adequate in the world.
And U.S. health care is getting so expensive that it will become fiscally unsustainable within a generation. The recent health care bill took some steps toward cost containment, e.g., requiring universal coverage, but it only set the eventual storm back a few years. The hurricane is just over the horizon.
Other nations have demonstrated that the cost problem can be solved with a single pay system but, as the recent political war in the U.S. Senate demonstrated, the political will simply doesn’t exist in this country. Even though administration in the for-profit system represents nearly a third (28 percent) of the price, versus only 2 percent in the Medicare system, there are too many interests with too much political clout who benefit from the present “non-system.” There is no way that politics will permit the U.S. to adopt single payer – no matter how desirable.
But the country might be able to take some baby steps in end-of-life costs. Between a quarter and a third of Medicare costs are incurred in the final year of life and – strikingly, more than a third of that total is spent on a life expectancy of less than 30 days. Maybe there’s a buck or two to be sequestered there.
Reaching the age of infirmity (75 or so?) puts most people in a “death worry” zone – not so much for death itself as for how and when. Where death will take them is of lesser concern than the method and length of the travel, at least medically. Most folks worry about pain, incontinence, dementia, and immobility. They fear the time when the head will droop enough to put the forehead in the soup – human fears that were craftily exploited by Republicans during the recent health debate As one scholar mildly observed, “The reasons that the Republicans found fertile ground with the death panel myth go well beyond the gullibility of half senile old farts.”
Extreme life-sustaining treatment for patients in their 80s is generally a zero sum investment – for either the individual or the health system. Even though a terminal heart patient may be successfully treated, a $100,000 heart surgery for an 85-year-old most likely means the patient will succumb to some other frailty of old age within a year or two. A 25-year-old patient at the same cost is an investment yielding another 50 years of productivity.
Until it hits an individual, aging is something that occurs to other people – and views seem to change. In 1987, Daniel Callahan, author of “Setting Limits, Medical Goals in an Aging Society,” recommended that, after a certain point, Medicare life-extending treatments could justifiably be denied. Age, however, may have awarded him another viewpoint. He recently (at age 79) had a life-saving, seven-hour heart procedure himself.
Who, then, shall make end-of-life decisions? Few geezers want to have some unknown 30- year-old making them. Or a board of 30-year-olds, for that matter. It’s best, perhaps, for each soul to have made his or her decision well in advance – long before awareness recedes or terror of the unknown saps personal choice. Each person should be his or her own one-member death panel. If this were the case, and the decisions were made unfettered by fear or infirmity, it might be that few fewer would choose to prolong their own miserable, painful life at all costs.
Please, all you healthy swingers, ask your doc’s advice, make your decisions now – and put them in clear, unambiguous, written form.
Along with a donation to your favorite hospice.
Rodney Quinn, a former Maine secretary of state, lives in Gorham. He can be reached at rquinn@maine.rr.com.
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