Aren't conservatives for euthanasia and health care rationing?

Great Debates
1

During the debate a few years back over Kevorkianesque assisted suicide, I recall a lot of complaints from the right that liberals were pushing euthanasia. And during the health care debate, the prospect of a government-run plan including rationing is also a major bugaboo on the right.

But with the massive cuts to the federal budget that we’re facing how are we going to keep the elderly alive?

“Rationing” could mean a number of things, but there’s no suggestion that the majority of Americans who get their health coverage through private insurance would be subject to rationing–any more than their benevolent insurance companies already subject them to.

I hear talk of “weaning” the elderly from Medicare. Does this mean that Medicare would pay less and less of an elderly person’s health care costs as he or she ages? That’s what I would support. There comes a tipping point where you’ve lived long enough and the health care you’re starting to need isn’t going to buy you enough additional life to be cost effective.

So given that government spending=life, have these economically hard-nosed conservatives gotten with the program on death?

2

Of course, many just conveniently ignore the fact there are millions of Americans with no health insurance whatsoever - they most certainly are subjected to rationing based upon what they can or can not pay for. That’s a far more harsh sort of rationing that anything else you’ve mentioned. It makes some very treatable conditions a death sentence, because if you have no health insurance you can only get emergency care to stave off imminent death. No insurance and you get cancer? you’re screwed - almost no one can afford the surgery/chemo/radiation required to put it into remission, even though so many people have been treated for cancer and gone on to live many more years, even decades, of quality life. As just one example.

The logical extreme of that is simply to abolish Medicare and when people retire simply spend no money on them whatsoever - that would be extremely “cost effective”.

How do you determine where that tipping point occurs? You do realize that such a thing would come at significantly different ages for different people, yes? I know a woman who is 101 years old and still works full time - in her late 90’s she was in a car accident and lost part of one leg. Should we, based on her age, simply not bothered to save her life, give her a prosthetic, and rehab her? But she’s still working full time, it’s hard to make the case she’s a drain on society. (Obviously, not a physically demanding job, but she is still employed last I heard) It’s hard, in my mind, to argue she’s not worth saving just based on her age alone.

I agree, there is a point at which one must accept the inevitable - that’s why we put my mom in hospice at the end, and I spent her last two months helping to take care of her in her own home. Much cheaper than constant interventions, and more humane for her. But I’m not sure you have any real-life experience dealing with the issues surrounding medical care for the elderly or end of life issues.

3

The question is, how effective would the free market be at keeping all these people alive?

4

Very poor, I’d say.

You’re talking about retirees, right? Why did the government institute Medicare? Could it possibly be that, once retired, companies had no incentive to keep subsidizing health care for these people, and the vast majority could afford individual policies on their own? The government stepped in because the free market didn’t want to serve those people.

Another factoid not well known - Medicare also contributes to physician training. Despite that, costs of training new doctors are quite high. How do you think a pure free market approach would affect that cost? Of course, with millions more unable to afford medical care I suppose we won’t need as many doctors. Perhaps we will then see a need to subsidize more funeral homes to accommodate the increased mortality.

5

Weaning the elderly off medicare means getting younger people into fully funded plans instead of the Ponzi scheme that is crashing now.

6

Or we could, you know, fully fund Medicare. But that would require government spending, and would therefore be evil.

7

Euthanasia is quite a bit different than rationing healthcare: euthanasia is taking active steps to end a life. Most people are pretty leary of euthanasia in any other form but assisted suicide, but the ones who object to even assisted suicide generally do so out of religious conviction–hence, it is probably stronger on the right than on the left.

8

What I’m getting at is that cutting off services to the elderly is a sort of de facto euthanasia. So the question is, where do these religious people-slash-conservatives draw the line when it comes to adopting policies that result in increased death.

You could say that the “upshot” of budget cuts is euthanasia. I’m just sayin’ you could say it.

Now in the past I’ve stated that I preferred to define “euthanasia” in a way that excludes assisted suicide. This is because the latter emphasizes individual liberty–as opposed to the Big Government telling you how to die (that is, more expensively and more painfully). I tend see euthanasia as a policy of mercy killing as adopted by a government or a hospital, etc.

9

How do these plans remain fully funded after they retire?

10

But a lot of medical care isn’t about preventing death, it’s about preserving or restoring quality of life. My husband takes a medicine that stops his gout flareups. Will gout kill him? No, but it might make him prefer to die, if he had to live with it all the time. Arthritis treatments, electric wheelchairs, joint surgeries–a lot of the health care needed by the elderly isn’t a matter of life or death, but it’s still really important. Medicare-only hospitals and nursing homes could be even more spartan than they are–big wards, pablum for food, no TVs–without actually killing anyone. One could quite easily be in favor of extending life absolutely as far as possible but also in favor of a lot of rationing schemes.

11

I’m 52, and in good health. But one of my greatest concerns is the confluence of corporate interests with religious views. I.e., I can imagine two people at my deathbed: a priest or nun praying that this poor soul be kept alive another minute, and an accountant with an adding machine agreeing wholeheartedly, because he’s found another bank account of mine that hasn’t been drained. (FWIW, I’m childless and atheist).

If it becomes necessary, I plan to deal with my own euthenasia. And I’m not the least bit worried about conservatives’ oppostion to it. Because they’re equally devoted to guaranteeing that I can walk into any pawn shop and buy an assisted suicide machine for under a hundred dollars.

12

“Death” won’t be increased. Everyone dies. Conservatives would simply say two words: Personal responsibility. There is always going to be some plan, better than whatever plan you propose, that would take more money from living people and give it to dying people to keep them alive for a few more months. (Unless you live in a completely socialist country.)

And most people use the term “rationing” to mean the government limiting consumption of a product, not when simple market mechanisms allocate resources in certain ways. No one says that there is “rationing” of flat screen TVs simply because they cost money.

You could say the “upshot” of every system is euthanasia.

13

Is this really a conservative vs. liberal issue?

I’m all for assisted suicides, euthanasia, and any other way to end a life with dignity.

I could see this being abused, of course. If there is a profit to be made, someone will figure out how to exploit it, so some control would have to be in place… I thought Dr. Jack’s method of videotaping the whole thing was great in that I never got the impression that someone didn’t want to turn the machine on.

For long term illnesses though, it’s an interesting question… as someone else mentioned, there are many elderly without any medical insurance, so when they get sick with something that will ultimately kill them, whether it be the flu or cancer, they will die from it.

If you look at it that way, then why spend all the research money on cancer, aids, ALS, altzheimers, or the other various illnesses that usually take out elderly people? Just let nature take its course, and it will.

14

I understand what the OP is saying, but I see some complications.

Baby Boomers are retiring now. Not as rapidly as some would wish, with the ruined 401Ks and all, but there’s a steady stream of them. In a couple of years, if we all haven’t turned into pumpkins, it will be a tidal wave of them. They are relatively healthy and active and want to enjoy the entitlements they believe they have worked hard for.

They will live longer than their parents because of increased standards of living and health prevention.

There will be a lot more of them too.

And they will continue to be a very strong voting bloc.

You think people now are hysterical about tampering with SS and Medicare? Wait till that’s all the Boomers have, and there will be riots (well, not really. we don’t riot like we used to. damn shame, too.)

Will we need to ration it more than we’re doing now? I think if we keep on our present course, yes. But if we make our population younger, through increasing immigration, then not necessarily. People keep talking about overpopulation and I get that immigrants are perceived to be a strain when there are job shortages, but this will not always be the case. When Boomers start moving into assistant living facilities or getting home care, or more start demanding that casinos be developed in their local towns so they don’t have to drive to another state, then jobs will open up. So too will the jobs they retire from. I can foresee labor shortages being a problem if we don’t do something. So…we open the door to more hard-working immigrants to balance out the age distribution, we tax their paychecks like we’ve always done, and maybe we don’t have to worry about being tapped out when papa has a brand-new colostomy bag.

Also, with increasing medical advances, perhaps there is hope that the new elderly won’t be as burdensome as the “old” elderly and the costs on Medicare won’t be quite so high as would be expected. Though, it might just delay the inevitable. Maybe instead of getting into serious problems in their late 70s, early 80s, things will just get pushed back five to ten years and we’ll still have to deal with them. I don’t know. I guess there’s a lot we don’t know.

15

So what do we do with the irresponsible? Euthanize them?

Or rather, is it the position that when a person retires, he or she will have to rely on their own savings to pay for health insurance, and once it runs out, the next time you get sick, you die and/or suffer the effects of the illness so long as it goes? If that’s the case, can’t we at least legalize assisted suicide and give people that option?

When a person is having a life-threatening medical crisis, we can do everything possible to keep that person alive or we can do nothing and let him die. If the patient has no money (and isn’t shopping the market for surgery), then the decision as to what treatment he gets is made by the one who pays the bills. That’s usually a bureaucratic institution like a government agency or an insurance company. If there’s a limited budget, then decision will often have to be to withhold treatment with the result often being the patient dying as opposed to not dying.

16

The position that conservatives take is that yes, it’s a matter of personal responsibility. As for assisted suicide, I think most conservatives object to that on religious or other moral grounds. I am not a conservative, though, so if you’re asking me, I have no problem with assisted suicide.

Bit of a false dichotomy there. Very few people have “everything possible” done when they are sick.

Yes. But like I said, no matter which plan you implement, there is always going to be another plan that takes more money from other people to pay for more treatment.

17

We can discuss the withholding of costly medical care from elderly patients as it’s currently practiced and use that as a basis for its inevitable ratcheting up (or can we?). But ultimately it does boil down to a dichotomy: Death or taxes.

But what we’re discussing here are the implications of plans that take less money from other people, because more of their money is going to be used to reduce the deficit.

18

The problem with your OP is that you are assuming that conservatives have a consistent position on this. Their actual position is just anti-government. You propose ways of treating old people, and they’ll say it won’t work because “doing everything” costs too much money. Say that then we need a rational way of making end-of-life decisions, and they scream death panels. They say “personal responsibility” except when it comes to end of life decisions. (At least libertarians are consistent about this one.) It is actually about the fear that money from me may go to keeping you alive. Oh, the horror. And I, of course, will either be rich some time in the future or will never need expensive end of life care.

19

Is that a retraction of what you said earlier? I can’t tell. But clearly there are alternatives other than “do everything possible to keep that person alive or we can do nothing and let him die”. Do you need me to spell them out?

Yes. But keep in mind that estimates are that 20- 30% of health care costs are spent in the last ~2 months of life, often keeping people in intensive care units where the cost can easily be $10k/day. You can call that “euthanasia” if we expect people w/o funds to pay for that to go to a hospice care facility instead, but you can also call it sensible use of health care dollars.

20

The way you worded this implies hospices are dumping grounds for people too poor to pay for treatment, but that’s not the case at all - there are plenty of people who could get the intensive care treatment, but chose not to and go to hospice instead. My mother for instance. It was her choice to stop the intensive treatments and go home, and it cost her no more out of pocket to do either (though yes, for her insurer, hospice was, in fact, much cheaper).

Of course, when it was proposed that doctors be paid for discussing end-of-life choices with patients, a discussion that should not be rushed whether the patient is terminally ill or entirely healthy and concerned with future planning, we heard screams of DEATH PANELS!!! again.