Question that came up today at work: Suppose you have two patients. The first is an 80 year old women with Alzheimer’s dementia who is confined to bed having a heart attack, the other is a 50 year old male, active father of 4 with a heart attack. Should we offer them both the same level of treatment? In some countries, certain procedures are limited based on age and medical condition. Here in the U.S.A. we leave all decisions regarding health care up to patients and their families. As a result, we spend a lot of resources on “futile care” for example: a 90 year old women with dementia on dialyis, artificial life support etc. It happens, and Medicare is footing the bill. The government is speculation that the Medicare resources are running out and many of us thirty-somethings will not have Medicare benefits by the time we reach that age. Any thoughts?
Ok, since I am not a fan of Medicare and such, I have to leave that part out of my answer. Besides, the 50 year old man may be on Medicare because of a disability, too many if’s in that area.
My question to you is, is a 50 year old man or woman’s life more precious than a 90 year old man or woman’s life? I think that’s the real question.
Do we favor the younger person because they may have more life to live or should we consider that life, no matter the age, is just as important as the next?
Now, if we refuse medical care for the same condition (both the 90 and the 50 year old) yes the 50 year old has a better chance at surviving. But I question if offer the care needed via medical means, why would anyone have precedence over another?
What if we refuse treatment to the 90 year old, who may have lived to 110 and during those years living as full a life as a 110 year old can. The 50 year old received treatment and because of the heart attack, ended up on public assistance because the heart attack had serious consequences on his brain. What I mean by that is, he is now essentially a 16 year old in a 50 year old body?
I only bring this up because my dad’s cousin’s husband had such a thing happen to him in his early 40s.
Is the life of a older person less suitable for society than the younger person?
< scratching head > where the hell did I come up with “But I question if offer the care needed via medical means, why would anyone have precedence over another?” That makes no sense. < thwaping self upside head >
To rephrase that: If the care required includes medical intervention, why would a younger person take precedence over the older person?
That’s exactly my question, Tech. I don’t know what the answer is. Abroad, they allocate resources. Here in the U.S., everyone is entiltled to the best healthcare. Resourses are limited, however, those who date AFTER the baby-boomer generation will be paying the consequences.
In case anyone was unaware, health care is already being rationed. In my mind, 46 million uninsured sure qualifies as rationing.
In regards to the question of should health care be rationed, I will risk angry responses by answering in the affirmative.
In this country, we have a warped distinction between rights and privileges. Is unlimited health care really a right bestowed upon every American? I don’t think so.
Health care currently accounts for about one sixth of our GDP even with one in six Americans uninsured. When you include the underinsured and everybody else who wants second, third and fourth opinions but are denied, unlimited health care could then eat up well over 30% of GDP (my amateurish estimate; for something more authoritative, see below).
If someone thinks this is in our best interest, I’m all ears.
I don’t know if anyone caught it but a little over a year ago, Greenspan was asked by a member of the House Banking Committee for his thoughts on unlimited health care. The deity’s response was that he felt unlimited health care for all Americans would eat up about 50% of GDP so “clearly some form of rationing is required”.
[aside]The sad part about this was that not one media story among the many I read mentioned this extremely important quote. The media I read or listened to were so busy reporting on his views on investing social security money into the stock market (this was right after Clinton’s SOTU) that there was no room for this bombshell (for those who would like to verify this exchange, I believe the Fed’s website archives speeches, testimony, etc. of the chairman and governor).[/aside]
IMHO, the major flaw in our health care delivery system is that the end user has no economic stake in his/her decisions regarding health care. This includes treatment (with someone else footing the bill, who wouldn’t want every procedure known to man?) as well as lifestyle (should the healthy foot the bill for an overweight smoker to have his arteries cleaned out?).
This flaw led to the explosion in costs that precipitated the rise of the HMO but the house of cards is now in danger of collapse. The cost savings brought about by managed care are now under assault as the pursuit of profit is demonized so the plaintiff’s bar can have their turn at the trough.
With an aging population continually out of touch with economic reality, this gets worse before it gets better. :eek:
Disrep: I agree 100%.
In my hospital (state funded), the uninsured do have unlimited access. The funds come from state resources, and the rest gets eaten by the hospital. Out of the hospital, access to specialized care is available, but difficult for those without resources.
I think managed care attempted to handle this situation, but in the wrong way. With managed care, people who NEED care are often denied because THE INSURANCE COMPANY has decided a test or treatment is unnecessary. Managed care will not address the problem treating the uninsured. It is only serving to make money for the insurance companies.
I think the comments to the effect that the real issue is whose life is more valuable are correct. However, if we try to answer this question, and decide that the rationing of resources is the way to go, then a certain difficulty arises. Who has to assert such regulations in practice? The politicians? The law-makers? The hospital administrators? No. The doctorss and nurses who are trained to save life. Do we really expect doctors to console the relatives of an elderly patient with the news that unfortunately, we can’t help your mother because she’s old, but don’t worry, given the same medical problem, we’ll help you, because you’re younger (and hence have a greater life expectancy)?
As an aside, the NHS in the UK (speciously referred to by politicians as ‘offering the best healthcare in the world’) is certainly not the way to go. It’s expensive (but still underfunded), burocratic and comprehensively fails to offer top quality healthcare in most circumstances eg survival rates for many cancers are not only lower than in th US and most of western europe, but in some cases lower than eastern europe. Comprehensive healthcare *could[/]work, but only if everybody is prepared to pay a lot of money in taxes. They are not. These points in no way detract from the hard work and dedication of the doctors and nurses in the NHS who work under almost impossible conditions.
The issue of healthcare should never be about money. It should be in doing what is right. When my grandma died at 98, I still wish she would have been able to live longer.
Frankly, advanced situations such as the OP describes DOES affect the care that is given. For example, my grandma - not when she died, but a few years earlier - would have had an operation for a problem she had, except the doctors thought at her advanced age, it would be more of a risk than not doing it.
I’m sure most cases such as this are decided just by that - smart medicine, not fiscal awareness. And that’s as it should be.
Yer pal,
Satan
And now a word from the evil Insurance empire!
You are right in that the insurance companies make money. So does every other industry, otherwise they wouldn’t be in business. The insurance industry isn’t out there to bilk you of your money. We are taking a bet (essentially) that you and people like you are going to average $X of claims each. We will charge each of you $X + $Y, where $Y covers my salary, claim payer salary, and, yes, profit for the investors in the company, much like a can of peas in the store covers the cost of the peas, salaries of the workers, and profits for the store (yes, I know I’m simplifying.)
A brief history of medical insurance.
In the 50s and earlier, medical insurance was intended for hospital stays. Many didn’t have insurance, but most hospital stays wouldn’t send you into financial ruin, either. In the 70s, group sponsored insurance started to become the norm, with many policies being comprehensive. Now, you are covering that doctor’s visit when you have the sniffles. Guess what? More coverage costs more. And, the physicians / hospitals / etc. now know that most people have insurance. It’s some faceless insurance company paying (who has “unlimited” resources), not a person (with very limited resources), so why not charge more? HMOs were born of a burocratic attempt to fix this. However, insureds don’t like being told what doctor to go to - they like the ability to choose to go to a podiatrist if they think they need to go to a podiatrist. PPOs were born of the backlash. For those of you who don’t know the difference, in an HMO, a physician is paid an annual “salary” for your care, regardless of how much treatment you get. In most arrangements, if you need specialist care, the specialists fees are taken out of your salary, so the physicians didn’t want to send people to specialists. In a PPO, the physicians aggree to give a discount from their standard fees. In return, your benefit package encourages employees to vist them.
We in the insurance industry have to balance
- products that people want
- prices that people can afford
- prices high enough so that we don’t loose money
- state regulation
Are medical prices high because of insurance, or is insurance high because of medical prices? Medicare / Medicaid pay less than actual expenses for the hospitals, so they have to pass that increase on to the “full paying” customers. The ones really getting screwed in this whole system are the uninsured. Even a short hospital stay now will ruin you for years to come.
Back to your initial question: does a person with an already diminished life (90, alzhimers) deserve the same medical treatment as a younger person? That should be a personal choice based on available resources. Life isn’t fair; medical care isn’t a god-given right; and my insurance rates shouldn’t have to go up because YOU can’t have a child naturally and end up with a litter of kids through infertility treatments.
“The large print givith, and the small print taketh away.”
Tom Waites, “Step Right Up”
Ah, but my friend, the real question is did your grandma wish to live longer?
People who don’t make their wishes known in writing or at least by telling their families what they would or would not want done if they were to become incapacitated place a tremendous burden on all of us. More often than not, families opt to “do everything” because they’ll feel guilty if they didn’t give gramma every chance.
On the flip side, often gramma doesn’t tell you she DOES want everything done; when she becomes critically ill the family may opt to remove life support. More often, the first scenario is the case.
Disreputable made a good point about many people choosing every medical treatment known to man if Medicare will pay for it. I once administered several doses of a rare clotting factor, flown in from a lab in California, to an 86 year old woman who had virtually no chance to survive (she did die) at $35,000 per dose. As her daughter said, “Well, Medicare’s paying for it, so we figure, why not?”
Doctors do take into consideration quality of life. That is to say, your 90 year old grandma may have several good years left in her; maybe she’s strong enough to withstand the surgery. A fifty year old man may have hepatitis A,B,C,D, and Z and be in full-blown liver failure and really itchy and in intractable pain. Decisions are not made on the patient’s age alone.
When dialysis first became available, it was rationed: there were simply not enough machines to treat everyone. Now, anyone can have dialysis. You have to jump through hoops to REFUSE dialysis if your kidneys fail. We can even do a new, improved sort of dialysis for those patients who are too sick to tolerate the usual kind: they’re on dialysis 24 hours a day, in the ICU, with their own personal nurse, at a much higher cost.
Is the expense worth it? The patient or his family always thinks so. Of course, they’re not paying for it.
I must differ with your assessment Satan. It is naive to think that money does not or should not have a hand in medicine.
Should medicine be exempt from the laws of economics because it is deemed a basic necessity? Food and shelter are also basic necessities and they are clearly subject to market forces.
I wish we lived in a utopian society where your statement would have merit. My perception of reality tells me otherwise.
BTW, excellent post Vroman.
You may as well say that the sky should never be blue. Healthcare costs money, and there is only so much money to go around. Basic economic reality is reality whether or not you think it’s nice or want to believe it. When you come up with a way to make healthcare magically free, then perhaps your statement will have some relevance on reality.
And I very much don’t think that enslaving those who are in good health to keep those in poor health alive for a short time longer makes any sense. As someone else on this thread has pointed out, Alan Greenspan estimates that unlimited health care would cost something like 50% of US GDP. Bringing in that kind of money is possible, but it means that you’d have to cut down on an awful lot of schooling, science (which gives us improved medicine), etc. Of course, the first place to look would be silly things not vital to anyone’s life, like this BB.
But that should be a concern for you and your family, not something that you steal money out of my pocket for.
Kevin Allegood,
“At least one could get something through Trotsky’s skull.”
- Joseph Michael Bay
Healthcare is a limited resource. There are only so many doctors, only so many medicines. We have determined as a civilization that money is the preferred way to deal with the reality of scarcity. I can’t think of a better way, can you? As far as I know, there are only two economies: money driven, and queue driven. Either you spend money on what you want (and outbid those with competing wants), or you wait in line until its your turn and hope you can get it.
Currently, some aspects of medicine are queue driven (example, organ donation). This is far from perfect - and you will have a very uphill battle convincing everyone to do all of medicine this way. Queue driven economies do not promote quality service.