Rationing Health Care?

You have probably heard a sick or dying person say, “What I wouldn’t give for one more day. . . .” Regardless of the setting, the meaning is the same: Life is priceless, something worth fighting for.

It turns out that “priceless” and “worth fighting for” may have their limits, at least measured in dollars and cents.

Some 30 percent of Medicare expenditures go to caring for people in the last year of their lives. Internationally, many countries and insurance companies explicitly ration health care based on cost effectiveness. Simply put, if a year of “quality life” costs more than a certain amount-usually $50,000-they simply will not pay for the care.

Medicare, in contrast, does not have a monetary threshold-at least not yet. Instead, Medicare makes a determination based on whether the treatment is “medically necessary and appropriate.”

A group of researchers at Stanford’s medical and business schools set out to determine if the $50,000 threshold was too low. They used kidney dialysis, which “typically has been used as a benchmark for evaluating the cost-effectiveness of all new technologies.”

In their new study, they conclude the $50,000 figure is much too low. They found that it costs $129,000 to provide a patient with what they called a “quality-adjusted” year of life-in their estimation, two years on dialysis was equivalent, quality wise, to one year off it.

To put it mildly, the implications of their findings are chilling. There is an obvious and disturbing question of how many people have died around the world because of the $50,000 threshold. While two years may not seem so long, it is priceless to those facing the end of life.

Even more frightening are the implications for the future: If Medicare were to follow the lead of other countries, how many Americans would be denied access to life-prolonging treatment?

To their credit, the authors of the study were aware of this and other ethical issues raised by their research. They also raised the prospect of the “sickest subgroups of patients” being “denied access to expensive treatments such as dialysis.”

It is not only the sickest who are at risk: When life is reduced to a cold calculation, the poor and marginalized are also at risk. We all are, as a matter of fact. Professor Peter Singer, for example, teaches packed classes at Princeton that funds should not be wasted on the terminally ill, or on abnormal babies-or who knows who is next, the severely disabled?

Few health care experts will go as far as the former governor of Colorado, who once famously said that the elderly have a “duty to die.” Showing how much it costs to keep people alive for another year or two, however, is the next-best-thing-the camel’s nose under the tent. It provides an economic rationale against prolonging life.

Now, there is a point at which we all must accept the inevitable. And that is why we should applaud efforts like hospice care that allow the terminally ill to die with true dignity.

But what we are talking about here is allowing people to die because we do not think their lives are worth $129,000 a year.

Whether they think the life is worth fighting for does not figure into the calculations — sorry.

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  • Ann

    This is an issue that has been much on my mind lately for some reason – I think because I have been seeing more and more articles about it. I fear for myself and for future generations in the US if we start to follow the “global” way of doing things…

    Peace and blessings to all!

  • Cooky642

    “Some 30 percent of Medicare expenditures go to caring for people in the last year of their lives”. I’m surprised the percentage isn’t higher since Medicare is reserved for the elderly, most of whom already are chronically ill.

    “If Medicare were to follow the lead of other countries, how many Americans would be denied access to life-prolonging treatment?” This is exactly the issue with the Democratic health-care plans. They insist on a comprehensive health care package for all Americans (not counting illegal aliens) that would have no other recourse than to ration and restrict health care to those “able to benefit” from it (i.e., productive members of society).

    Does anyone remember the film “Soylent Green”?

  • christymomof3

    In the state of Oregon, “As of now any treatment that doesn’t provide at least a 5 percent chance of survival after 5 years won’t be approved.” The story of one woman’s struggle for life against Oregon’s socialized medical plan in the Statesman-Journal (http://www.statesmanjournal.com/apps/pbcs.dll/article?AID=/20080603/UPDATE/80603027) explains how Barbara Wagner was offered assisted suicide in lieu of chemotherapy for her cancer. The drug manufacturer decided to provide her medication for free, so she can have those priceless few more days.