Taxpayers spend billions annually to briefly extend the lives of elderly Medicare patient while thousands die each year because they lack insurance,
Notes Ira Rosofsky
In "The painful side effects of Obama’s healthcare reform," (Opinion, July 5) Charlotte Allen warns that reform may lead to the rationing of scarce, expensive medical resources. In particular, she worries that the elderly may be abandoned on metaphorical ice floes as bean-counting government bureaucrats determine that prolonging the lives of frail, sickly 86-year-olds is not worth it when the resources are diverted from prolonging the lives of frail, sickly 36-year-olds.
This argument neglects the important fact that healthcare rationing is already as American as apple pie. We ration healthcare based on the ability to pay.
The roughly 47 million uninsured Americans, and the millions more who are underinsured, mostly do not get to consider whether it is worth the effort to undergo costly, life-prolonging or life-enhancing procedures. It is simply not part of their personal equation.
What happens? They die.
This is strikingly underscored by an Urban Institute estimate that in 2006, more than 22,000 Americans died because they lacked medical insurance, and 137,000 died between 2000 and 2006. Thousands more have struggled on with a reduced quality of life.
For those who don't die, medical debt is the No. 1 reason for bankruptcy filings.
I have no easy answers for the bioethical questions raised by Allen, but I submit that any answer to them should account for the millions whose current answer is no healthcare at all.
The elderly, thanks to the government program Medicare -- which the American Medical Assn. and most conservatives opposed -- are virtually 100% insured. Most of the uninsured millions would love to be on that ice floe. Medicare operates as an indemnity program. You want to see a doctor or undergo an expensive procedure? You make an appointment. Unlike the managed care that covers millions who are too young for Medicare, there are no bean-counting private bureaucrats deciding which procedures are covered. There is no private-sector rationing by decision makers with an eye on the corporate bottom line.
I am a psychologist who works with the elderly in nursing homes, and I, along with my physician colleagues, like to complain about the discounted reimbursement rates from Medicare. But I know that my career would not be possible without Medicare, and I suspect that my physician friends recognize that their high six-figure salaries would be at risk without Medicare.
And here's a harsh reality for those like Allen who insist that they alone should determine whether they can "afford that hip replacement in extreme old age," and not some "government mucky mucks." Aside from the understandable fact that those older than 65 -- who constitute about 12% of the U.S. population -- account for one-fifth of all medical expenditures, the numbers become more skewed when it comes to end-of-life care. Spending for Medicare beneficiaries who will die within a year accounts for nearly 30% of overall Medicare spending.
The elderly aside, a marginal prolonging of life is expensive at any age. A commentary by Tito Fojo and Christine Grady, "How much is life worth," in the Journal of the National Cancer Institute looked at the costs of a drug, cetuximab, used in the treatment of non-small cell lung cancer. Eighteen weeks of the cetuximab treatment extends life for an average of 1.2 months at a cost of $80,000. This means it would cost $800,000 to prolong the life of a patient for one year. "At this rate, it would cost $440 billion annually, an amount 100 times the [National Cancer Institute's] budget, to extend the lives of 550,000 Americans who die of cancer annually by one year," say Fojo and Grady.
Estimates of the price tag for insuring the 47 million uninsured vary widely, but the potential $440 billion savings from not spending on briefly extending the lives of cancer patients alone would pay for a huge chunk of the premiums for the currently uninsured.
In other words, perhaps 22,000 people would live each year because some others did not live one year longer. This is not to mention the pain and suffering and the reduced quality of life from a treatment that marginally prolongs life.
I might well choose to be put on the ice floe. [rc]
Ira Rosofsky is a psychologist and the author of "Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare" (Avery/Penguin).
Copyright 2009 Los Angeles Times
July 14, 2009
USA: When I'm really old, put me on that ice floe
.
LOS ANGELES, California / Los Angeles Times / Blowback / July 14, 2009
Taxpayers spend billions annually to briefly extend the lives of elderly Medicare patient while thousands die each year because they lack insurance,
Notes Ira Rosofsky
In "The painful side effects of Obama’s healthcare reform," (Opinion, July 5) Charlotte Allen warns that reform may lead to the rationing of scarce, expensive medical resources. In particular, she worries that the elderly may be abandoned on metaphorical ice floes as bean-counting government bureaucrats determine that prolonging the lives of frail, sickly 86-year-olds is not worth it when the resources are diverted from prolonging the lives of frail, sickly 36-year-olds.
This argument neglects the important fact that healthcare rationing is already as American as apple pie. We ration healthcare based on the ability to pay.
The roughly 47 million uninsured Americans, and the millions more who are underinsured, mostly do not get to consider whether it is worth the effort to undergo costly, life-prolonging or life-enhancing procedures. It is simply not part of their personal equation.
What happens? They die.
This is strikingly underscored by an Urban Institute estimate that in 2006, more than 22,000 Americans died because they lacked medical insurance, and 137,000 died between 2000 and 2006. Thousands more have struggled on with a reduced quality of life.
For those who don't die, medical debt is the No. 1 reason for bankruptcy filings.
I have no easy answers for the bioethical questions raised by Allen, but I submit that any answer to them should account for the millions whose current answer is no healthcare at all.
The elderly, thanks to the government program Medicare -- which the American Medical Assn. and most conservatives opposed -- are virtually 100% insured. Most of the uninsured millions would love to be on that ice floe. Medicare operates as an indemnity program. You want to see a doctor or undergo an expensive procedure? You make an appointment. Unlike the managed care that covers millions who are too young for Medicare, there are no bean-counting private bureaucrats deciding which procedures are covered. There is no private-sector rationing by decision makers with an eye on the corporate bottom line.
I am a psychologist who works with the elderly in nursing homes, and I, along with my physician colleagues, like to complain about the discounted reimbursement rates from Medicare. But I know that my career would not be possible without Medicare, and I suspect that my physician friends recognize that their high six-figure salaries would be at risk without Medicare.
And here's a harsh reality for those like Allen who insist that they alone should determine whether they can "afford that hip replacement in extreme old age," and not some "government mucky mucks." Aside from the understandable fact that those older than 65 -- who constitute about 12% of the U.S. population -- account for one-fifth of all medical expenditures, the numbers become more skewed when it comes to end-of-life care. Spending for Medicare beneficiaries who will die within a year accounts for nearly 30% of overall Medicare spending.
The elderly aside, a marginal prolonging of life is expensive at any age. A commentary by Tito Fojo and Christine Grady, "How much is life worth," in the Journal of the National Cancer Institute looked at the costs of a drug, cetuximab, used in the treatment of non-small cell lung cancer. Eighteen weeks of the cetuximab treatment extends life for an average of 1.2 months at a cost of $80,000. This means it would cost $800,000 to prolong the life of a patient for one year. "At this rate, it would cost $440 billion annually, an amount 100 times the [National Cancer Institute's] budget, to extend the lives of 550,000 Americans who die of cancer annually by one year," say Fojo and Grady.
Estimates of the price tag for insuring the 47 million uninsured vary widely, but the potential $440 billion savings from not spending on briefly extending the lives of cancer patients alone would pay for a huge chunk of the premiums for the currently uninsured.
In other words, perhaps 22,000 people would live each year because some others did not live one year longer. This is not to mention the pain and suffering and the reduced quality of life from a treatment that marginally prolongs life.
I might well choose to be put on the ice floe. [rc]
Ira Rosofsky is a psychologist and the author of "Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare" (Avery/Penguin).
Copyright 2009 Los Angeles Times
Taxpayers spend billions annually to briefly extend the lives of elderly Medicare patient while thousands die each year because they lack insurance,
Notes Ira Rosofsky
In "The painful side effects of Obama’s healthcare reform," (Opinion, July 5) Charlotte Allen warns that reform may lead to the rationing of scarce, expensive medical resources. In particular, she worries that the elderly may be abandoned on metaphorical ice floes as bean-counting government bureaucrats determine that prolonging the lives of frail, sickly 86-year-olds is not worth it when the resources are diverted from prolonging the lives of frail, sickly 36-year-olds.
This argument neglects the important fact that healthcare rationing is already as American as apple pie. We ration healthcare based on the ability to pay.
The roughly 47 million uninsured Americans, and the millions more who are underinsured, mostly do not get to consider whether it is worth the effort to undergo costly, life-prolonging or life-enhancing procedures. It is simply not part of their personal equation.
What happens? They die.
This is strikingly underscored by an Urban Institute estimate that in 2006, more than 22,000 Americans died because they lacked medical insurance, and 137,000 died between 2000 and 2006. Thousands more have struggled on with a reduced quality of life.
For those who don't die, medical debt is the No. 1 reason for bankruptcy filings.
I have no easy answers for the bioethical questions raised by Allen, but I submit that any answer to them should account for the millions whose current answer is no healthcare at all.
The elderly, thanks to the government program Medicare -- which the American Medical Assn. and most conservatives opposed -- are virtually 100% insured. Most of the uninsured millions would love to be on that ice floe. Medicare operates as an indemnity program. You want to see a doctor or undergo an expensive procedure? You make an appointment. Unlike the managed care that covers millions who are too young for Medicare, there are no bean-counting private bureaucrats deciding which procedures are covered. There is no private-sector rationing by decision makers with an eye on the corporate bottom line.
I am a psychologist who works with the elderly in nursing homes, and I, along with my physician colleagues, like to complain about the discounted reimbursement rates from Medicare. But I know that my career would not be possible without Medicare, and I suspect that my physician friends recognize that their high six-figure salaries would be at risk without Medicare.
And here's a harsh reality for those like Allen who insist that they alone should determine whether they can "afford that hip replacement in extreme old age," and not some "government mucky mucks." Aside from the understandable fact that those older than 65 -- who constitute about 12% of the U.S. population -- account for one-fifth of all medical expenditures, the numbers become more skewed when it comes to end-of-life care. Spending for Medicare beneficiaries who will die within a year accounts for nearly 30% of overall Medicare spending.
The elderly aside, a marginal prolonging of life is expensive at any age. A commentary by Tito Fojo and Christine Grady, "How much is life worth," in the Journal of the National Cancer Institute looked at the costs of a drug, cetuximab, used in the treatment of non-small cell lung cancer. Eighteen weeks of the cetuximab treatment extends life for an average of 1.2 months at a cost of $80,000. This means it would cost $800,000 to prolong the life of a patient for one year. "At this rate, it would cost $440 billion annually, an amount 100 times the [National Cancer Institute's] budget, to extend the lives of 550,000 Americans who die of cancer annually by one year," say Fojo and Grady.
Estimates of the price tag for insuring the 47 million uninsured vary widely, but the potential $440 billion savings from not spending on briefly extending the lives of cancer patients alone would pay for a huge chunk of the premiums for the currently uninsured.
In other words, perhaps 22,000 people would live each year because some others did not live one year longer. This is not to mention the pain and suffering and the reduced quality of life from a treatment that marginally prolongs life.
I might well choose to be put on the ice floe. [rc]
Ira Rosofsky is a psychologist and the author of "Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare" (Avery/Penguin).
Copyright 2009 Los Angeles Times
