Medicare spent $50 billion last year to care for patients in the last two months of their lives. As “60 Minutes” pointed out on Sunday, “that’s more than the budget of the Department of Homeland Security or the Department of Education.” It means we give liver transplants to the terminally ill, defibrillators to those with untreatable cancer. It means we use lots of money and resources, as if we have an endless supply of both, in order to briefly delay the reaper, or avoid looking him in the eye.
As a nation, perhaps that is how we want to spend our money. That’s fine (if foolish). But we have so far reached that conclusion without having an honest debate over the benefits and costs. As others have pointed out, we condemn “rationing” as if we don’t already do it. For example, instead of buying some of those defibrillators and paying for some of those transplants, we could computerise America’s medical records. At this time, someone holding up a placard might accuse me of “killing grandma”. In reality, though, my decision would save many more grandmas—a study found that between 2002 and 2004 nearly a quarter of Medicaid beneficiaries died due to safety incidents, many of which were likely preventable with better record keeping. But improving record keeping doesn’t quite have the emotional appeal of caring for the elderly. So we give grandma her procedure, whatever it may be, while ignoring the fact that more money spent in one place means less money spent in another. Ignoring that every excessive procedure comes with a cost, in terms of the nation’s overall health.
If nothing else, let’s debate this (with Godwin’s law in mind). I’m not arguing for a “Boomsday” scenario where we start enticing the elderly to end their lives early. But I do think we should become acquainted with the reaper before he comes for us. Not only will it allow us to have more honest discussions about how we use our limited resources (by the way, feel free to use your own money to pay for any care you want), but it will also lead to more dignified deaths. I know that sounds odd, but so does this statistic presented by “60 Minutes”: “A vast majority of Americans say they want to die at home, but 75% die in a hospital or a nursing home.” That is because we and our loved ones often do not consider death before it is upon us. That was the idea behind the so-called “death panels”—to make dying more dignified, not to bring it on more quickly. As a nation, we’ve so far dealt with that topic in a very immature way.
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