When Medicare was created in 1965, it wasn’t supposed to be a budget-buster. The health insurance program kicked in for seniors at age 65. The average American’s life expectancy was about 70. Many costly high-tech treatments hadn’t yet been invented, so medical science didn’t possess as many ways to keep sick people alive an extra few days or weeks or months or years.
Americans live a lot longer now. The average life expectancy is about 78, and far more people are living into their 80s and 90s.
That’s a good thing. But it’s also expensive. The longer you live, the more medical care you’ll need. And much of that spending comes, not surprisingly, in the final months of life. Care in the last year of life accounts for almost 30 percent of Medicare’s $447 billion budget. Much of it is warranted, but some — billions every year — doesn’t significantly improve health or extend life. What can we do about that? Or as one headline writer put it: “How to save Medicare? Die sooner.”
Life-and-death decisions on when to suspend medical care are made by a doctor, a patient and, often, a family. No American wants a federal bureaucrat intruding on that decision with a calculator and a whistle, tapping his foot impatiently.
That’s the fear driving the political furor over so-called federal “death panels” that former Alaska Gov. Sarah Palin and others suggest would be created by the House Democrats’ health care overhaul.
Let us first explain that there are no such panels in the House Democrats’ health care overhaul bill. What is in the bill is a provision that would pay doctors to counsel patients and families on end-of-life care. Those sessions could include such decisions as finding hospice care, or establishing a proxy to make health decisions when a patient no longer can. Medicare usually doesn’t pay doctors to have those conversations, although of course many do.
But what’s being proposed and how such a law could eventually be interpreted (or someday expanded) is the stuff of intense speculation.
For those who oppose more government in medicine (remember, Medicare and Medicaid already account for about a third of the nation’s medical spending), and with all the talk about bending the curve on spending downward, any end-of-life provision raises the specter of government rationing of seniors’ health care. That has stoked fear that end-of-life consultations could take on the veneer of an Orwellian imperative from Washington, not a voluntary option.
As we said, that is speculation. What we know is that such care has always been an excruciating balancing act. Families, patients and doctors reach painful decisions every day about whether to continue treatment in the face of steep odds or opt for a less aggressive course. What families and patients decide is often guided not just by financial concerns, but by religious beliefs and deeply held moral principles.
We believe these aren’t matters for government intervention. We do, though, believe that Americans need to acknowledge that better end-of-life planning would both assist the elderly and, indirectly, assure that medical resources are available for others who need care.
The House’s end-of-life provision isn’t likely to survive in any overhaul that lands on President Obama’s desk. On Friday came word that the Senate Finance Committee, working on its own bill, won’t include a similar end-of-life provision. Sen. Chuck Grassley (R-Iowa) said the panel dropped the idea because it could be “misinterpreted or implemented incorrectly.”
Smart move. These bills are ambitious, complicated and expensive enough without provoking fright about “death panels.”
But this issue won’t go away. When Medicare officials peer into the future, they behold a hemorrhage of red ink, thanks to aging Baby Boomers and a shrinking workforce of taxpayers. Without serious changes, Medicare spending will overwhelm the federal budget.
Agonizingly hard choices lie ahead.
In 1987, former Colorado Gov. Richard Lamm framed the issue succinctly in a Los Angeles Times Op-Ed: “We refuse to even discuss the reality that in an aging society, with exploding numbers of elderly and exponentially rising health-care costs and myriad other unmet needs, the level of treatment for a 90-year-old might be different from that for a 9-year-old. Should we not put our limited dollars into more quality of a healthy life rather than more quantity of a sick life — more to the recoverable young rather than the terminally ill?”
Obama and other Democrats want to curb health costs and expand coverage. They’re focused on more than costly end-of-life care. But if Americans want to improve the health care system, they do need to grapple with Lamm’s question.
