Wednesday, December 3, 2008

Life By the Pound

There is a very interesting story in today's NY Times about the British health care system. They have appointed a commission to do benefit/cost calculations on expensive treatments, particularly ones that will extend life for fairly short periods of time. The story begins with the decision to deny purchase of a treatment that would cost $55k and extend a patient's life by 6 months.

As the cost of health care continues to rise, these are the types of difficult decisions that societies will have to make. I often tell my students that they will have to decide how much life my generation is entitled to, as the current Medicare system will be come far too expensive as new treatments extend life, health costs continue to climb, and we Baby Boomers enter the system. (I suggest the best decision will be not to cure us but to give us really good pain drugs...we are the "just say yes" generation!)

Here is one particularly interesting quote from the story:
After consulting a citizens group, the institute decided that the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old.

A few months ago I wrote about my outrage that one of my students was in danger of losing his job and having to quit school because he is sick. This kid is a productive member of society trying to become more productive....which everyone would agree is good for both him and our society. But, he is in an income trap where he can't afford health insurance, but makes too much money to be given it for free. Meanwhile, both of my parents enjoy excellent coverage via Medicare.

Now, think about the efficiency and logic of the above paragraph. We are willing to spend almost unlimited amounts in this country to extend the lives of seniors, whose productive years are behind them (sorry Mom and Dad!), while letting those who are productive, or will be, fall through the cracks of our system. And, based on the above quotes, the English also agree that it is willing to spend as much as someone in their later years as on a child. On a strictly economic basis, this is crazy.

I am not advocating killing off the elderly. I am, however, attempting to point out the difficult moral and economic decisions that will have to be made if we want to prevent most of our national income being spent on medical care. Does is make sense to spend more on extending the life of a 90 year old than on keeping younger people healthy? And for how long and at what cost? Meanwhile, we are so "moral" that we won't even allow people who are in great pain and want to die to do so, yet not so moral that we make sure every kid in this country has proper care.

These are tough decisions that will have to be made, but will be delayed until the problem becomes a crisis. No politician wants to talk about this stuff.

No comments: