March 8, 2010
"Death panels" aren't such a terrible idea after all
This story serves to demonstrate why, I think.
The people responsible for making medical decisions for a given patient are, in order, the patient, and then either the patient's next of kin or the person/persons the patient has legally designated to make such decisions. In one sense, this is perfectly rational, as the people with the most invested are the ones responsible for the tough decisions.
But in another sense it's completely irrational, because that very investment makes it impossible to make objective choices.
End-of-life issues are some of the hardest decisions people will face. Part of the problem is that we have no real idea how much the medical care we consume actually costs, but I think what this story serves to highlight is that even if we did, we have a terribly hard time making decisions which take them into account, especially when other people will wind up paying most of them anyways.
Six hundred thousand dollars for what may or may not have given a single man an extra few weeks or months of life? Really? I can think of no ethical system under which this is the right thing to do. But the people who make these decisions have everything to gain and nothing to lose. It's someone else's money, so why not spend if there's any chance that a loved one will live even another few hours?
All of a sudden the idea of bureaucrats making decisions about end of life issues doesn't seem quite as far-fetched or unnatural. If you want someone else to pay for your health care, it's only reasonable to expect that that someone should have some say on what gets spent and what doesn't. If the article is correct, 25% of Medicare spending--about $100 billion a year is spent on the last few months of life. Hospice costs a mere fraction of what a full-court hospital press costs. So we're looking at saving tens of billions of dollars every year, possibly more than that if we cut things off earlier.
Everybody dies. Bankrupting our grandchildren won't change that.
