Tribe Elder: Today I, your eldest elder, am...(pause)
Tribe Member: (whispering) You’re 72.
Tribe Elder: ...72 years old. I have lived long, and witnessed many wonders. But now, I am old, I am slow, and I get up 16 times in the middle of the night. I can no longer keep up with the herd. I straggle behind, attracting predators, endangering my brethren, and making us late for everything. Don’t act like you haven’t noticed. Therefore, I wish to be hurled from the highest cliff into a tar pit.
Tribe Elder: (waves for silence) But before I go, I now decree that, from this day forward, all dinosaurs, upon reaching their...(hesitating)...oh, 72nd birthday shall be hurled into a tar pit. And this day shall be known as...Hurling Day. And so that this tradition remains holy and solemn, each dinosaur shall be hurled by a loving relative.
Spectator: (raising hand) Uh...excuse me.
Tribe Elder: (pointing) Yes? In the back.
Spectator: Uh. So this won’t be a total loss, could you make it that guys also get to hurl their mother-in-laws?
Tribe Elder: Sure, why not?
(From a 1991 episode of the ABC television series Dinosaurs)
True to our national values, the antediluvian-American family at the center of my favorite Jim Henson Productions series chose to keep Grandma around rather than hurl her. We are fond of our senior citizens. Programs like Medicare and Social Security that provide for the elderly are “entitlements,” designed to provide benefits regardless of budgetary constraints.
The Obama administration and congressional Democrats are aggressively pushing for health care reform this year. They want to provide medical coverage to nearly 50 million people who currently lack it. They want to constrain the nation’s rapidly rising medical spending. And they want to somehow reconcile the built-in conflict between these two objectives. As with any plan to make ends meet, tax increases are likely to be a big part of the Democrats’ solution to this fiscal quandary.
There are a lot of reasons why health care costs so much. One that gets too little attention is the disproportionate amount of money spent during the last six months of life, when in many instances there is little that doctors can realistically do other than relieve suffering. But dying patients receive many procedures that do not significantly prolong life or relieve pain. Because of the long average lifespan in this country, much of this questionable effort is directed toward the elderly.
Any serious effort at cost control is going to force us to ask ourselves uncomfortable questions. Our country probably can afford health care for everyone, but it cannot afford unlimited health care for everyone. Where, and how, do we draw the lines?
A biventricular pacemaker can prolong and improve the life of a patient with congestive heart failure. The devices have become increasingly popular in the past five years as studies have shown that they can be more effective and less costly than long-term drug therapy...but they cost between $20,000 and $30,000.
The economic case for these devices is easy to make for a patient who is 70 years old. But what about a patient who is 80, or 90, or 100? At some point, a rational allocation of resources would deny coverage in these situations to leave more money available for younger patients’ care. Or to leave more funds for education, workplace safety, road repairs and other societal needs. Instituting effective cost controls will require us to address these competing considerations.
But it is very hard to be rational when Grandma is sick. Our impulse is to do what we can for her, even if we know that age or other medical conditions limit the benefits of anything we do. We don’t want to say no to Grandma. Turning her down makes us feel as though we are hurling her into that tar pit.