The Harsh Reality

Daniel Callahan explains his position on rationing health care for the elderly: is 80 years of age where we draw the line?

There are in the end only two decisive ways to control Medicare costs: raise taxes, cut benefits, or both. Neither political party is game to raise taxes, for Medicare or anything else. As for cutting benefits, Congress this year voted for $20 billion in new expenditures, ignoring the need for frugality.

Yet there is nothing of importance left to do other than to reduce benefits. That move would mean denying elderly patients both what they might want and need. Or are there some less draconian alternatives? A long-standing refrain of many older people is that much money could be saved if they were more easily free — by living wills or the appointment of surrogates — to turn down expensive life-prolonging measures of dubious benefit. Maybe so, but some studies have shown that would not make much economic difference in an overall Medicare budget of hundreds of billions.

More important, despite what they say in advance, many elderly people will in fact choose to be aggressively treated for a critical illness even when there is a good chance it will not save them — but just might. Doctors endlessly complain to me that excessive patient expectations of medical miracles, or those of their family members, make it harder, not easier, these days to curtail aggressive treatment. Not all of us can resist the lure of a slightly longer life, despite what we may have said in advance.

Ninety seems like a safer bet to be palatable right now than eight as an age limit, but his points are worth pondering.

-Wes