the cost of end-of-life care.

So the new Japanese finance minister said something about not keeping old people artificially alive because it incurs unnecessary public costs, and some folks went predictably ballistic over it. See? This is an example of socialized medicine! They’ll just discard old folks when they’re no longer useful! ZOMG DEATH SQUADS!

Here’s the thing I don’t get about a lot of Conservatives, who are for the most part stringently against socialized health care:

Most of lifetime Medicare costs are incurred in the last year of life and palliative care. You can’t bitch about the insane costs of the health care system and then not have a problem with taxpayers being on the hook for a quarter million dollars so that a 93-year-old lady can live for another five months in a nursing home, bedridden and unaware of her surroundings. (Ask anyone who works in one—a lot of those places are about “let’s bill what we can while the patient is alive, because at death, that money is ‘wasted’.”) But suggest that it may not be a wise expenditure to buy Grandma another five months of morphine-hazed semi-sleep with a suitcase full of looted public cash, and people flip out. How dare you quantify the value of a life! That’s a slippery slope! You want to disconnect feeding tubes and respirators next to save a few bucks?

Well, if every life is so valuable that no amount of public money should be spared to extend the life of a 93-year-old hospice patient a few months, then STOP BITCHING ABOUT TAXES. And stop bitching about socialized health care. If five months of your grandma’s life are worth an unlimited amount of taxpayer cash, so are five months of life for the bum under the highway bridge who pickled his liver with cheap hooch for twenty years. Anything else is a slippery slope, right?

It seems to me that if the pro-life Conservatives were consistent in their views on the priceless nature of life, they’d be flag bearers for socialized medicine.

14 thoughts on “the cost of end-of-life care.

  1. Yeah, I remember the same thing in Quebec a few years ago. On average a person uses X$ of healthcare in their lifetime, with something like .8X or .9X being the amount spent the last year. ( forget the exact numbers but it was something of that order.)

    With modern technology and drugs they can keep you “alive” for a VERY long time.

    So frankly it behooves us all ( if only because YOU don’t want to spend the last 6 months of your life as semi-concious meat puppet, do you?) to have a “do not engage in anything more than basic palliative care” clause in your legal documents – and if you trust people to have your best interests in mind – give some other people the right to instruct the the medical people to back off when hope is gone.

    I do not think it should be the government or the medical people, though they can advise.

  2. I’m guessing that there’s a lot of folks in the argument that have never really been in a position to know what it’s really like to make a decision of that magnitude.

    Being in the small group of family members who – for executing a living will – must make that decision is not something that you want to have happen when it happens, never mind that you said, “yeah, sure…whatever; I’m honored that you asked” when the once-healthier person asked you to join the list of those to whom she wanted entrusted these matters. There’s a huge honking difference between trying to imagine what it’s like to be in that position – “Oh, I know what I’d do/say/feel” – versus actually having it happen that you are suddenly the family spokesperson in dealing with the hospital staff.

    So the decision was made; disconnect the machines. I met with the appropriate medical staff; the deed was done. She lived and got better and is healthier now than she was when she went in to the ICU. Who woulda thunk it.

    Still to this day and forever more that experience changed me. I not only made the choice to end the life of a dear oved one, but I also acted on it. Just because it didn’t end up that way doesn’t mean that it won’t affect you deeply, forever.

    I have a hard time taking sides in the argument in your OP, but I do agree very much that there is a bit of hypocrisy in some of the arguers. And I will have a long heart-to-heart with anyone who may be close to having to make such a decision themselves.

  3. Pro life conservatives are in favor of paying their own way, or not, and living or dying with the consequences.

    Once socialized, the medical costs AND CHOICES are taken out of your hands. Even a private billionaire theoretically no longer has access to any sort of private healthcare resources to buy his last five months at any price.

    • I’d be way more sympathetic to that argument if the same pro-life conservatives weren’t all about lack of choice when it comes to terminally ill peoples’ choices to treat their pain any way they want, or check out because they have no quality of life left by their own assessment.

      • Marko, I’ve been voting conservative since I turned 18, and before that since I was old enough to know the difference between Reagan and Mondale.

        I’m absolutely in favor of:

        (a) Not killing, on a whim, an infant who hasn’t yet had the chance to fuck up the world around him;
        (2) Killing, by court order and after due process, someone who has been proven to have fucked up the world around him;


        (D) Assisting in, or at the least not preventing, the death of a person that doesn’t wish to face a long-term (or any term) existance as a fucking meat puppet, or in long-term pain from a terminal illness. And that includes me. Actually, I don’t care what anyone else does, so long as I at least get a few minutes alone in a room sometime after the diagnosis but before they turn me into a chunk of zucchini.

        • *TWEEEEEET!*

          “Misuse of technical terms for emotional impact. 10 yard penalty. Also, check a dictionary for the definition of the words ‘infant’, ‘fetus’, ’embryo’, and ‘zygote’.”

          Vanishingly few “pro-choice” advocates have ever suggested that actual human “infants” (if you went and looked, you’ll know that that term only applies after birth) should be killed.

          • Perlhaqr, point well taken. “Infant” does refer to post birth. However, have you noticed that “fetus”, when used by someone not of the trained medical professional persuasion is invariably used when it has been deemed not human. Doctors and nurses are careful in referring to the object causing the pregnancy until they know what the woman’s intentions are. “Fetus”, therefore, is a form of hate speech.
            Curious how virtually every aspect of human activity is regulated, and this is the one place where somone has a choice (but generally speaking the man has no input beyond the obvious).

  4. I participated in just such a decision for a close & beloved family member who suffered a *massive* stroke, i.e. they were dead and modern medicine brought them “back” in machine supported “life”.

    It was their wish to not be on life support for any but temporary reasons. We waited a few days to make sure and then disconnected. They passed away.

    AW above – I agree, it’s a really dreadful decision to have to make. As much as I miss them, I know they would have done the same for me, and thank God. I too have no wish to hang indefinitely until everything just quits.

  5. As ILTim pointed out, many conservatives want the patient and the family to make the decision.

    I oppose socialized medicine for a simple, personal and selfish reason. If I’d been living in a England or Canada in my 30’s, I’d be dead. Scheduling a non-emergency Angiogram takes 17 months in Blighty. I had no clear symptoms, yet had a 99% blockage of the LAD (the “Widomaker”). Cheaper for society if I died waiting, but not so nice for me.

    In England, if you get cancer over the age of 75, they will proscribe palliative care only. My 97 year old neighbor, who is sharp as a tack and regularly beats me in cribbage and scrabble, and who just recently stopped doing her own shopping and yard work, would have been sent home to die in a morphine haze in 1994, the year her great-granddaughter was born. I’m not sure her family would have approved. I’m certain she wouldn’t have.

    That’s the reality of Socialized Healthcare. Call them Utilization Committees, call them Procedure Review Boards, call them Pre-authorization Programs, the reality is that the system has mechanisms to deny costly care when SOMEONE decides it’s not worth it. I don’t want that someone to be the same people that brought us the TSA and the IRS. Call me sentimental, but I want the family and the physician to make that call, without a bureaucrat interfering.


  6. I had to make that decision for my mother. It isn’t easy. All the same, I’d rather make the decision than the state.

    Even without the state making the decision, there’s plenty of pressure from the medical establishment for the elderly to not get care. I couldn’t believe one social worker who shoved a piece a paper in front of my mother (who had dementia) to sign saying that she didn’t want to be revived. This wasn’t in a hospital bed. It was at a routine appointment.

    You might want to find out what’s going on now before hoping we speed things up. And heaven forfend that the state gets to decide. The financial incentive for the state to pull the plug is enormous. It isn’t just that there is a slippery slope, which there is. It’s that there is such a hellish conflict of interest.

  7. As some professor said many years ago, the problem with socialized health care is that the demand grows infinitely while the resources are finite. He said the system will eventually end up in a huge crisis because of this imbalance.

    As nice as it sounds that every person gets the maximum care that theoretically could be provided, the reality is not so nice because resources are limited.

    When the society does not tackle this question of limited resources, doctors and other personnel end up prioritizing, making life and death decisions. It is not fair to burden them with that. The society should openly discuss these matters and set up guidelines.

    On the other extreme we could make medical care billable for full costs. Those who have the money or relatives with money will get medical attention, those with no money have to get by without health care.

  8. I’d settle for not haveing my tax dollars subsidize terminating pregancies. You want to kill your unborn kid, go right ahead- it’s legal. Don’t ask me to pay for it.

    Don’t ask me to pay for your health care in general, either, other than basic “scrape you up off the road and take you to the ER” ….. my resources are finite, unlike the “need” for health care.

    As for “When the society does not tackle this question of limited resources, doctors and other personnel end up prioritizing, making life and death decisions. It is not fair to burden them with that.”

    …. everybody makes those choices every day…… Docs just make more informed choices, when people have made poor ones/ avoided making good decisions …… that’s why they get paid the big bucks.

  9. I’m against socializing health care for one simple reason: the government will screw it up. Period. No one with a shred of common sense can look at all of our government programs in their current state and call them a success. They’re all broke, we’re over our heads in debt, and it only continues to get worse because no one has the backbone to start making the necessary cuts in spending. And now we’re going to pay for everybody to go see the doctor? Do you really want to turn your annual checkup into something akin to an afternoon at the DMV?

  10. The problems with government being in charge of anything are the lack of feedback, both positive and negative, and the scale involved.

    When an individual screws something up, the consequenses are usually immediate for him, and affect him or those in his immediate vicinity. When a Government screws something up, it gets paid the same, and the consequenses affect many more people.

    The same can be said for Bad Behavior: A lone nut might kill a dozen, but it takes a Government to truly put the “mass” in massacre.