Ridiculous to Extend Life at All Costs

Friday, 07 Jan 2011 02:36 PM

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An Op-Ed by David Rivkin Jr. and Elizabeth Price Foley in the Dec. 30, 2010, Wall Street Journal reported, “ObamaCare created a commission — the Independent Payment Advisory Board — tasked with limiting spending on Medicare. Its recommendations will be binding, unless Congress can come up with equivalent cost-savings of its own. For the first time, an unelected group will be empowered to limit health spending for the vulnerable elderly.”

This brings us back to a discussion of “death panels.” In the original Obama legislation, there was a section “that would have provided for end-of-life counseling that might coax the elderly away from life sustaining but expensive treatments.”

Congress removed that part of the bill. But the article states, “The administration has resurrected that provision through regulations and Medicare will now pay for such counseling as part of elderly ‘wellness assessments.’ Yes, the ‘death panels’ charge is somewhat crude, but combine cost-based rationing with end-of-life counseling and well, here we are.”

The article attempts to draw a distinction between “government imposed rationing and treatment decisions in the private sector.”

Their reference is to treatment deemed “experimental” by the insurance company or “not medically necessary.” The authors say that’s OK because the policyholder agreed to the contract language giving the insurance company these powers, adding a comment worthy of Marie Antoinette, “You’re free to shop around.” Ridiculous.

I dare say every offered policy has these powers given to the insurance company. So the issue is really whether Medicare and Medicaid — government provided care — should have those same powers.

I am 86 and not yet on Medicare because I am still working. Under existing law, if I have private insurance, which I do, Medicare is not my first provider.

Irrespective of whether my provider is a private insurance company or Medicare, I believe there should be reasonable limits on insurance and government expenditures — while allowing individuals to use their own money without limitation — to extend life through hugely expensive drugs and extraordinary measures.

But expending government dollars (Medicare and Medicaid) is another matter and one that is subject to limitation. Those expenditures should, in my judgment, not be open-ended, but subject to panel decisions, appealable to the courts, which would decide whether an expenditure was warranted, taking into consideration the costs and benefits, including the quality of the extended life.

I recall discussing with friends about 30 years ago a case involving an infant who was described in the media as needing a replacement of every organ in the child’s body to live, at a cost of $300,000.

The participants in the discussion were split on whether the expenditure should be made. Today, the $300,000 cost would probably be a million or more.

In our current climate, every editorial writer and many government leaders are urging changes in the Medicare and Medicaid programs — meaning reductions in services and coverage — so as to keep the programs solvent.

Yet I do not doubt that the Wall Street Journal Op-Ed represents the opinion of many, perhaps even a majority in the U.S. with no limits on expenditures in extending the life of an individual.

My opinion is firmly to the contrary.

I believe that Americans are unduly afraid of death. Death is an inevitable part of life. We start the process of dying the day that we are born. What I hope is the Almighty does not engage in what I call "salami tactics" when he decides he wants me.

I ask that I not be sliced up and suffer in the process of dying. I think it quite reasonable that a panel be authorized to decide whether expenditures of public funds for extraordinary efforts to extend a life should be authorized, taking into consideration a number of factors agreed to by medical experts and ethicists including common sense, age, dignity, and other factors.

I do believe you can use your own money to provide services the government will not provide, as we are permitted to do in every other aspect of our capitalist economy.

Perhaps if we call the panels “life panels,” people who are put off by the very word “death,” would be able to examine the issue more responsibly, taking into consideration the needs of their fellow citizens covered by the same limited pools of money.

When I lay in bed in intensive care in New York-Presbyterian Hospital back in June 2009, having had a quadruple bypass with serious consequences that on two occasions caused my physicians to believe I was in danger of death, I was visited by Edward Cardinal Egan, a friend — I am Jewish — and I said to him, “Your Eminence, I am not afraid of death. I believe in God and the hereafter, and reward and punishment. I hope to be rewarded. But if the Almighty needs a good lawyer and decides to take me now, I am ready to go.”

Cardinal Egan responded, “Don’t worry, He’s not taking you. Your rates are too high.”

I am not lowering them in 2011. Happy New Year to all.

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