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Wednesday, August 12, 2009  

Let's Make a Deal

OK, conservatives, here's my best offer: for every 150,000 people our death panels get to euthanize, you get to pick a country to invade.

Or alternatively, you could acknowledge the reality that as we get better at defeating or indefinitely postponing various causes of death, we will need to impose some reasonable limits on publicly-funded end-of-life care. It seriously distresses me that on the last day of my 85-year-old grandmother's life, there was still in essence a blank check for care at her and her doctors' disposal, had they wished to use it, while if my son were to fall seriously ill and our insurance company figured out a way to cancel our policy, we'd have no guarantee at all. We'd have to pauperize ourselves (not that hard, I suppose) to qualify for Medicaid or hope that we could get on the rolls for SCHIP, but there would be no federal guarantee that my son would get basic care as there was that my grandmother could get pointless care.

This is not to say that I'm unhappy about Medicare, the VA, or any of the programs that sheltered my grandparents in their old age. I thank God for them. But if we're going to extend some basic security of health care to everyone, as we can and must, we will have to limit what a public system will pay for.

So I'm imagining some combination of age, underlying health, and short-term prognosis at which Medicare says that from now on, it's all palliative. The problem is that some people won't accept this and will insist on continuing to "fight" a terminal illness or an eventual crisis (hint: they will lose). For that, we'll need to have some way for people to save in advance for the expenses associated with high-cost, low-benefit end-of-life care. Have a tax-advantaged savings account (the catch: if you don't use it, it all goes away when you die). It could be a CD, like some people have for burial expenses, or maybe a version of life insurance, or even a non-profit group plan, with the DOAs, accident victims, and so forth cushioning the premiums. The "pro-life" movement could even get out of the business of trying to dictate to health care providers and get into the business of funding giant corpse farms maintained by elaborate life-support systems.

I haven't been convinced that physician-assisted suicide is a good thing, and I'm inclined to take a fairly expansive view of what constitutes helpful end-of-life care. A few months, spent in reasonable comfort, can be a real blessing. But at some point the public can't foot the whole bill. If people are so anxious about death and so stuck with magical thinking about it, they can figure out a way to pay to keep it at bay a little longer.

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posted by Benjamin Dueholm | 5:52 PM
Comments:
I think you nailed this issue perfectly in your second paragraph. I hope you don't mind if I repost that part.
 
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