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Health Care Reform: A Test of Moral Leadership - Part I

On June 24, 2009, ABC aired a “town hall” meeting. Jane Sturm, a member of the audience, related the story of her 105 year old mother.  Five years ago, the doctor recommended a pacemaker for her mother. However, a specialist told her that she was too old.  Another doctor disagreed. He gave her mother the pacemaker and she continued to enjoy life.  After relating the story, the woman then asked President Obama how such a situation would be handled under the new health care plan that he is strenuously endorsing.
 
The President responded by first speaking in general terms of providing good quality care for all people.  Beginning in this way, he could be saying that all people, including our senior citizens, are entitled to quality care.  Or he could be saying that the quality care of all people requires us to weigh in the balance the advantage of spending our resources on the elderly against the care of younger people.  We need to know clearly what he is proposing.
 
The idea that our senior citizens should accept the deteriorating health that comes with age and not expect to use the best available medical advances to prolong their life is not a new idea.  Daniel Callahan is the co-founder of the Hastings Center, an internationally-acclaimed research institute for biomedical ethics.  In 1987,he published his book Setting Limits: Medical Goals in An Aging Society.  He argues that the best way to cut the costs of the Medicare program is to use the criterion of age for the most expensive technologies, even those like lifesaving open-heart surgery.  He strongly believes that “a good society should use its resources to help young people become old people, but is under no obligation to help the old become indefinitely older.  The latter is a fiscal black hole, abetted by endless new and costly technologies” (cf. The Economic Woes of Medicare, newoldage.blogs.nytimes.com).
 
Already, in other parts of the world, the elderly bear the brunt of universal health care.  The U.K. health board approves or rejects treatments using a formula that takes into account both the cost of the treatment and the number of years the patient would benefit from it. On this basis, treatments for younger patients receive approval more readily than those for the elderly.  In 2006, the board decided that elderly patients with macular degeneration would not be treated until they went blind in one eye.  The new drug to treat the disease was just too costly.  People with good conscience and clear minds loudly protested such a decision and it was reversed.  But this took three years.
 
At the present time, 27-30% of Medicaid spending goes for the care of those in the sunset of life.  When the government implements its reform of our heath care system, will we be told that it is more cost efficient to spend our limited resources on younger, rather than older people? Will the introduction of the President’s new health program effectively do away with Medicare?
 
Continuing his remarks about the 100 year old woman and the pacemaker, the President said, “End-of-life care is one of the most difficult sets of decisions that we're going to have to make… At least we can let doctors know and your mom know that, you know what, maybe this isn't going to help.  Maybe you're better off not having the surgery but taking the painkiller.”  The President’s response should make us question what is being proposed.
 
At what point does age become a determining factor in granting health care to someone?  Is the President’s response an indication that the new health care proposal will reduce sharply the medical services for the elderly?  Will it now be government workers making the decisions on the basis of cost and age what medications are to be approved, what treatments allowed, what surgeries performed?
 
The answer to these and many other questions that arise in framing a reform of our health care system ultimately puts to the test the moral leadership of our elected officials. Will politics or principles prevail?
 
 
 
                                       To be continued
 

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