Sunday, November 23, 2008

Why Discussing Limiting Medicare Benefits for the Elderly Is Worthwhile

While browsing the opinion section of the New York Times, I came across an interesting editorial about limiting benefits for senior citizens in order to make health care more effective. The article, by Daniel Callahan, can be found here: http://newoldage.blogs.nytimes.com/2008/11/13/heart-surgery-how-old-is-too-old. Callahan, in essence, argues that we should limit expensive treatment given to the elderly in order to cut costs upon the Medicare system and avoid otherwise necessary increases in taxes.
Callahan succinctly explains the burdens levied upon the Medicare system by expensive treatments for the elderly. While I believe some will find that assessing life-saving treatments as “burdensome” or perhaps “wasteful,” as Callahan certainly implies, the cold numbers are extremely persuasive. And they should at the very least not be overlooked. So let’s examine the numbers. The Medicare program cost $429 billion in 2007, and has a 7% annual cost increase. Thus, by 2017, it should cost $884 billion. Most importantly, by 2017, the Medicare program will be bankrupt.
Now, how do expensive treatments for the elderly factor in? While Old age itself is certainly not a barrier to coverage. In fact, the average age of those undergoing heart surgery, organ transplantation, kidney dialysis, and cancer treatment is continually rising, Callahan explains. Essentially, science is finding ways of keeping the sick or weak alive longer. It is important not to forget that just a few decades ago, the methods used to keep people alive were not even dreamed of. Significantly, not only are people staying alive longer, but many elderly people are opting for expensive, aggressive treatments, even when the likelihood of success is dismal. I personally do not blame anyone for this decision; if your life is on the line, wouldn’t you opt to try to extend it? But the fact remains: people aren’t likely to simply roll over and die. If treatment is available, they’ll want it.
Thus, the effect on the system is significant. Callahan writes that the average Medicare recipient has to spend between $5,000 and $10,000 for treatment not covered by the program. Doctors are becoming reluctant to take on elderly patients because they are often poorly reimbursed. Out of pocket costs for drugs and co-payments are expected to jump anywhere from 31 to 60 percent in 2009 alone. Therefore, if I interpret the numbers correctly, it seems that not only is the system going bankrupt, but recipients are facing significant price increases or will have to pay out-of-pocket because the system itself cannot afford to treat them.
In light of these numbers, Callahan argues that limiting benefits based on age should be done, because it is not likely that the other possible fix (raising taxes) will be seriously considered in the near future. I thought the most important part of Callahan’s argument was the simple fact that he acknowledges that age-based rationing will not be accepted. Thus, I think he effectively removes that contention from the argument. However, his point is that we can’t completely factor out cost and age from the equation. Congress has refused to allow Medicare to take costs into account in its coverage decisions. But should it play some role? Should age? Callahan’s answer is emphatically yes. I agree with Callahan’s sentiment that our society “can not, and should not, promise open-ended, progress-driven medical care that is indifferent to costs.” Because in the real world, age does matter. It matters in that there are more and more elderly people undergoing expensive care, putting increasing burdens on a system that is already on the brink of collapse. This is a practical way to save money. This is not a proposal to eliminate access to benefits for the elderly altogether. It's a proposal that cuts extremely expensive treatments that likely either won't work or won't work for long. And freeing up cash helps the system. And, although now I am editorializing, I wonder: at the end of the day, what is better? A functioning system that, admittedly has its flaws and is imperfect? Or no system whatsoever? I say an imperfect system.
Keep in mind, age isn’t the only factor. Likelihood of success, cost, and patient wishes should all weigh in. Perhaps a government-regulated healthcare system would solve ALL of these problems? But we’re not there yet, and I think it is important to try to make our system work until we get there. I think Callahan’s point is that we need to consider solutions that may not be popular or pleasant, not because they will ultimately be implemented, but because they are often realistic and therefore, a reasonable starting point to formulate serious solutions.

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