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Another Health Care Concern

by Vicki ThornI think we have to include another awareness in our thinking on health care. I have heard little discussion of euthanasia and yet, when we begin to rethink health care coverage and the costs, this issue is going to be front and center in decisions.The Boomers are aging! According to an old U.S. Census statistic, the estimated number of baby boomers in July 2005 was 78.2 million. 7,918 people were turning 60 each day in 2006, approximately 330 per hour. The projection is that there will be 57.8 million Baby Boomers aged 66-84 living in 2030, with 54.9 percent being female.As American society transitions through our newly minted health care system overhaul, how will this demographics challenge affect our ability to provide medical care?After all, it’s clear that this topic of the march of the Baby Boomers into old age has been on people’s minds for a while. Back in 1984, then-Governor Richard Lamm of Colorado said that elderly, terminally ill patients have a “duty to die and get out of the way” instead of have their lives prolonged by artificial means.“Let the other society, our kids, build a reasonable life,” he had told a meeting of the Colorado Health Lawyers Association.According to a Rand report four years ago, Americans’ life span has nearly doubled over the last century, from barely 49 years in 1900 to nearly 80 years in 2000. The implications? “Americans today can expect longer and healthier lives, but most of them will spend their last few years living with disabilities or chronic illnesses.”The report continued, “These changes are straining the U.S. health care system, which did not develop in the context of needing to serve large numbers of chronically ill and disabled individuals.”The same year as the Rand report, a USA Today article reported that over a quarter of Medicare’s annual $327 billion budget was going to care for patients in their final year of life.The article continued, “While not the major factor driving health care spending, costs involved in sustaining patients in their final days are likely to get a closer look by both Medicare and private insurers as health costs continue to spiral and the population ages.”Looking forward, who will make the judgement calls about what consitutes care for the elderly  especially those with dementia, diabetes, kidney disease or other debilitating diseases? Will families have a say? Or will it all be about “cost-benefit analysis” based on the individual’s “quality of life”?What about children who are born prematurely or with disabilities that slip through the net of prenatal testing, or who develop a problem shortly after birth? Their care is considerable and costly. Addressing such a scenario, Princeton’s utilitarian ethicist Peter Singer takes the “quality of  life” argument to the extreme, as he suggests euthanizing disabled infants not only to relieve their suffering, but also their parents’.“The difference between killing disabled and normal infants lies not in any supposed right to life that the latter has and the former lacks, but in other considerations about killing, Singer wrote in Practical Ethics. “Birth abnormalities vary, of course. Some are trivial and have little effect on the child or its parents; but others turn the normally joyful event of birth into a threat to the happiness of the parents, and any other children they may have.”“Parents may, with good reason, regret that a disabled child was ever born,” he concluded. “In that event the effect that the death of the child will have on its parents can be a reason for, rather than against killing.”You need only search the internet briefly to find more recent discussions of the economic cost of treating the most vulnerable in our hospitals. A January article from Politics Daily began, “Should the U.S. continue to spend ‘whatever it takes’ to help a premature infant survive? Is it cost-effective to give a 99-year-old woman a pacemaker? Answering these questions is not easy, as one person’s wasteful expenses are another person’s essential expenses.”It continued with an analysis of premature birthrates in America – and their cost to the health care system:How much does it cost to care for those half-million premature babies born each year in the United States? Business Week reported the National Academy of Sciences’ calculation: about $26 billion.What is the economic benefit? That’s difficult to say, but in a study published a decade ago, economists David Cutler and Ellen Meara estimated that technological advances added 12 years in life expectancy for each low-birth-weight baby. Thus, although neonatal technology is expensive, the authors calculated that the rate of return in these cases exceeds 500 percent. (The study excluded extremely low-birth-weight infants.)The value of the human person may soon carry a price tag!In the age of health care reform, we are going to be faced with questions that we never anticipated having to deal with. Who is qualified to determine which lives have value and which do not? We must remain vigilant and involved in the protection of all life … life of the unborn, life of the newly born and life of those who are frail and elderly.pastedGraphic.pdf(The views expressed in this column are those of the author and do not necessarily reflect the positions of Headline Bistro or the Knights of Columbus.)

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