
Wednesday, October 10, 2012
Taking place at Chicago Ideas Week:
Just because we can extend life, should we? The U.S. is expected to spend $2.8 trillion on health care in 2012. Medicare alone will cost taxpayers $590 billion, with over 25% going toward patients in their last year of life. If health care is a scarce resource, limited by its availability and our ability to pay for it, should government step in to ration care, deciding whose life is worth saving? In other words, how much is an extra month of life worth?

Chair in Policy Analysis, RAND Health

Ira W. DeCamp Professor of Bioethics, Princeton University

President and Chief Executive Officer, Pacific Research Institute

Chairman, Center for a Just Society

Author & Correspondent for ABC News
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Chair in Policy Analysis, RAND Health
Arthur Kellermann holds the Paul O'Neill Alcoa Chair in Policy Analysis at the RAND Corporation. Before joining RAND, he was a Professor of Emergency Medicine and Public Health and Associate Dean for health policy at the Emory School of Medicine in Atlanta. Kellermann founded Emory's Department of Emergency Medicine and served as its first chair from 1999 to 2007. As a Robert Wood Johnson Health Policy Fellow, Kellermann worked for the professional staff of the Committee on Oversight and Government Reform, U.S. House of Representatives. A clinician and researcher, he practiced and taught emergency medicine for more than 25 years.
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Ira W. DeCamp Professor of Bioethics, Princeton University
Peter Singer is the Ira W. DeCamp Professor of Bioethics in the University Center for Human Values at Princeton University. He specializes in applied ethics and approaches ethical issues from a secular, preference utilitarian perspective. Singer is well-known for his book, Animal Liberation, a canonical text in animal rights/liberation theory. From 2005 on, Singer has also held the part-time position of Laureate Professor at the University of Melbourne, in the Centre for Applied Philosophy and Public Ethics.
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President and Chief Executive Officer, Pacific Research Institute
Sally Pipes is President and Chief Executive Officer of the Pacific Research Institute (PRI), a San Francisco-based think tank founded in 1979. In November 2010, she was named the Taube Fellow in Health Care Studies. Prior to becoming President of PRI in 1991, she was Assistant Director of the Fraser Institute, based in Vancouver, Canada. Pipes' latest book, The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare, is a follow-up on her book The Truth About Obamacare (2010). She writes a weekly health care column called “Piping Up” for Forbes.com.
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Chairman, Center for a Just Society
In 2005, Ken Connor founded the Center for a Just Society, where he serves as the organization’s Chairman. Connor is affiliated with the law firm of Connor & Connor, LLC, a firm nationally known for its successful representation of victims of nursing home abuse and neglect. He served as Counsel to Governor Jeb Bush in Bush v. Schiavo, one of the country’s most watched cases in the long-running legal battle to protect a severely disabled woman, Terri Schindler Schiavo, from a court order to remove her feeding tube. Because of his advocacy on behalf of nursing home residents, the state’s Democratic Attorney General appointed him to Florida’s Task Force on the Availability and Affordability of Long Term Care.
Learn moreSo, we start by classifying the old as not worth the expense, then the IPAP decides that a mentally retarded person does not warrant the expense, then a person with certain physical disabilities or deformities are deemed unworthy. Where does it end? I believe history shows us where this disregard for life mentality leads. Recent history...say 1937-45 under the the National Socialist regime.
I call bs on Mrs. Pipes stories about Canada. I'm Canadian and I've never heard of any of the problems Mrs. Pipes complains about. I've had several family members who've had to deal with the medical establishment and most are more than happy with the outcome. I would suggests that her story is an exception, not the average
I was for the motion before and after the debate. I don't mean to disrespect the against panelist, but I believe that they were not at the level of the other side. The quality of their oratory was sub-par, Intelligence square needs to bring better representatives for the conservative side. Kellerman and Singer tried to engage them, but Pipes and Connor were arguing from a very emotional place.
The only concern I have for rationing is the possibility that it stifles innovation. For example, a lot of the safety technology we have in cars were first developed in luxery cars, which later trickled down to all of us, could the same dynamic be applied to healthcare?
The results of this debate were extremely disturbing. I don't want insurance companies or the government making these kinds of decisions.
A rationing board would not restrict the decisions around end-of-life. It would limit the government's (and taxpayer's) responsibility for paying for unlimited health care when the vast majority of doctors agree that further treatment will not lead to meaningful improvements in the quality of life.
Every individual has the right to live as long as they want to, but I can assure you that if those individuals and their families incurred the costs of that end-of-life care, they would not choose unlimited care.
Luckily, if some policymakers (party affiliation unnamed) are able to push their voucher plans for Medicare forward, we will be able to see what happens very clearly, sort of a "natural experiment." At that point, end-of-life care will be rationed for everyone, regardless of the ability to improve quality of life. It's sad that some don't see the contradictions in their policies...
But that's the thing, Willy. This is already happening - insurance companies are doing this all time time. Heck, the side against admitted this and even said that this should continue!
In fact, before Obamacare sick folks could be denied coverage (because it wasn't profitable to insure them), so plenty of people died that would otherwise have lived.
So really the question evolved to "Are people for government rationing over insurance companies rationing" and 81% felt that the government would be fairer and more sympathetic than private (profit motivated) companies.
I remember seeing a study that said that an average person contributing to MediCare contributes in the vicinity of $100K, but uses around $300K. Just how long do you expect this to last?
I am not saying it is impossible to increase MediCare tax, although I would rather pay for Johnny's new textbook than for John Sr.'s 3rd heart-lung transplant. Life was not meant to be infinite (you can wrestle with your god about that), and just because doctors can keep you breathing ad infinitum, does not mean that a society is obligated to pay for it.
Given that money available for government services is a limited resource, we should treat it as such. My proposal would be to define a maximum limit of medical benefits paid by the society for any given individual, and once the limit is reached, provide a person with means to end their life peacefully. "But this means that the rich will get to live longer", you will argue, and you are right, they will. They already drive fancier cars, live in fancier houses, vacation in fancier resorts, and use stay in fancier hospital rooms - that's life. Look on the positive side, they still do die, just like the rest of us, and I doubt that they insist on spending more money for the right to suffer for one more year.
Willy: Did you actually listen to the debate or read the transcript prior to posting your note? It really helps to do so.
Your life is already monetized by people you have never met, whether it's via whatever salary you're paid, taxes you pay on your property, the money given to your school district, or healthcare allotted you. To think otherwise is naive. Things in the medical industry are unsustainable as they currently exist, so changes must be made. What do the people who oppose the motion propose as an alternative?
Also, on a more lighthearted note - Ken Connor is a laughable panderer, referring to the "smoke-filled rooms" in the "federal city." You've got to be kidding me with this absurd rhetoric. And to bring in alternative energy, wow. *facepalm*
This is chilling. Only in Chicago would 81% of an audience approve of removing the decisions around end of life care to a rationing board. Maybe this seems like a good idea, but I can't imagine thinking so as they weigh the advantage of keeping you alive as you watch helplessly from your hospital bed.
A patient can always choose DNR. A patient can always request to die naturally. To invite a bureaucratic third party with implicit judicial and legislative authority - with an inimical interest in reducing costs - into the hospital room strikes me as a very dangerous idea.
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