Category Archives: the class divide

Not Death Panels, Just the Bottom Line

Scientists are working every day to prolong life, and to solve the thorny health problems that can make living longer expensive and perhaps miserable. I am not sure why they are doing this given the amount of frustration older folks seem to engender in the rest of the population. Old people are not really revered in this culture. Although we may love our own elderly relatives, we usually do not appreciate those who are not related to us. Old people are slow, they are sometimes cranky, they can be stubborn, they – well you know we can always find many traits to complain about. Watching my mom try to justify her existence at the age of ninety-four is sometimes illuminating and often poignant. She does not do much housework these days, but her guilt about being so “lazy” is endless. She keeps asking, “Why am I here?” But when we visit with her she is still quite good company, and it is so nice that she gets to enjoy her great grandchildren, who are very sweet with her.
However, I find myself asking a question that my mom would understand. Why are scientists fighting so hard to prolong life if no one really wants to put up with old people anyway? Many of the meds and procedures that are used to prolong life are so expensive that when people want to take advantage of them they find that their finances may never recover from the costs, or the insurance company is unhappy or totally unwilling to cover these pricey procedures. Are these life-lengthening discoveries only intended for the very rich? Is this another way we will widen the divide between the rich and the poor? If the bottom line determines who gets exceptional care and who doesn’t, it will turn out to be one way to thin out the ranks of the poor, however unintentionally. Common sense tells us that performing lots of procedures helps perfect technique and bring down prices. And the more people who test experimental meds the more data we have about their effectiveness and the price will also come down. These factors argue in favor of using the poor as somewhat expensive guinea pigs, unintentionally of course.
We probably cannot expect insurance companies to cover these procedures if they remain as expensive as they are and if they are needed by so many people in order to make it into that privileged group who live past their 90’s. What we resent is that the decision seems to belong to the health insurance companies instead of being a medical strategy planned between a doctor and a patient. Can we really be pragmatic about something that is so personal and emotional? I am sure of one thing. We won’t stop trying to figure out how to prolong life.  We are the generation that was told to “live long and prosper” after all. We are human. Our curiosity about our universe is hard-wired into us. We can’t stop trying to figure things out; we apparently must keep tinkering to change things that feel like absolutes. We are doomed to open Pandora’s Box over and over again and then we must learn to deal with both the good things and the bad things that pour out of that box into the world. Every discovery is a double-edged sword and living longer is no exception.
Based on the rising costs of health care and of the technology required for effective contemporary diagnostic tests and medical procedures most likely we will have to decide who gets to opt for an expensive procedure and who doesn’t? In fact people are involved in decisions like this every day. This decision may gradually (or quickly) become strictly one of finances. If you can afford it, you can have it. The meds or the procedure will be a luxury only affordable by the rich.
The option of a carefully designed procedure for euthanizing those who choose not to pursue expensive, radical, and/or painful end-of-life options might help level the field assuming that the rich might need to partake of this choice as often as the poor. But there is that double-edged sword again. There are so many opportunities to abuse a system like this.