Life at All Costs: Part Three, The Politics

The political hyperbole surrounding the health care debate has shut off a frank discussion of how to approach end-of-life care

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The Fiscal Times
March 9, 2010

Representative Earl Blumenauer doesn’t remember the exact moment last summer when the death panel frenzy began. A thin, professorial-looking Democratic Congressman from Portland, Oregon, Blumenauer had authored a bipartisan provision in the House health reform bill that provided funding for end-of-life counseling to Medicare patients. Then the Republicans, led by Sarah Palin and others, seized on the provision as a foil to attack the bill by insisting the Democrats   wanted to kill old people to save money.

And so the “death panel” sound bite was launched like a sidewinder missile into the health care debate, with demagogues on one side accusing the other side   of wanting to kill granny.

"I didn’t mean to kill Grandma. I didn’t even mean to create death panels."
-- Earl Blumenauer

Truth and Consequences

“This was an outrageous distortion of the truth,” says Blumenauer, who wears bow ties and was first elected to Congress in 1996. “Even Sarah Palin supported the idea of end-of-life planning when she was governor of Alaska.”

Regrettably, this dust-up has obscured the real issue that needs to be discussed. As painful as it is, Americans need to address what to do about a tech-driven health care system that is able to keep dying people alive for additional weeks or months, often with a diminished quality of life, and at an extraordinary cost. Is this something we want? This conversation is particularly urgent as America’s senior population rises from about 13 percent of the population today to 20 percent by 2030, according to government projections

Until now, the U.S. has been able to pay its medical bills, despite the share our Gross Domestic Product spent on health care since   the 1970s doubling. But left unchecked, costs are likely to get significantly worse with a triple whammy of 78 million aging baby boomers entering their “medical years,” people living longer, and the ever-quickening pace of pricey technological advances.

Medicare costs are projected to nearly double during this decade, from $432 billion in 2007 to $830 billion in 2117. About a quarter of that spending will be devoted to caring for people in the final year of their lives. That will mean that just seven years from now, the government will be spending $208 billion annually on end-of-life care.

The Big Squeeze

Many lawmakers, administration officials and policy experts agree that tough political decisions need to be made soon to slow or reverse this growth trend. Maintaining the status quo will mean spending a full one-third of our GDP on health care in 2040, with the last year of life accounting for 2 percent of GDP by 2040. That’s a $500 billion price tag for dying just three decades from now.

Maybe, after a vigorous national debate, we will decide that this is fine — that this is how we want to spend our money. But there will be trade-offs as health care displaces education, transportation, housing, infrastructure, the environment and the military as national spending priorities.

The alternative to lavishing ever more resources on health care is to do something that does not come easily to the richest country in history: As individuals and as a society we have to learn to say no. Better yet, we need to do exactly what Earl Blumenauer   — and Governor Sarah Palin — proposed: informing seniors and the terminally ill and their families about end-of-life options so that those people who do not want expensive high-tech care can opt out in advance.

Bring this up in the wake of the summer of 2008, however, and you risk being called a Nazi. That’s essentially what Fox’s  Glenn Beck said after Palin’s death panels comments — that the Nazis advocated the elimination of the infirm to save money for the healthy. Other attacks on “Obamacare,” including some from Democrats, raise the possibility of rationing and health care being doled out by government bureaucrats.

David Ewing Duncan, The Fiscal Times
is chief correspondent of public radio's Biotech Nation, a contributor to Fortune, and a columnist for MIT Technology Review. He is also the director of the Center of Life Science Policy at UC Berkeley. The author of seven books, he's written for Wired, Discover