Single-payer. Insurance-based. Socialized medicine. Free-market reform. A lot of terms are flying in the debate over what shape healthcare reform should take in the U.S. Ask two people to tell you how it should be approached, and you'll get six answers. But at this stage in the process, it's important to put all ideas on the table. With that in mind, we present three viewpoints on what a new system should -- and shouldn't -- look like.
Here's a way for America to cut its spiraling healthcare costs: ice floes.
This idea isn't mine. It's President Obama's. Or rather, it's where we're likely to end up if the president prevails on Congress to pass the adventurous healthcare reform proposal currently being discussed, which the Congressional Budget Office estimates will cost about $1 trillion over the next 10 years. That's on top of Medicare's annual $327-billion budget, whose massive deficits, if they continue at the same rate, are predicted to bankrupt the Medicare system by the end of the next decade.
In looking for a way to fund healthcare, Obama has set his eye on the oldest and sickest. You see, according to the Centers for Medicare & Medicaid Services, about 30% of Medicare spending -- nearly $100 billion annually -- goes to care for patients during their last year of life. What if there were no "last year of life," the president seems to be asking. The Eskimos used to set their elderly and sickly adrift on the ice or otherwise abandon them during times of scarcity, and that, metaphorically speaking, is what Obama would like us all to start doing.
The scarcity of resources to pay for expensive medical procedures will only increase under a plan to extend medical benefits at federal expense to the 47 million Americans who lack health insurance. So why not save billions of dollars by killing off our own unproductive oldsters and terminal patients, or -- since we aren't likely to do that outright in this, the 21st century -- why not simply ensure that they die faster by denying them costly medical care? The savings could then subsidize care for the younger and healthier.
Sound too draconian? Enter the ghost of Obama's late maternal grandmother, Madelyn Dunham, who died of cancer at age 86 two days before her grandson's election to the presidency. Dunham's health issues first surfaced in a New York Times interview with the president on May 3. There, Obama questioned the appropriateness of a hip replacement that his grandmother had undergone after falling and breaking her hip shortly after being diagnosed with terminal cancer last year. The alternative to such surgery is typically excruciating pain and opiate dependency. Obama made it clear that he loved his granny and would have paid for the surgery out of his own pocket if he had to, but he said there ought to be a "conversation" over whether "sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model." Obama suggested that such decisions be made not by patients or their relatives but by a "group" of "doctors, scientists, ethicists" who are not part of "normal political channels."
Obama brought up his grandmother's hip replacement a second time in his June 24 town hall event on healthcare on ABC. The "question was," Obama said, "does she get hip-replacement surgery, even though she was fragile enough they were not sure how long she would last?" At that point I was thinking: If he says, "No hip replacement for you, Grams" one more time, it's going to be a drinking game.
An audience member, Jane Sturm, told the story of her 99-year-old mother, who had initially been turned down for a pacemaker on account of her age. Sturm's mother persuaded a second physician impressed with her joie de vivre to perform the life-extending operation -- and she's still hale today at age 105. "Outside the medical criteria," Sturm asked, "is there a consideration that can be given for a certain spirit ... and quality of life?"
Nope. "I don't think that we can make judgments based on people's spirit," Obama said. "That would be a pretty subjective decision to be making. I think we have to have rules that we are going to provide good, quality care for all people."