Average life expectancy is one of two statistics commonly used to compare the health-care systems of different nations. (The other is infant mortality.)
One of the puzzles about the U.S. system is that we spend far and away the most money per capita for health care, but we rank 50th in average life expectancy — after Macau, Malta, and Turks and Caicos, among others.
We are all familiar with statistics about how much of health-care spending takes place in the last year of life, and with stories about old people who are tortured with costly treatments they don’t want and which prolong dying but don’t extend life in any meaningful sense.
Certainly, ailing old people should be allowed to die in peace, if that’s what they want, and not be subject to excruciatingly painful surgeries and drugs that will do nothing for them. These are more the fault of lawyers than doctors. In our experience, doctors can be all too cool and rational in their thinking about the end of life. It’s fear of lawsuits (or, in a few cases, trolling for customers) that prevents doctors from behaving rationally when prescribing treatment for the old and terminally ill…
So what do we do about old people who, on balance, would rather get even older — whatever that means in terms of “quality of life” — than give up? This is one of the indelicate, unmentionable questions in the health-care debate…
In short, all the Republican talk during the health-care- reform debate about “death panels” was melodramatic and unfair, but not ridiculous. One way or another, holding down health-care costs will require policies that deny treatment to people who want it. And want it because it will extend their lives.
This goes on already, all the time. Health insurance companies have been known to deny payment for treatments deemed unnecessary. Age limits for organ transplants are another example. All policies that involve denying care because of “quality of life” considerations are, in effect, “death panels.” But no society can afford to give every citizen every possible therapy…
How do you persuade fellow citizens to accept limits on their right to consume health-care resources? The trick, we think, is to ask them when they’re healthy, not when they’re sick. If you think a $200,000 operation is going to give you a few more years to live, it’s going to be hard to convince you that it’s not worth the cost. But before then, when your odds of needing that expensive operation are the same as everybody else’s, you might well choose a system that offers a higher life expectancy, even though it costs less. In fact, why wouldn’t you?
Bloomberg View articles don’t always try to answer the questions they ask. This is one that sort of suggests alternatives; but, the final resolution isn’t settled yet. We’re stuck with politicians, insurance companies, healthcare corporations and their own versions of “death panels” in charge of negotiating with us.
You already know who has the most power in that dialectic – and it ain’t us.