Whatever You Do, Don't Get "Too Sick"

Something potentially sinister is emerging because of the health care debate we're failing to have.

No matter which candidate you favor or whose plan you back, if you look at the spiraling costs of medical tests and doctor visits, you have to wonder who will be sacrificed.

Yes, that's what I meant - sacrificed. Now we all know life doesn't go on forever, but a recent Wharton/Stanford study proposes an "empiric estimate of the value of life" that is more than a little unsettling.

The co-authors of the study conclude from their findings that there must be cost effective thresholds of a sort to determine whether to keep patients alive. If a dialysis patient, for example, were to go beyond this threshold, treatment would be terminated and they'd die. In what the researchers call a "pragmatic and modern" application of social justice they advocate thinking about the percentile of patients up to which medical coverage would be provided.

As a business professor, I understand purely economic vantage points and credit the researchers for their work. But my ethics and preventive medicine background render things less clear in this domain. One more "quality-adjusted" year of life can be priceless in what can be accomplished and enjoyed.

When I was diagnosed with breast cancer at age 32, doctors wanted to save me. They were totally vested in the enterprise. I could feel that. I'm still young enough to find a doctor who cares. But it's getting harder. And any of you who have had or have serious illnesses and are, let's say, over forty know what I mean.

So while universal health care is a very good thing, the presidential candidates need to grapple with reality. How will we avoid becoming a society that blames very ill people for depriving those who are less ill? How do we avoid health elitism among those who have not yet come up wanting in the coin toss of life? Will there be thresholds? Who will define them? How do we avoid bias?
And why not work diligently to lower what have become ridiculously high health care costs instead of picking people to die?

My mother lived twenty-six years after five cerebral hemorrhages and coma to walk, talk, laugh, drive and even work again. Someone gave the order to move her out of intensive care at age 52 because there was no hope when I, barely out of my teens and not then "trouble", nonetheless started yelling about mercy killing in the hallways of a Catholic hospital, my determination to contact the bishop and write to the Pope. My mother stayed in intensive care and lived.

But had some "objective" person with a clipboard looked at her potential for a worthwhile "quality-adjusted" life prior to that success, she would have been deprived of it under the guidelines we may soon face.

Who's to say how low the thresholds of sustainable life will go to make health care cost effective? They might continue to move until many of us and those we love with years to live will not be given that opportunity.

Barack Obama proposes for chronic illnesses improvement of coordination and integration. Hillary Clinton provides more details, but neither addresses the dilemmas described above. John McCain is simply going to give us too little money to even purchase health care. I guess that's one way of solving the problem.

It's time for some serious thinking on issues like who among those with chronic disease will be allowed to live and who allowed to die. Better sooner than later when people who could enjoy long, reasonably healthy lives are deemed expendable because according to some statistically impressive callous calculation, they simply aren't worth saving.

Dr. Reardon also blogs at politicsdoc.