August 31, 2011
IS THERE AN END-OF-LIFE RIGHT TO LIFE -- REGARDLESS OF COST?

ANALYSIS & OPINION BY RUSS STEWART

Contrary to popular presumption, the "truth" does not set one free. In fact, the "truth" makes people angry, for they believe what they wish, do what they want, refuse to admit that they might be wrong, and cannot comprehend why others do not believe as they do.

This column, contrary to the usual analyses of the inanities and insipidities of politicians, addresses a serious issue: Is there an end-of-life right to life? And, if so, who pays for it?

In short, is it fiscally justifiable -- and I avoid the aspect of morality -- to spend hundreds of thousands of Medicare (meaning taxpayer) dollars to keep someone's 80-year-old body alive for a few months or, at best, a few years? A knee replacement costs $75,000, a hip replacement $125,000, and chemotherapy for lung, pancreatic or liver cancer upwards of $350,000. Kidney dialysis can cost more than $1,000 a week.

Here's an example: Medicare shells out $1 billion annually in rental payments for scooters which assist those who are not ambulatory. Yet, according to a Dartmouth College study, 52 percent of the scooter recipients have not documented their need. Television ads hype "free" scooters, and Medicare blithely pays for everybody who applies.

Medicare pays an average of $11,000 annually for 40 million eligible Americans, and that outflow, roughly $500 billion, exceeds Medicare revenues generated by payroll taxes. In the next decade, as Baby Boomers retire and as longevity creeps into the 80s, an ever-smaller pool of taxpayers will be paying for medical care for an ever-widening pool of retirees. According to projections, by 2025 some 63 million Americans will be on Social Security/Medicare, amounting to 18 percent of the population, at a cost of $3 trillion.

Contemporary America is suffused, literally bursting, with "rights." There are governmentally enforced edicts, most based on court decisions, which accord special protection, entitlements or preferences to a plethora of particularized groups, based on accidents of birth (gender, race, disability, sexual orientation) or to those with certain predilections: There are "civil rights" for blacks, Hispanics and other minorities; there are "rights" for women, gays and the handicapped; and there are "rights" for those seeking abortions, keeping guns and voting. Most of those "rights" are cost-free, and it doesn't burden those outside the protected group with additional tax dollars, except special, costly accommodations for the handicapped.

However, within the past decade a new "right" has emerged -- the "right" to health care -- and that right is not cost-free.

According to the Dartmouth study, 30 percent of the medical procedures accorded retirees under Medicare have no tangible health benefit, and 46 percent of beneficiaries, when in need of care, must see 10 or more specialists. In other words, "defensive medicine" is now practiced, as the industry defends itself not against the Grim Reaper, but against the rapacious tort lobby and aggressive attorneys who will sue doctors, hospitals and nursing homes for any oversight or negligent act which precipitates death. Subjecting the patient to dozens of meaningless but expensive tests is the best defense.

Approximately $1.96 trillion of the current $3.6 trillion federal budget is expended for Social Security and Medicare, and that amount will increase by 2 percent to 5 percent every year. In a $15 trillion economy, more than $2.5 trillion is spent on medical care, emanating from Medicare, insurers and private pay. That amount will explode over the next decade.

In 1970 Social Security payments were 3.2 percent of the country's gross domestic product; in 2010 it was 5.0 percent. Medicare/Medicaid was 2.0 percent in 1970; it's now 4.7 percent.

Relative to retirees, "everybody wants a meaningful quality of life," observed a health-care consultant. "Unfortunately," he adds, "everybody wants to extend their life. Nobody wants to die. Nobody wants to forgo any procedure which will keep them alive. Nobody cares about the pain or the cost, since Medicare pays for almost all the bills."

The consultant noted that surveys have shown that 64 percent of retirees are satisfied with their Medicare coverage, but only 32 percent are satisfied with their private insurance coverage. "They love Medicare because it pays everything," he said. "They detest their insurer because they contest their claims."

Given that senior "entitlement" mind frame, it was not surprising that the Medicare "reform" proposals of Wisconsin Republican U.S. Representative Paul Ryan unleashed a firestorm of opposition. Ryan proposed that every American over age 57 be locked into the existing Medicare plan, with a 20 percent co-pay; that costs Medicare an average of $11,000 per eligible recipient. He also suggested that all others, upon retirement, chose a private insurer, with Medicare paying up to $8,000 in annual premiums and with a ban on lockouts for pre-existing conditions.

Some time around 2050, when nearly all of 2010's post-57-year-olds will be dead, the government would be out of the Medicare business and American health care would be wholly privatized. Absent a private-pay cap, Medicare expenditures will balloon to $15,000 per recipient by 2020, with Social Security /Medicare outlays approaching $3 trillion by that year.

Predictably, Democrats pounced on Ryan's proposal, claiming he would either "gut" or "end" Medicare. The issue was astutely utilized by Democrats in a June special New York congressional election in a Republican-held district, and a Democrat was elected in an upset. Ryan's "reforms" have not been heard of since, and the congressman will be targeted by Democratic, labor and liberal groups in his Racine-Kenosha district in 2012.

Ryan wisely eschewed a presidential bid, and not a single Republican contender has even mentioned the politically toxic issue of Medicare reform. Instead, they focus on "deficit reduction," even though the national debt of $14 trillion is 5.7 percent of the budget, while Social Security, pensions, Medicare and Medicaid are 56.5 percent of the budget.

Republican presidential candidate Ron Paul, a Libertarian, has a simple solution: Stop the wars. Of the budget's $1.3 trillion in discretionary spending, $900 billion is spent on defense and foreign aid. Bluntly, if America is to remain healthy and wealthy, it can't continue as the world's policeman.

According to the U.S. Centers for Disease Control, deaths are declining by 36,000 annually (to 2.4 million), while births have declined by 2.6 percent. One in 12 births are from illegal immigrants. Nevertheless, America's population of 308 million rose by 2.6 million in 2009, growing by one person every 14 seconds. In 2010 the U.S. birth rate declined to 13.5 births per 1,000 people, down from 14.3 in 2007 and 30 in 1909.

Life expectancy is increasing: Males now live an average of 75 years and females live an average 83 years, a development which the MacArthur Foundation predicted "will have a dramatic negative effect on health (and) the national economy." There are 5.7 million Americans age 85 or older; by 2050, they will number 19 million. Between 2000 and 2050 America will add 35 million working-age people (age 15 to 64) to the job force. Younger, less skilled workers will bear the burden of the oldsters' health-care costs.

There is the issue of causation. Obesity shortens life and creates medical problems. So do alcoholism and smoking. Those who most abuse their bodies will absorb the bulk of health-care costs, while those who remain fit will pay for their negligence. Is that fair?

And then there's the "golden parachute." Children covet their aging parents' inheritance. As an attorney, I hear the constant refrain: How can we keep mom's money and have the government pay for nursing home care? That involves Medicaid and public aid. Just conceptualize this: 20 million Americans in nursing homes, at a cost of $10,000 per month. That amounts to $2.4 trillion annually. If it's only 10 million, that's still $1.2 trillion. It cannot happen.

So what will evolve? If the Republicans win the presidency in 2012 and control both the U.S. Senate and the U.S. House, they could pass Ryan-like Social Security/Medicare reforms, raising the retirement-eligibility age and imposing some privatization. The Democrats would erupt in a fury, sensing political advantage, accusing the Republicans of "gutting" Medicare. In 2014, on a tide of seniors' votes, Democrats would sweep back into control of Congress and ensure gridlock.

If Barack Obama is reelected in 2012, with a Republican Congress, he would veto any Social Security/Medicare reforms.

Alan Grayson, a defeated Florida congressman, opined in 2009 that the Republicans' health-care program was "don't get sick," and if you do, "die quickly." Within a decade, due to fiscal imperatives, that will be the country's policy. Health care will be rationed. Terms like "need-based," "cost-effective" and "recovery-likely" will soon be operative.

For America's seniors, the golden age of "free" health care will remain in effect to at least 2020, but thereafter, life-extending procedures will no longer be affordable or available. Baby Boomers, be forewarned: Don't get sick.