Monday, August 10, 2009


Megan McArdle asks if it's fair to worry about the proposed end-of-life counseling for seniors.
No, and yes.  No, because I don't believe that they want to bamboozle people into ending their lives before they should.  It's quite clear from what Obama has been saying that he thinks there is a great deal of unnecessary care, particularly late in peoples' lives, that makes them worse off, or at least, no better off.
But though the implication that the Democrats are heartless technocrats is thoroughly wrong, I think the worry underlying it is legitimate.  First of all, Obama has made a number of missteps that paint a worrying picture of what he thinks an "unnecessary procedure" is.  Or at least worrying for seniors and other important voting blocks.  It is actually entirely true that if you're focused on cutting costs, you would never install a pacemaker in a 99 year old woman.  The number of quality-adjusted-life-years you could expect to get out of that procedure is not high.  Meanwhile, she's very likely to die on the table, wasting thousands of dollars and the last days of her life.  If Obama is serious about bending the cost curve, he will create some sort of agency that will say no.  And it's no good saying, as you do to under-65's, that this rationing will only apply to bonus care for people who currently lack insurance.  Cutting costs means taking options away from seniors.  You may think that they would be better off without those options.  But they clearly don't.

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