How “old” is too old for a fellow citizen to receive expensive medical care? Does it matter, if someone else is paying the bill?

This question about the age at which a fellow citizen should or should not receive medical treatment, especially the expensive treatments available these days, has been debated since the mid 1980s. The initial catalyst for increase healthcare costs years ago was the Medicare Act in 1967 but costs of care and premium did not really begin to accelerate faster than any other facet in our economy until the 1980s. 

For the past 35 years Insurers as well as the CMS/Medicare/Medicaid have analyzed the cost factors of delivering the healthcare people require or want. But with the advances in technology, medicine, new treatments for many diseases and expected life span into the 80s, controlling or even slowing costs has been a losing battle.

In 1990 the healthcare industry and all Payors acknowledged that the greatest volume of healthcare cost is consumed during the first year of one’s life and the last year of one’s life. When we consider the health issues of many expecting mothers, premature births, drug births as well as the heroic healthcare actions usually taken in the last year of one’s life, it’s easy to agree with that statement.

We need to remember what we’ve Posted before and what hinders cost control:

  • People are living longer and doing so with better standards of living.
  • Unlike any other population on the planet, Americans want (expect) to live forever and think their healthcare should help them achieve that goal.
  • The total cost of healthcare is the unit cost of care multiplied by the number of units of care consumed.
  • Americans want the best healthcare money can buy.
    (as long as it’s someone else’s money is paying the bill).

The last one is snarky to be sure but it’s also key to the issue at hand in this Post. Don’t think for a minute that this statement about “the best healthcare money can buy” is not true. We have all heard someone say that or maybe said it ourselves.

But much has changed since 1990 to our population, to Medicare, to Medicaid, to technology, to premium cost and to the changing opinion that quality of life may be more important than quantity of life.

My opinion on this issue of “how old is too old” has changed over the past twenty years. Partly, if I’m honest, because I’m getting near an age where younger folks might ask “why does he need a particular treatment”. Ouch, that hurts.

But the bigger influence to my opinion are the advances in medicine, in technology, and the life styles Seniors are enjoying these days.

I could list for you dozens of examples of good and poor decisions:

  • My Mother-in-law had knee replacement at age 86. She had always been active and loved to walk to visit friends. She lived to age 96 and was able to enjoy her mobility until the very last year of life. Good or poor decision?
  • A 100 year old lady had knee replacement at age 98. She lives in a nursing home and uses a wheel chair but she can walk if she desires. Good or poor decision?
  • A 90-year-old mother was in a coma after having a major stroke. The doctors said she had brain damage so she needed to be put on a breathing machine or she would probably die. The family said no because they remembered Mom saying that she did not want to live like that. Their mother died peacefully a few hours later.
    Good or poor decision?
  • I’ll tell you about my Mom below.

Many treatments or services are getting common for elderly above 80 years of age. Knee and Hip replacements are common, heart regulators or surgery are common, and cancer treatments are common just to name a few.

Those who face this dilemma about elder care must weigh their decisions hindered by so many unknowns and so many factors. Not the least of these factors is the financial motivation of the doctor or facility. Healthcare providers and facilities get paid by the procedure or days spent regardless of the outcome. So, as hard as it sounds, decision makers must weigh these factors along with the quality/quantity of life for a love one.

According to the U.S. census bureau, Americans aged 85 and older make up the fastest-growing segment of the US population. The number of Americans 100 or older is expected to rise from around 65,000 today to over 208,000 by 2030. 
So, these decisions are going to be more frequent and more difficult to make than ever before.

Many believe that we each should be able to decide when enough is enough. I mean, if one’s quality of life is not good, if one’s siblings and friend are all gone then why should someone endure a painful and depressing last few months on earth?

I wonder how many of our Seniors feel that way today although they do not verbalize it to their families. Even if they are a joy to be with the Senior may feel like they are a burden to their family. I truly wonder what each of us would choose if we could say a good bye to our family then quietly take a pill that painlessly let us drift off to forever. Would you do that?

It’s a tough question both emotionally and spiritually.

But is it a tougher question than deciding if your love one should or shouldn’t receive a particular treatment, regardless of cost, that might or might not provide a quality extension of life. 

My Mother smoked cigarettes for over 50 years then contracted a serious “brand” of lung cancer at age 66. The cancer Docs said a vigorous treatment of chemo and radiation treatment could extend her life by 18 months but without the treatment she would only last about 9 months. She/we elected the treatment which brutalized her body and mind making her feel miserable 20+ hours each day. She died 9 months later, almost to the day of that conversation with the cancer Doc.
Had she known that she would only last 9 months regardless of treatment, she might have altered her decision. She may have chosen to live “normally” without the side effects of the treatment until she past. I’m sorry, that’s a tough story.

The point is these decisions are extremely difficult. The treatments cost insurers and Medicare $billions each year. But each patient and each family may approach it differently with a different set of circumstances. No judgement here, just information for thought.

But, as we discussed before, we can impact healthcare cost and premiums for those years between birth and death if we stop politicizing the subject every damn time.
What do you think? You know that we’re all in this together, right?

Until next week.

Mark Reynolds, RHU



2 Responses to “How “old” is too old for a fellow citizen to receive expensive medical care? Does it matter, if someone else is paying the bill?”

  1. Deanna O'Leary Says:

    Great post!

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