Health Care Reform: A Test of Moral Leadership - Part I
Bishop Arthur Joseph Serratelli, Bishop of Paterson, New Jersey
Published on the Diocesan Website
July 27, 2009
On June 24, 2009, ABC aired a “town hall” meeting. Jane Sturm,
a member of the audience, related the story of her 105 year old mother. Five
years ago, the doctor recommended a pacemaker for her mother. However, a
specialist told her that she was too old. Another doctor disagreed. He gave her
mother the pacemaker and she continued to enjoy life. After relating the story,
the woman then asked President Obama how such a situation would be handled under
the new health care plan that he is strenuously endorsing.
The President responded by first speaking in general terms of providing good
quality care for all people. Beginning in this way, he could be saying that all
people, including our senior citizens, are entitled to quality care. Or he could
be saying that the quality care of all people requires us to weigh in the
balance the advantage of spending our resources on the elderly against the care
of younger people. We need to know clearly what he is proposing.
The idea that our senior citizens should accept the deteriorating health that
comes with age and not expect to use the best available medical advances to
prolong their life is not a new idea. Daniel Callahan is the co-founder of the
Hastings Center, an internationally-acclaimed research institute for biomedical
ethics. In 1987,he published his book Setting Limits: Medical Goals in An Aging
Society. He argues that the best way to cut the costs of the Medicare program is
to use the criterion of age for the most expensive technologies, even those like
lifesaving open-heart surgery. He strongly believes that “a good society should
use its resources to help young people become old people, but is under no
obligation to help the old become indefinitely older. The latter is a fiscal
black hole, abetted by endless new and costly technologies” (cf. The Economic
Woes of Medicare, newoldage.blogs.nytimes.com).
Already, in other parts of the world, the elderly bear the brunt of universal
health care. The U.K. health board approves or rejects treatments using a
formula that takes into account both the cost of the treatment and the number of
years the patient would benefit from it. On this basis, treatments for younger
patients receive approval more readily than those for the elderly. In 2006, the
board decided that elderly patients with macular degeneration would not be
treated until they went blind in one eye. The new drug to treat the disease was
just too costly. People with good conscience and clear minds loudly protested
such a decision and it was reversed. But this took three years.
At the present time, 27-30% of Medicaid spending goes for the care of those in
the sunset of life. When the government implements its reform of our heath care
system, will we be told that it is more cost efficient to spend our limited
resources on younger, rather than older people? Will the introduction of the
President’s new health program effectively do away with Medicare?
Continuing his remarks about the 100 year old woman and the pacemaker, the
President said, “End-of-life care is one of the most difficult sets of decisions
that we're going to have to make… At least we can let doctors know and your mom
know that, you know what, maybe this isn't going to help. Maybe you're better
off not having the surgery but taking the painkiller.” The President’s response
should make us question what is being proposed.
At what point does age become a determining factor in granting health care to
someone? Is the President’s response an indication that the new health care
proposal will reduce sharply the medical services for the elderly? Will it now
be government workers making the decisions on the basis of cost and age what
medications are to be approved, what treatments allowed, what surgeries
The answer to these and many other questions that arise in framing a reform of
our health care system ultimately puts to the test the moral leadership of our
elected officials. Will politics or principles prevail?
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