Not the Timely Issue

But a really good, complex, lengthy consideration of the issue. Click on the link for many more nuances:

Meet the Real Death Panels: Should geezers like me give up life-prolonging treatments to cut health care costs?

Nearly every other industrialized country recognizes health care as a human right, whose costs and benefits are shared among all citizens. But in the United States, the leaders of both political parties along with most of the "experts" persist in treating health care as a commodity that is purchased, in one way or another, by those who can afford it. . . .

Looking at the numbers, it's pretty safe to say that with an efficient health care system, we could spend a little less than we do now and provide all Americans with the most spectacular care the world has ever known. But in the absence of any serious challenge to the health-care-as-commodity system, we are doomed to a battlefield scenario where Americans must fight to secure their share of a "scarce" resource in a life-and-death struggle that pits the rich against the poor, the insured against the uninsured—and increasingly, the old against the young. . . .

Old people's anxiety in the face of such hostile attitudes has provided fertile ground for Republican disinformation and fearmongering. But so has the vacuum left by Democratic reformers. Too often, in their zeal to prove themselves tough on "waste," they've allowed connections to be drawn between two things that, to my mind, should never be spoken of in the same breath: death and cost. . . .

I am a big fan of what's sometimes called the "right to die" or "death with dignity" movement. I support everything from advance directives to assisted suicide. You could say I believe in one form of health care rationing: the kind you choose for yourself. I can't stand the idea of anyone—whether it's the government or some hospital administrator or doctor or Nurse Jackie—telling me that I must have some treatment I don't want, any more than I want them telling me that I can't have a treatment I do want. My final wish is to be my own one-member death panel. . . .

Perhaps reflecting what economists call "supplier-induced demand," costs generally tend to go up when the dying have too little control over their care, rather than too much. When geezers are empowered to make decisions, most of us will choose less aggressive—and less costly—treatments. If we don't do so more often, it's usually because of an overbearing and money-hungry health care system, as well as a culture that disrespects the will of its elders and resists confronting death. . . .

Here is the ultimate irony of the death-panel meme: In attacking measures designed to promote advance directives, conservatives were attacking what they claim is their core value—the individual right to free choice. . . .

Personally, I don't mind the idea of the government promoting the blue pill over the red pill, as long as it really is "just as effective." I certainly trust the government to make these distinctions more than I trust the insurance companies or pharma reps. But I want to know that the only target is genuine waste, and the only possible casualty is profits. . . .

Simone de Beauvoir wrote that fear of aging and death drives young people to view their elders as a separate species, rather than as their future selves: "Until the moment it is upon us old age is something that only affects other people." And the more I think about the subject, the more I am sure of one thing: It's not a good idea to have a 30-year-old place a value on my life. . . .

You can say this is all a Debbie Downer, but people my age know perfectly well that these questions are not at all theoretical. We worry about the time when we will no longer be able to contribute anything useful to society and will be completely dependent on others. And we worry about the day when life will no longer seem worth living, and whether we will have the courage—and the ability—to choose a dignified death. We worry about these things all by ourselves—we don't need anyone else to do it for us. And we certainly don't need anyone tallying up QALYs while our overpriced, underperforming private health care system adds a few more points to its profit margin. . . .

What happened during the recent health care wars is what military strategists might call a "bait-and-bleed" operation: Two rival parties are drawn into a protracted conflict that depletes both their forces, while a third stands on the sidelines, its strength undiminished. In this case, Republicans and Democrats alike have shed plenty of blood, while the clever combatant on the sidelines is, of course, the health care industry. . . .