Additional Thoughts on Healthcare Costs

In my last post I suggested there are things to think about – things that will need to be resolved through a political process that seems to have little stomach for “cutting benefits to retirees” – specifically, deciding how to pay for care for an aging population, while at the same time healthcare costs are rising and the quality of employment opportunities for those who are paying the taxes are declining. It is not a pretty picture. The same dynamic of course implicates our Social Security system. The current trajectory is unsustainable.

As I indicated below, one answer is to make all government healthcare services means-tested. Is it right that Bill Gates gets healthcare paid by the government because he paid taxes (probably a lot of taxes) and therefore is qualified for Medicare? Should rich people pay more? And if that door opens further (as discussed below, it has already been opened), how long before middle class retirees are in the same boat, and healthcare becomes just another system of wealth redistribution?

Assuming we simply won’t have enough money to keep this house of cards standing, one answer, or one part of the answer, may be cultural. Do we start believing in assisted suicide? The entry of California into the assisted suicide arena a couple months ago should have been louder. It is one thing for Montana, Oregon, Vermont and Washington to allow physician-assisted suicide, but California is a whole other matter. That’s big time. Like it or not, physician-assisted suicide is coming to your state sooner or later, and probably sooner than you think.

The thing about assisted suicide is that it brings with it the implication that there may be a point in life when staying alive is no longer in our best interests. Sometimes things get so unpleasant, the person would be better off dead. As shocking as that sounds, I can’t count the number of clients who have told me that their family member would not want to be alive in their current situation (if that had the capacity to express themselves).

So if we move from a culture that places a premium on quantity of life to one based on the concept of quality of life, will we then accept the proposition that we live life as long as it feels good and get out before or when the ugly part starts? That would certainly reduce healthcare costs. Healthcare for those with chronic conditions, particularly those in institutional care, makes up a disproportionately large part of the healthcare budget. The big challenge would be, where money (healthcare costs) is involved, how would we keep what may be a sincere change in cultural perspective from becoming a tool of the insurance companies – or are we fooling ourselves? Are cultural values always nothing more than expressions of societal convenience?

More questions. Few answers. Just thoughts. I know.