Elder Care
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Elderly Care

Health Care Rationing Elderly

Elderly Care
Because we could in principle spend many times our gross national product on health care, it must be rationed in some way. The primary way in which it is health care rationing elderly in the United States is by individual choice. When the expected cost of medical care exceeds its expected benefit, people forego it.

For example, some people choose self-medication with nonprescription drugs. What deters them from going to the doctor's office every time is the physician's fee, the time cost, the travel cost, lost wages, and other inconveniences. If everyone who purchased nonprescription drugs saw a physician instead, the United States would need 25 times the current number of physicians.

In the United States , the elderly have a privileged position with respect to health care rationing elderly. Medicare covers virtually all of them, plus people under age of 65 who are disabled. But in other countries, where the entire population is part of the same government-funded health care plan, the elderly are usually pushed to the end of the rationing lines.

Thus, in Britain , it is extremely difficult for an health care rationing elderly patient to get kidney dialysis or a kidney transplant - or any other transplant, for that matter. Moreover, pressures that have developed in other countries are developing in our own.

While the subject of healthcare rationing for the elderly is under extended debate and discussions, one school of thought professes that in an ideal system, rationing would be by patient choice wherever possible.

The system would be organized so that people would have the funds necessary to purchase health care through medical savings and reimbursements from insurers. But people, specially the elderly would have strong incentives not to purchase health care unless the expected value of the care was greater than the monetary costs. Patients, of course, could consult their physicians.

But the power of choice would be in the hands of the health care rationing elderly, not the bureaucrats.

Thousands of people die annually - even in a developed country like the United States - for lack of access to organ transplants. Vastly greater numbers die worldwide for lack of access to immunizations, or antibiotics, or prenatal care.

The inescapable question echoes around the world: When there is not enough for everyone, who gets it and who doesn't? Who lives and who dies? There was quite an exposé in Life magazine a few decades ago about how hospitals were deciding who would live and who would be left to die. In many cases, according to this article, people who were socially attractive were the winners.

Why these mushrooming interests in age-based health care rationing elderly? The most commonly cited reason for limiting the lifesaving resources available to older people in the U.S. is the economic impact of the rapidly growing number of elderly persons.

The percentage of the U.S. population over age 65 has grown from less than 2 percent in 1790 to nearly 12.5 percent in 2000. Particularly fast-growing are the ranks of the oldest persons - those 85 years or older. By 2000, their number in the U.S. had topped 4.2 million, representing 1.5 percent of the population; moreover, this number is projected to increase considerably in the future.

The mental association of age and cost is an understandable one. As the reasoning goes: Health care rationing elderly persons is costing more and more money, so in order to cut costs it will be necessary to cut back on the health care resources that will be available to them.

However, health care costs are increasing due to a variety of factors, many of which have no special connection to elderly persons. Why then are older people singled out as a group to bear the brunt of cutbacks in lifesaving care? Moreover, although it is claimed, economically speaking, those elderly persons are receiving a "disproportionate share" of health care rationing elderly resources, the question must be raised: "disproportionate to what?"

They are not receiving disproportionately to their medical need (assuming that medical criteria are being applied equitably to all). Why do those concerned about disproportionate shares so readily assume that the appropriate frame of reference for "proportion" is age?

Challenges for an Aging Society:

Has the time come when we decide that prolonging the lives of the elderly who "no longer serve the land" is truly a burden on the youth of society? Is the day of rationing our nation's health care services on the basis of age close at hand? As the ranks of the elderly swell, and demands on the nation's scarce health care resources increase, the once whispered suggestions that health care should be rationed by age are now growing audible.
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