THE POLITICS OF DEATH: COUNTING THE DEAD
Your incentive to care about how my life ends is because measuring how many people die each year, along with what they die from, is how we determine how various diseases and injuries are affecting the living. Having these numbers helps health authorities determine whether they are focusing on the right kinds of public health actions, which is why they have to be accounted for. A country where deaths from heart disease and diabetes rapidly rise over a period of a few years has a strong interest in starting a vigorous program to encourage lifestyles that will help prevent these illnesses. On the surface that sounds reasonable enough--your interest in my death helps keep you alive. What complicates this process is that most industrialized countries now have systems in place that "attempt" to assign each life an economic value. Your family may consider the value of your life to be priceless, but modern societies don't consult your family in determining what you're worth. And the process they use is often far more political than you might think and the cost of healthcare is front and center in this highly charged debate.
WHAT IS YOUR LIFE WORTH?
The international standard used by government run healthcare systems to determine whether to authorize a new medical procedure is $50,000. In order for a treatment to be worth this cost it must "guarantee you" one additional quality year of life. If it won't then the odds are great they won't cover it. Clearly under this standard the older you are the odds are really against you. We don't use that system here. Medicare decides whether to pay for a procedure based on whether it is "medically necessary and appropriate." So if you're looking for a fast answer to why healthcare is more expensive in America than it is in the rest of the world a lot of it is because of this difference. Few of us doubt America is moving for toward a more cost based system and a new study by the Stanford Graduate School of Business has demonstrated that $129,000 is a better number. That's better than the $50,000 used by Canada, Britain and the Netherlands, who ration healthcare based on the cost effectiveness of this threshold, but it is a long way from the "medically necessary and appropriate model" we use now.
Most Americans understand the cost of Medicare has to be addressed and few believe the amount of money spent to save their life should be unlimited. According to Time Magazine, a survey of New Yorkers concluded 75% felt cost should be part of the equation in determining treatment under Medicare. The Stanford Study used a complex formula tied to the average cost of Kidney Dialysis in arriving at the $129,000 threshold to determine treatment. In other words if the "incremental cost of the treatment" exceeds $129,000 then it would not be covered under Medicare. Sounds simple enough, but it raises all kinds of philosophical questions that are counterintuitive to what we think of as the American way of life. Not the least of which is Medicare isn't the only benefit we pay for throughout our lives that we expect to receive when needed. We contribute to social security, unemployment insurance and a host of other things too. There are millions of Americans who have never used a dime of these benefits. Are we going to say "no" in their hour of need if the procedure required to save their life exceeds the new threshold? The politics involved in who gets what has only just begun.....
WE SPEND $5,000,000 PER YEAR ON CATS
For some additional perspective you might want to read "people versus panthers" which lists how much we spend protecting the lives of some of our endangered species. The Indiana bat and the California delta smelt are particularly interesting. People versus Panthers