Video: Are the elderly cost effective?

posted at 2:35 pm on May 12, 2009 by Ed Morrissey
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Greg Hengler at Townhall captures this revealing moment in the Senate Finance Committee hearings on health-care reform. The speaker, Professor Stuart Altman of Brandeis University, tells the committee that resources get wasted in the American health-care system, especially for one segment of the population. Professor Altman says he’s reluctant to mention it, but why waste money on in-depth treatment for people who won’t live long anyway? Better to warehouse them and save the resources for the young:

Remember, our population is aging. And with the very, very elderly, the costs go down, so that percentage should be falling, and it’s not. Second, the cost of care is growing by so much, so at the same percentage, it’s worth a lot more. So let’s go back to the issue of comparative effectiveness, which we’re supporting. That’s where that can have a big impact. It’s not only there, but that’s where the waste is. That’s where people are using technologies that really either don’t work at all or keep people alive for for very limited [time] and [at] very high cost.

Hospice is one option, but we do need take account of the cost — you know, I hate to say it, the cost-benefit of some of the things we do. And either we can do it directly, or we can do it by bundling the payments and let the delivery system deal with it. So it’s a combination of the delivery system dealing with it, or, and/or providing more information for people to make the right decisions, both for themselves and for the care.

Once again, we have people taking the shortage, rationing approach to its logical conclusion. In a non-shortage, free-market approach, people can choose for themselves whether to pursue cost-effective strategies based on their own resources, and the free market would incentivize the creation of enough resources to meet the demand. Only by restricting choice and setting prices will resources become scarce, which we have seen gradually for the last several decades in our own heavily-regulated health-care system, and seen dramatically in the various single-payer systems around the world.

What happens when the state controls all the resources? New resources do not develop, and the government winds up rationing care based on its own priorities, and not the priorities of the patients or caregivers. Professor Altman’s suggestion that the elderly get hospice treatment to save scarce care resources is exactly the kind of decisions the state will make for its citizens, and it won’t be limited to the elderly, either. Anyone whose value does not show a positive “cost-benefit” ratio to the state will also likely wind up without the kind of care necessary to stay alive and healthy.

Progressives who back this plan get offended that people with more resources can get better care, just as they can get better housing, better food, and better entertainment, among many other things. Like in all other arenas, their prescription for equality of result will mean that everyone gets treated equally poorly, and that we will eventually start culling out the weak in favor of the strong. We’ve essentially returned to the eugenics arguments of the early 20th century, a dark period of human history we should be avoiding rather than embracing on the floor of the Senate.

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