Are Survivors’ Costs a Pro-Life Issue?
posted by Frank Pasquale
The conservative Manhattan Institute recently commissioned a study of a gap in life-expectancy gains over the past 20 years. The data that inspired the study are startling:
While U.S. life expectancy increased by 2.33 years from 1991 to 2004, some jurisdictions — the District of Columbia (5.7 years), New York (4.3 years), California (3.4 years) and New Jersey (3.3 years) — led the way, while others, such as Oklahoma (0.3 years), Tennessee (0.8 years) and Utah (0.9 years), trailed the national average by significant margins.
To make a long story short, the researcher found that found that “longevity increased the most in those states where access to newer drugs . . . in Medicaid and Medicare programs has increased the most.”
Unfortunately, budgetary rules often make the federal government concentrate more on the costs of such interventions than their benefits. For example, the CBO counts “increased costs to the Medicare program for extending the life of its beneficiaries” as “survivors’ costs.” Tim Westmoreland’s fascinating article on the topic (95 Georgetown L.J. 1555, June 2007) calls this “euthanasia by budget:”
In describing why its model included costs but no savings from new access to pharmaceuticals, the Congressional Budget Office said, inter alia, “ [T]o the extent that a drug benefit helps people live longer, they may consume more health care over their remaining lifetime than they would have without the benefit.” In other words, it is still cheaper for Medicare beneficiaries to die.
One wonders if the same reasoning was behind a Texas law that permitted hospital authorities to cut off life support to a conscious woman.
I admit that Daniel Callahan has eloquently questioned the “research imperative,” and perhaps his reasoning could be extended to health care more generally. But it strikes me that in our accounting the costs and benefits of health care in this country, budgetary savings arising out of early death ought to be suspect.
July 11, 2007 at 12:00 pm
Posted in: Bioethics, Economic Analysis of Law, Empirical Analysis of Law, Health Law, Intellectual Property, Law and Inequality, Legal Theory, Philosophy of Social Science, Technology
Print This Post
Responses (4)
Daniel Goldberg - July 11, 2007 at 9:04 pm
Great post. My comments were obese, so I posted them here.
Maryland Conservatarian - July 12, 2007 at 1:09 pm
“But it strikes me that in our accounting the costs and benefits of health care in this country, budgetary savings arising out of early death ought to be suspect.”
“Suspect” as in “probably not real” or “suspect” as in “distateful to even consider any positives arising from an early death”?
Frank - July 12, 2007 at 1:13 pm
The latter, though there are people I respect who likely disagree with me; see, e.g.,
http://www.boston.com/news/globe/editorial_opinion
/oped/articles/2007/03/26/good_programs_vs_bad_apples/
“Pneumonia, once regarded as the “Old Man’s Friend,” offered the very frail a dignified death. Now we spend millions of dollars per year offering Alzheimer’s patients an abysmal existence by keeping them alive on dialysis.”
Schuck blogged onthis topic on Volokh.
Politicized Prognostication at CBO : HEALTH REFORM WATCH - July 28, 2009 at 9:57 pm
[...] anyone familiar with Timothy Westmoreland’s work on CBO budget scoring would have been suspicious of its prognostications from the outset. As he noted in 2008: The budget process systemically favors policies that let sick [...]
Leave a Reply