The Medicare health program for seniors jeopardizes the country's fiscal health a lot more than the fiscal stimulus or Wall Street bailouts.
At Medicare's present rate of expansion, according to the Government Accountability Office, Americans living in 2080 will have to pay 10 percent of their incomes just to cover cancer surgery, heart operations and other care for old people, many of whom will die a few months after treatment.
How can we avoid the worst? President Barack Obama has made the first move by starting a tough conversation about the high costs and questionable benefits of care at the end of life.
In an interview to be published in Sunday's New York Times Magazine and available on the Web, Obama talked about his grandmother, Madelyn Dunham, who died just before November's election.
She had been diagnosed with terminal cancer and given three to nine months to live when she broke her hip. Naturally, her doctors wanted to spend thousands of dollars to give her a new hip and charge it to taxpayers.
"I don't know how much that hip replacement cost," Obama told the Times. "I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question."
But it's a question the country must ask. As he did a year ago in his speech on race, Obama has broached a taboo topic and launched an overdue discussion.
We spend ungodly sums treating people who will soon die anyway. A fourth of all Medicare dollars are spent in the last six months of life, according to the Dartmouth Institute for Health Policy and Clinical Practice. That'll come to $100 billion this year, enough to pave a lot of roads, build a lot of schools and fight a couple of wars.
A couple of years ago, Medicare paid an average of $85,729 at Johns Hopkins Hospital for each patient in the last two years of life, a statistic that underscores the Baltimore medical-industrial complex's stake in this debate. At the University of Maryland Medical Center, it was even higher - $94,901. Both figures are from Dartmouth.
So do we start "rationing" care for people like Obama's grandmother? Should a terminal diagnosis limit patients' taxpayer-financed medical options?
