Health Care Thoughts: How Old is Too Old
by Tom aka Rusty Rustbelt
Health Care Thoughts: How Old is Too Old
Former VP Dick Cheney had a heart transplant according to several news sources today.
I will refrain from making “he never head a heart before jokes.”
Serious question though – Cheney is 71, how old is too old to receive a heart transplant?
71? 75? 80? Or is there no upper bound?
Hearts are rare and the procedure costs a lot of money. How old is too old? Or not.
Great question, but I do not have an answer only an experience as of late (which is why you see me rarely here of late, and possibly a bit bitter).
My parents both got dementia at the same time. One is late stage, the other mid. I cannot tell if they are in pain or not. For both, the home costs total $17,000 per month, which will be gone pretty quickly if they live too long. After that Medicaid gets stuck with the bill. It has been an eye opening expreience, and in about 5 years a baby boomer nightmare. At times I wonder at what expense does all this carry on? Is it worth it?
Also your question is where the thoughts of death panels start to enter the picture, which I think is unfair as it is actually a serious question. Most people make DNR decisions all the time, is that not death panel-like?
At some point I would love to write a post on how liability and regultions drive up the cost of their care IMO unecessarily. Also this whole scenario proves to me how our system is severely broken.
My 90-yr-old mother had her 2nd hip replacment last year. The first was 2 or 3 years earlier. She was in frequent pain and constant discomfort. These surgeries have made a dramatic improvement in the quality of her life.
Should she have been denied that because of her age?
I love my mother a hell of a lot more than I love Dick Cheney – but this question isn’t about the personality characteristics of the recipient of a medical procedure. It’s about the age. I suppose you can get all actuarial, if you wish. But we are talking about human (or in Cheney’s case quasi-human) life and relief from suffering.
Is the how old is too old question really worth asking?
The “hearts are rare” issue does cast it in a slightly different light. But Cheney is rich, and the rich are always going to have access to the body parts of their chosing. That’s just reality.
Not long after I wrote this, on Monday evening I took part in a symposium on PPACA. At the dinner beforehand I sat with a philosophy professor who is a well regarded progressive and a well respected expert on health issues, including the morality of rationing (he thinks failing to ration with forethought causes misallocated resources).
So the first thing the prof says to me is “Do you think Cheney should have gotten a heart?”
He then rattled off a encyclopedic version of all statistics related to organ transplant supply and need.
Very interesting conversation.
(I am writing this 5 hours post anesthesia and I’m not sure I am hitting the proper keys.)
I know this situation well and replacements to stop intractable pain are, in my opinion, well worth the costs, IF the patient can tolerate the surgery.
Our best to your mom.
I assume Cheney has Medicare (plus a Cadillac private topoff?). What’s the taxpayer cost?
I don’t worry about the taxpayers as much as the family of that poor donor. What a cruel joke on their loved ones noble gift.
Hearts are rare, yes, but what’s even rarer is a tissue match. Hearts are not in fact widely interchangeable.
I agree that I’m not entirely convinced by this myself but it is possible that Cheney was just the best tissue match for this heart.
And his health care? Paid for by your taxes I’m sure. Wasn’t he a Congressman at one point, a Rep? And then VP…..yup, I’d certainly be guessing that that is Federal health care insurance.
In jazzbumpa’s mother’s case, I think rusty is right, but the idea that jazzbumpa is making the point rather than mom is part of what makes the issue so difficult and why all those DNRs have been initiated by the patient not the patient’s children–in most instances. I have no problem saying that I think Cheney was too old for a heart transplant and that I very much doubt he would have gotten one–at least in this country–if it had not been for his money and political power. Which is a fundamental issue with universal health care. The rich are always going to have more than evryone else as long as we live in a capitalist, property based society. We all need to get over that and make sure that everyone gets a reasobale and affordable level of health care. If that means no one over 70 gets heart transplants unless they are in the 1%, I can accept that.
I have to admit that my first reaction to the news of Cheney’s new heart was the thought that the taxpayers are probably paying for it. That would be ok if the taxpayers had equal access to heart transplants. They don’t.
Philosophically, I support the concept of rationing. However, what I run into in practice is that a lot depends on the general health of the recipient both pre- and post- transplant. Cheney has had heart trouble for years. I’m not a doctor so I don’t know if this transplant is going to solve all those problems or not.
I tend to believe that at some point while a transplant might prolong life, that life might not be significantly improved post-transplant. An easy example would be a transplant on someone with mid-stage Alzheimer’s. I would be against that, regardless of age.
The difficulty arises from the perceived need to set rigid criteria. On the other hand, without those rigid criteria, we can be fairly certain that money, power, and influence will skew any more flexible or qualitative way of determining eligibility.
Setting a cut-off age ignores the differences among people. Age 70 strikes me as too early. Having known people 100 years old who are still mentally vibrant and functioning well (with some help), Many elderly people will choose not to get a transplant, will recognize that ultimately one must die of something. As for the others, I wouldn’t set the age limit below 85 but I’d like to see other criteria that would take post-surgery quality of life into account.
I’m perfectly willing to agree on “no upper bound”; likelihood of surviving surgery is a fair proxy, and I can easily imagine losing out to a Very Fit Person 10-20 Years my senior for that reason.
How Richard Cheney got to the top of the list–even, as noted above, for that specific type of compatible heart–is left as an exercise, though. It seems more similar to Mickey Mantle’s liver transplant than John Carter getting one from George Clooney and Julianna Margulies (with help from Los Lobos, iirc) on ER.
Transplant lists are one of the few (semi-)public markets in Health Care. That they can be arbitraged has never been a secret. The good news is that cases such as Mantle and Cheney make it more interesting for someone to do the research and bring a ray of sunlight to the matter.