Jonathan B. Wight

Via Mark Frum comes a link to a Stephen Marche article in Esquire that captures the essence of the ethical and medical dystopia in America:

There may be no white America and no black America, no blue-state America and no red-state America, but one thing is clear: There is a young America and there is an old America, and they don't form a community of interest. One takes from the other. The federal government spends $480 billion on Medicare and $68 billion on education. Prescription drugs: $62 billion. Head Start: $8 billion. Across the board, the money flows not to helping the young grow up, but helping the old die comfortably. According to a 2009 Brookings Institution study, "The United States spends 2.4 times as much on the elderly as on children, measured on a per capita basis, with the ratio rising to 7 to 1 if looking just at the federal budget."

Personally, I think those of us who are entering the growing elderly class have to voluntarily cut back on the extravagance of dying, paid for by other people's (e.g., Medicare's) money. And I think Medicare can help us do that. Since most of health care is spent on heroic but failed attempts to keep a dying person alive a few more months in a hugely expensive intensive-care hospital rooms, think of some practical alternatives. One is a short vacation to Oregon, but I have reservations about doctor-assisted suicide.

But a second idea is to have Medicare make an attractive offer to elderly persons on their last legs:

Insurance Offer: Treating you (the patient) for the next five months before you die will cost us $500,000 using the grandiose and highly expensive crisis medical system. However, if you agree to go into a hospice, where you'll get all the pain medicine you need, our cost will be only $50,000. Medicare (and society) will save $450,000, and we're willing to split that and give you an inheritance to your estate of $225,000.

Now, does this sound like a good deal? Readers: has this been tried anywhere?

[Problems: An elderly person could feel coercion—that they are being shunted off to a nursing home so the greedy kids can get a fat check. But I'd rather think this offers a clear-headed dying person a chance to give their offspring a much-needed bequest at little personal cost. The relatives I've seen who've spent their last months in a hospital have had a pretty miserable quality of life. A hospice may offer greater solace, love, and the opportunity of death with dignity than the advanced medical approach. The key thing is—this would be a voluntary program, and elderly people, while still fully rational, could make the decision ahead of time that "Less is more."]