At press time, he was reported to be doing well. We physicians are very pleased when medical technology and physicians’ skills can stave off a heart attack and prevent disability and premature death.
But what would Bernie’s Medicare for All mean for you if you get chest pain—especially at age 78 or older, like Bernie?
Too Old to Matter?
Remember the famous article by Obamacare architect Zeke Emanuel: “Why I Hope to Die at Age 75: An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly.”
Emanuel stated what he says will happen to him after age 75. “If I develop cancer, I will refuse treatment,” Emanuel wrote. “Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery.” Maybe he would accept a stent.
What about those who want to choose otherwise? From the standpoint of “population health” and bioethics, with its focus on “limited resources,” what is the correct answer when an older patient presents with chest pain?
We might say, “Sorry, there are 40-year-olds who need drugs for HIV; babies who need a well-baby check; migrants with multiple-drug-resistant tuberculosis; pregnant women without prenatal care; teenagers seeking an abortion. How can we justify cardiac catheterization labs in every hospital when there are so many unmet needs? And an elderly patient with bad arteries is likely to have future emergencies also.”
Emanuel and others outlined the “complete lives system” in The Lancet in 2009. Societal resources, it holds, are best allocated to persons between the ages of 15 and 40. Bernie’s fans might ask whether this should apply to their favored candidate—or to themselves and their loved ones.
Medicare for All will clearly reallocate resources now used for the elderly.
Jane M. Orient, M.D. ([email protected]) is executive director of the Association of American Physicians and Surgeons.