Con

Amitai Etzioni, PhD, University Professor at George Washington University, wrote in his June 11, 1988 article "Spare the Old, Save the Young," that appeared in The Nation:

“[Daniel] Callahan’s call [to ration health care for the elderly] raises the problem known among ethicists and sociologists as the ‘slippery slope.’ Once the precept that one should do ‘all one can’ to avert death is given up, and attempts are made to fix a specific age for a full life, why stop there? If, for instance, the American economy experiences hard times in the 1990s, should the ‘maximum’ age be reduced to 72, 65–or lower? And should the care for other so-called unproductive groups be cut off, even if they are even younger? Should countries that are economically worse off than the United States set their limit, say, at 55?…

In addition to concern about slipping down the slope of less (and less) care, the way the limitations are to be introduced raises a serious question. The advocates of changing the intergenerational allocation of resources favoring rationing health care for the elderly but nothing else. This is a major intellectual weakness of their argument. There are other major targets to consider within health care, as well as other areas, which seem, at least by some criteria, much more inviting than terminating care to those above a certain age. Within the medical sector, for example, why not stop all interventions for which there is no hard evidence that they are beneficial… Why not take the $2 billion or so from plastic surery dedicated to face lifts, reducing behinds and the like?…

If we cannot stop people from blowing $25 billion per year on cigarettes and convince them to use the money to serve the young, shouldn’t we at least cut out public subsidies to tobacco growers before we save funds by denying antibiotics to old people? And there is the matter of profits. The high-technology medicine Callahan targets for savings is actually a minor cause of the increase in health care costs for the elderly or for anyone–about 4 percent. A major factor is the very high standard of living American doctors have, compared to those of many other nations… Another important area of saving is the exorbitant profits made by the nondoctor owners of dialysis units and nursing homes. If we dare ask how many years of life are enough, should we not also be able to ask how much profit is ‘enough’? This profit, by the way, is largely set not by the market but by public policy.”

June 11, 1988