Age, Wealth, and Medicare

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July 23 2008 7:59 AM

Age, Wealth, and Medicare

Should Medicare pay big bucks to extend people's lives past 100?

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William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right. Follow him on Twitter.

I've been noodling that question since Friday, when the New York Times ran a story headlined, " Rise Seen in Medical Efforts to Treat the Very Old ." The story focused on a woman who got a pacemaker and defibrillator a month before her 100th birthday, apparently courtesy of Medicare. Estimated cost: $35,000. The doctor who did the surgery "said that he has implanted about two dozen devices like hers in patients 90 or older over the past five years," according to reporter Anemona Hartocollis. Other doctors said they've done similar procedures on patients in their mid- to late-'90s.

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There's going to be a lot more of this, Hartocollis pointed out. Doctors say they're doing more and more bypasses, cancer surgeries, cataract operations, and joint and valve replacements on people 90 or older. The population of U.S. centenarians (people 100 or older) has nearly doubled since 2000. Trends suggest that within 40 years, it could exceed 1 million.

The objection to spending Medicare funds on all these procedures is obvious: The money would be better spent on younger patients.

The rebuttal offered in the Times is that people who survive to very old age are particularly healthy. They've "demonstrated a survival prowess," said one medical expert. "The older you get, the healthier you've been." The implication is that they're worth spending money on because they'll live longer.

I wonder whether this rebuttal looks at the question the wrong way. Suppose we were talking about wealth instead of age. A woman with an unusually large fortune asks for an investment in some project of hers. Her advocate points out that people with lots of wealth tend to have accumulated it through unusual talent or connections and are therefore more likely to get the best return on money invested in them.

We'd see that argument as rewarding and compounding inequality. Why not look at age the same way? Isn't health, like wealth, an unequally distributed asset? Isn't it, in fact, the ultimate asset? And if that's the case, should we means-test people on Medicare not just for wealth, but for age?

Actually, means testing is the wrong term. Age isn't really a means; it's more like an end. So let's call it an ends test. The theory is that just as some people have enough money, others have had enough time.

If you make it to 100 and can fund your own surgery, that's terrific. But Medicare should focus its resources on people who haven't been as lucky as you. Living to 99 is no tragedy. It's a blessing.