Age, Prejudice, and Prognosis

Science, technology, and life.
Dec. 14 2008 7:52 AM

Age, Prejudice, and Prognosis

Earlier this year, I criticized Medicare for spending $35,000 on a heart implant for a woman who was about to turn 100. The basic argument was:

Should we means-test people on Medicare not just for wealth, but for age? ... 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.

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Several of you chastised me for callousness. And now a report from a recent American Heart Association conference backs you up. Marilynn Marchione of the Associated Press tells the story :

Eighty-year-olds with clogged arteries or leaky heart valves used to be sent home with a pat on the arm from their doctors and pills to try to ease their symptoms. Now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, new studies show. ...

In Florida, Dr. Paul Kurlansky led a study of 1,062 octogenarians who had heart bypass surgery at Mount Sinai Medical Center in Miami Beach from 1989 through 2001. ... Average survival was roughly six years—almost the same as similarly aged people who do not have heart disease. Overall, 90 percent survived their surgery to leave the hospital. This improved dramatically as the study went on, from 85 percent in the early years to 98 percent by its end. Even more impressive: 65 percent survived without surgery-related complications and even more without long-term complications ...

A Yale cardiologist draws exactly the conclusion I rejected: "Age itself shouldn't be an automatic exclusion." Marchione adds: "Not every older person can undergo such a challenging operation, but the great results seen in the new studies show that doctors have gotten good at figuring out who can."

This doesn't settle the underlying question of whether there's such a thing as having lived long enough, regardless of what a new device or surgery will do for you. But it does underscore that age, like race , is a crude basis for making individual projections.

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

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