Running Head: POLICY BRIEF 1

Policy Brief

Jacquelyn Ficco

The Pennsylvania State University

HPA 301: Health Policy Issues

13 April 2018
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Age is Just a Number

Life-sustaining medical care is care that keeps someone or something alive. This is care that
should be offered to people of all ages, races, genders, etc. According to The New England
Journal of Medicine, end of life care is very costly. The cost of dying is high and the medical
practices for sustaining life are some of the most expensive. A patient’s last year of life can be
very expensive, however, the last month of life can be the most expensive. Approximately 40%
of a patient’s health care costs in their last year of life is accumulated in the final month of their
life (Emanuel, 1994). Life-sustaining medical care can be extremely expensive for a patient, the
hospital as well as the insurance providers. Therefore, there is often times a debate about whether
or not this care should be rationed. Some people believe that life-sustaining medical care should
be rationed to patients based on their age. They believe a person who is 45 should receive the
medical care instead of the 85-year-old man who needs it as well. Because he is older, some
people believe he should not receive the medical care because he is likely to die soon anyway.
Who is one to determine the years of life left in a person? That 85-year-old man could live 15
more years when the 45-year-old person could die a year from now. It’s impossible for anyone to
determine exactly how much time someone has in their life. Therefore, age is not an accurate
determinant of whether or not someone should receive life-sustaining medical care. The task now
is if life-sustaining care must be limited to a certain number of people then we must come up
with other key components and criteria that should be taken into consideration for determining if
a patient should or should not receive life-sustaining medical care. The overall issue that comes
with this topic is how does one define the value of someone’s life by simply just their age.
However, there could be other alternatives that could be taken into place such as the requirement
of advanced directives. Another alternative is the implementation of an education program for
the population about preventative measures and reducing the high costs of unnecessary high-tech
medical procedures to focus on caring for patients and their preventable diseases.

Scope of Problem

The problem that needs to be addressed is that life-sustaining medical care cannot be limited to
certain age groups. First and foremost, there should be no limit to this medical care. All people of
all ages should have the access to life-sustaining medical care, if they wish. Not every person
may exercise their right to receive life-sustaining medical care, but everyone should have that
right to receive this care. With the growing rate of older people in the world today, more people
are requiring medical care. According to the University of Pennsylvania, “The number of nursing
home beds, [for example] grew from fewer than 570,000 in 1963 to approximately 1.4 million by
1976” (Mechanic, 1992). The number of people in the world today is growing astronomically but
that also means that the number of people who require medical care is also growing
astronomically. With the cost of life-sustaining medical care being extremely high, it is
becoming very expensive for health systems to offer these life-sustaining medical procedures to
their patients. According to Bioethics Research Library, “The development of complex medical
technologies in the last 50 years not only saves lives and provides increased longevity, but also
greatly increases the cost of treatment” (McCarrick, 1990). These technologies and medical
procedures are beneficial for many people however; it drives the price of health care up. Due to
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the fact that this care is expensive, some people think that it’s acceptable to ration medical care.
This is why the topic of rationing life-sustaining medical care is brought to the surface. People
believe that age is a good determining factor of whether or not someone should receive this care.
One cannot predict the amount of life left in a person. Therefore, limiting life-sustaining medical
care by age would require people putting a time frame on the life of a person and evaluating what
they think the value of that life is. Not only does it put value on a human life, it also makes
medical care targeted to the young population rather than caring for the population as a whole.
Medical care should be an equal right for all people. It cannot be a right that is denied to people.
Although limiting people to receiving life-sustaining medical care would save money, the cost of
dying is still very expensive (Smith, 2009). The money saved from the life-sustaining medical
care would still be spent due to the high cost that is associated with dying. Another issue that is
faced with the issue of rationing life-sustaining medical care to patients based on age is the issue
of inequality and discrimination. Having age as the only factor to accept or denying someone the
ability to receive medical care is wrong and cannot happen. It is ethically wrong and in certain
cases could result in actually denying a patient to the right of life itself. There must be other
factors that are considered if rationing is going to be a reality and age cannot be the only factor.
It needs to be based of the actual condition of the patient not how long they have been living
their life or how they are paying for their medical care (Smith, 2002).

Policy Alternatives

The first proposed policy alternative is to implement price rationing rather than age rationing.
One should be allowed to receive life-sustaining medical care if the patient can afford to pay for
the care, whether that is the patient themselves or through their insurance (Churchill, 1988). With
this approach, the poorer part of the population and the part of the population that does not have
insurance would be left out. They would be the ones who suffer from this alternative, because
they cannot afford life-sustaining medical care. The price rationing alternative approach to this
problem places the costs on the patient who wants to receive the medical care. It takes away
slightly from the government paying for medical care for citizens. With the patient covering
most of the costs of the life-sustaining medical care, it is thought to make the patient think more
about the care they are going to receive. The patient will think more about whether it is
something they really want and can afford. The patient will take the decision process very
seriously, weighing all the different options and outcomes. It is thought that with this approach,
the patient is less likely to choose unnecessary medical care and truly evaluate and consider what
is absolutely necessary due to the fact that they are the ones who are responsible for covering
most of the costs of it (Mechanic, 1992). The idea of this is having the government or insurance
cover only a small portion of the cost and the patient covering majority of it. Through this
alternative, it would weed out some people who would receive life-sustaining medical care as
well as take away some of the costs from the government and insurance. However, it would take
out a specific group of people through this alternative, that group of people being lower class,
poor people who are unable to afford the cost of care.

Another policy alternative that should be considered is implementing a program to reducing the
use of unnecessary medical technology and focusing on the preventative measures to making
people healthier. According to Case Wester School of Law, “Advances in medical technology
are given much of the blame for the rising cost of health care” (Mehlman,1997). Health care
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costs have gone up significantly since the creation and implementation of technology. As a
country, it is said that we are spending too much money on acute care measures but not enough
on preventative measures. We aren’t taking care of our patients to make sure their overall health
is good and we aren’t working to make sure that people aren’t getting sick or in some cases
sicker. If doctors focused on preventing illnesses, the use of the acute care technology would
decrease and save money in the long run. Not only could the doctors focus on preventative
measures but also could implement a program that educates patients on better care and
preventing different illnesses and diseases to help them stay as healthy as they can for as long as
they can. It would help them live a healthier lifestyle while staying out of the hospital and stop
them from raking up hospital costs and bills (Etzioni, 1991). Through this alternative, there could
be a lot of money that is being saved by reducing the use of these technologies. By saving this
money, it could be reallocated to cover the costs of some of the life-sustaining medical practices
that are used for patients. This would help the government save money as well as the healthcare
systems. This approach doesn’t limit a certain group of people from receiving care but rather
reallocates the money from another area to help more people to be able to receive this care. It
also educates patients on the best ways to lead a healthy lifestyle to remain in the best shape they
can for as long as they possibly can.

A final policy alternative is to require all patients to establish what they want for themselves if
faced with the option of receiving life-sustaining medical care. Often times, people come into
hospitals without advanced directives and it is left up to the families to make the decisions for
them. Sometimes, these patients do not want the care but cannot make that decision for
themselves. Therefore, a patient should meet with their provider and establish what him or her
would like their advance directives to be (Balch, 2009). Establishing advance directives prior to a
patient getting sick would allow the patient to state their desires for advanced care. It would also
prevent any confusion or decisions that would have to be made by the family members in the
moment when they need to decide if they want their loved one to receive life-sustaining care or
not. According to the New England Journal of Medicine, “Advance directives and hospice care
were developed to ensure patients’ autonomy and to provide high-quality care at the end of life.”
(Emanuel, 1994). This is the option that allows the patients wants and needs to be heard. It
allows them to be able to choose their future. The same journal also states when discussing
patients who do not wish to receive life-sustaining care, “If doctors would stop using high-
technology interventions at the end of life, the argument goes, then we could simultaneously
respect patients’ autonomy and save tens of billions of dollars” (Emanuel, 1994). As a result of
implementing advance directives, it would allow the patient to establish what measures they
would like to be taken for them. Therefore, doctors and families would have a guideline of their
wants, if ever faced with making the decision for their family member. It overall decreases the
costs spent on life-sustaining medical care because not every patient would like the same care
and therefore, money can be saved from patient to patient.

Policy Recommendations

The policy recommendation that I would like to set forth to try to reduce the issues that come
with age-rationed life sustaining medical care would be to implement a program to reduce the
use of unnecessary medical technologies and focus more on preventative measures to making the
population healthier. I believe that this is the best alternative because it doesn’t focus specifically
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on one group of people. It focuses on the population as a whole. One group of people isn’t left
out or neglected through this alternative. It is a program that overall encourages the population to
be healthier as well as taking steps to help make that happen. The first alternative isn’t the best
fit for this issue because it neglects the poor and uninsured. It would prevent them from being
able to receive care simply because they are unable to afford it. It would prevent people from
receiving care by simply one characteristic of them, much similar to the argument about age. The
other one isn’t the best alternative either because some people could make decisions about life-
sustaining medical care before they get sick but change their mind after getting sick. Therefore,
the other two alternatives have potential to not make any change to the current issue we are
facing. We have current policy that supports and encourages this alternative and that is through
the Affordable Care Act. “The ACA seeks to reduce socially undesirable rationing of care by
eliminating insurance limitations on preexisting conditions, by mandating coverage of annual
physical exams and other preventive services, and by defining essential health benefits that will
set a ‘‘floor’’ rather than a ‘‘ceiling’’ on care” (Cohen, 2012). This shows that through the
implementation of education as well as the focus on preventative measures, it could lay the
ground work for healthcare. Not only would this education and focus on preventative measures
help to resolve some of the issues that come along with age-rationed medical care, it would also
improve other areas of health care. One important focus of this would be different education
based on groups and ages of people. For example, poor people don’t have access to the same
things that wealthier people have access to. They also are unable to afford all the same things.
The education for these two groups of people will be different. For wealthier people, educating
them on the types of diets they should consider as well as exercising makes you a lot healthier of
a person and in the long run can prevent diseases. For poorer people, educating them on different
exercises they can do even without access to gym facilities. Although healthier food is often
times more expensive, they can still be educated on what is the best food for their health. Lastly,
one important thing that can be educated to this group of people is the effect that drugs have on
their health and how much it can harm them and the problems it can lead to later on in life.
Through these preventative education programs, it will help teach people the best way to live a
healthy lifestyle. As far as the healthcare field goes, their job is to use the resources they have
and help patients have a better and healthier life. Focus on the health of the patient in the long
run rather than focuses on the expensive acute care procedures that require a lot of funding that
could be dispersed elsewhere.
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Works Cited

Balch, B. J. (2009). Facing the Challenge of Health Care Rationing. NRL News,36(7-8).

Churchill, L. R. (1988). Should We Ration Health Care by Age? American Geriatrics

Society,36(7), 644-648.

Cohen, A. B. (2012). The Debate Over Health Care Rationing: De ́ja` Vu All Over

Again? Inquiry Journal,49, 90-100.

Emanuel, E. J., & Emanuel, L. L. (1994). The Economics of Dying -- The Illusion of Cost

Savings at the End of Life. New England Journal of Medicine,330.

doi:10.1056/NEJM199402243300806

Etzioni, A. (1991). Health Care Rationing: A Critical Evaluation. Health Affairs,88-95.

McCarrick, P. M. (1990). The Aged and the Allocation of Health Care Resources. Bioethics

Research Library.

Mechanic, D. (1992). Professional Judgement and the Rationing of Medical Care. The University

of Pennsylvania Law Review,140, 1713-1754.

Mehlman, M. J. (1997). Rationing Expensive Lifesaving Medical Resources. Wisconsin Law

Review,239-303.

Smith, II, G. P. (2002). Allocating Health Care Resources to the Elderly. Elder Law Review,1.

Smith, II, G. P. (2009). The Elderly and Health Care Rationing. Pierce Law Review,7(2), 3.