Healthcare and the Elderly

What Should They Get?

Colin Greenup
Whittier College

Abstract
When considering who should get healthcare, many thing must be taken into
consideration, but more importantly we must consider what kind of healthcare people
receive. Healthcare should be given to those who are paying or have paid for it, and not lowincome families. Also, healthcare should be more focused on helping those who will require
assistance over a long period of time rather than shortly prolonging the lives of those who are
terminally ill. The main focus should be not on finding cures and treating fatal diseases to
prolong life, but rather to find solutions to diseases that reduce the quality of life, and putting
a priority to the quality of a life rather than the length of a life.

No matter how old or young you are, you will sometimes get an injury that will
require medical assistance. Whether its a broken bone from falling off the monkey bars or a
broken hip from slipping in the shower, the medical attention to repair the damage can be
costly. Healthcare benefits were created in order to assist those in need of it, but the cost of
maintaining healthcare programs is exceedingly high, reaching roughly $993.7 billion per
year, only $6.3 billion away from $1 trillion (3). With such an astronomical cost, its no
wonder that the government limits these programs to specific people. But who should it be
limited to? Should the young and healthy be able to maintain their youth for as long as
possible using these benefits? Or should the elderly get to prolong their life as long as they
possibly can? From a providers viewpoint, it would make sense to provide healthcare to the
young and healthy. If the young are already healthy, they wont have to use their insurance as
much and providers can earn more money. However, Daniel Callahan, the co-founder and
president of the Hastings Center argues for the latter, saying that health care should be
limited to helping those who need it rather than who qualify for it. He says that the
government wants Medicare to determine what benefits it will make available, based on
costs and other considerations, and then simply not pay for those that dont pass their tests
(2). The ethicist claims that it is unethical to stand by and allow people who need the
treatments to be refused service based on pre-existing conditions and social status, as well as
extending a life by very little rather than providing for helpful assisted living quarters.
Under the current governmental healthcare system, Daniel Callahan would be
displeased. Medicare and Medicaid, two government programs designed to help provide
healthcare, are aimed at helping mostly the elderly, but also those who cannot afford

healthcare. Currently, 90 million Americans are enrolled in Medicare and Medicaid, with 45
million elderly being enrolled in Medicare, and 55 low-income Americans being enrolled in
Medicaid, with 10 of those 55 million being enrolled in Medicare as well (1). However,
when one stops to consider the cost of the programs compared to who the programs are
designed for, one might see a problem: how are low-income and elderly Americans supposed
to fund this program they use? The answer lies in taxpayer money, which comes from people
who arent even allowed to apply for the programs theyre paying for. For this reason,
healthcare should not be used to prolong the lives of the elderly and those who do not pay for
it, but rather be used to help with the quality of life of the elderly and
First off, we should figure out exactly how much the government should be doing for
healthcare. Government controls both Medicare and Medicaid, and they are limiting it to the
elderly and poor. This gives them a lot of responsibility that they should not have. The
governments current responsibility can be examined in 2 parts, which are production, and
availability and consumption (3). Production refers to all the doctors, nurses, hospitals, and
ambulances (3). It is fair to say that spending should be used to help provide doctors and
hospitals, because otherwise there would be no healthcare for anyone to use. This is the only
responsibility that the government should undertake; helping to pay for doctors and hospitals
is a necessity that would benefit everyone who pays taxes rather than only a select few that
qualify for it.
Availability and consumption, however, must be looked at more closely. Availability
and consumption of healthcare is defined as who pays for the healthcare compared to who it
is available to (3). When thinking of healthcare and its costs and uses, it is important to

separate the consumers from the payers. The consumers are the 90 million that are using the
programs, whereas the payers are the nearly 200 million who do not receive the benefits, but
instead pay for it (3)(4). The huge discrepancy between those who have to pay for it and
those who actually get to use it is astounding. Why, then, should those who dont pay or pay
very little receive all of the benefits while those who pay the bulk of the cost are forced to sit
back and watch their hard-earned money be taken from them and used for other people? This
is the type of responsibility that should not be given to the government, but rather should be
given to the people to decide how the money is spent.
In order to balance out the amount of benefits people receive for paying money to
things like Social Security and Medicare or Medicaid, there should be an option to opt-in or
opt-out of paying for them, and balance out the amount each person receives. If you plan on
using Social Security when youre retired and you can afford paying $5,000 a year for it,
then you can opt-in with that amount as your premium, paying that until you retire, and
receiving amount similar to what you paid. If you cant quite afford Social Security at that
rate, you can still opt-in at lower rates per year and receive slightly less benefits when you
retire. If you choose to opt-out, you wouldnt have to pay anything, but would not qualify for
any benefits whatsoever. By doing this, we have allowed people who do not need Social
Security to not have to pay for it, and have balanced out the benefits that people receive if
they do opt-in.
So what should those who pay for it use the money for? Daniel Callahan suggest that
we should use the money not on trying to keep the elderly alive, but rather use it for getting
housing and minimal care for the elderly, as well as finding cures for miserable diseases

rather than lethal ones (2). After one has lived a full life of about 80 years, talk about death
becomes inevitable. Rather than focusing on keeping someone alive, Callahan suggests that
it is better to accept death and prepare for it, making the elderly as comfortable as possible
before their death. It is a grim way of thinking, but in the end, death is a fact of life, and
delaying it is an impractical practice.
When asked about our current healthcare system, Callahan was concern with the cost,
but more concerned with the current model, which he described as infinite progress (2). He
said:
Cost is a symptom of a deeper problem. We have an infinite progress model.
Nothing is ever good enough. The standard of care is raised higher and higher but death
always wins. The National Institutes of Health is always giving priority to the most lethal
diseases; cancer, heart disease, strokes. Things that really make you miserable like mental
health [problems] or arthritis dont get nearly as much money. The fight against death has
been a very central part of American medicine. Its a weird system where you get saved from
heart disease at age 65, treated for cancer at age 75, and then after that end up with
Alzheimers at 85. This is progress?
When examining Callahans example of being treated for heart disease and cancer instead of
Alzheimers brings up an issue of priorities. One could argue that developing treatments that
can save someone from cancer at the age of 65 and allowing them to live on to be 90 is more
important than developing cures for diseases like Alzheimers, which is not fatal like cancer.
However, in doing so, we put value in the quantity of years lived, rather than the quality of
years lived, and forget that living a life with diseases that turn you into an almost vegetable

like state really isnt living at all. The main focus of medical progress should not be focused
on extending lives, but rather improving the quality of lives.
This is not to say we should let those with fatal diseases die. We should have some
focus on curing these diseases. However, when one prioritizes curing fatal diseases rather
than curing diseases that affect quality of life, it brings up an age old question of whether
quantity or quality is better. Should we focus on providing someone with a 100 year long life
where they suffered from Alzheimers and arthritis, or should we focus on helping someone
live to be only 80, but being able to remember it all? In current times, people seem to expect
their doctors to have a cure for everything, and get angry when they dont. It would then
seem natural that our focus would be on extending a life for as long as possible. However, it
is important to note that a lot of life extending procedures are very unsatisfying. For
example, an average colorectal cancer treatment will cost upwards of $800,000 due to the
need for both a 3 hour long surgery as well as chemotherapy (2). However, this expensive
process will only extend your life for an average of 1.5 months (2). This is staggering, and in
the end may not seem very practical or fair, especially when you consider that the nearly 1
million dollar cost was paid by taxpayers.
One could argue that it is unfair to call the cost of extending the life of a person with
such high costs is a waste of money, and that it is unethical to let them suffer from their
painful and deadly diseases. However, diseases such as Alzheimers and arthritis that may
not be deadly can have much more of an impact upon a persons life than a fatal disease that
would only allow a couple extra months of life if cured. During the summer of 2014, I was
able to experience the life of an Alzheimers patient up close. I worked for a family, taking

care of the grandfather who suffered from Alzheimers. The amount of suffering that he went
through was agonizing both to watch as well as to suffer from. In the 3 short months I spent
with this man, he went from being able to dress himself, make his coffee and meals, and
walk 2 miles every day, to being unable to properly dress, being unable to remember whether
or not he ate, and getting lost walking to his mailbox. Whats worse is that he knew he was
losing his mind. At times he would stop and say I know what I was doing, I just dont
remember how or why I was doing it, and I dont think I can do it anymore even if I wanted
to. The degeneration of his mind was a very painful process for everyone around him to
endure. Why, then, are procedures that will only extend the life of a man by 1.5 months being
put at a higher priority than one that this man has to endure for the next 10-15 years of his
life? There is no reasoning in saying that it is more important to extend the life of a man for a
couple months than preventing a man from suffering for many years to come.
One of the worst parts about living with one of these conditions is the fact that it is
hard to get any type of assisted living. An average one bedroom apartment in an assisted
living home is around $3000 per month, and remaining at home and hiring a professional to
come and take care of them costs even more, reaching $5000 per month (5). Even hiring an
18 year old family friend at very low rates can cost upwards of $2500 per month. These costs
are ludicrous when you compare them to the cost of one colorectal cancer treatment. If we
switched these expenses, saving one mans life for 1.5 months translates to paying to keep 10
people in their home with assisted living for 16 months, or 1 person for 160 months, which is
over 13 years. Thats a major discrepancy. The money that is used to extend a life very

minimally would be better used helping someone who will actually live for an extended
period of time.
Healthcare is a very hard subject to discuss. On one hand, it is important to help
prolong the lives of those who are suffering from fatal diseases so they may enjoy the little
time they have left in this life. However, when the cost of helping one person live an extra
month is enough to help others live comfortably for over a year, we need to examine how we
use our money. At that point, we need to not focus on slightly prolonging a doomed life, and
instead focus on helping those who will survive for years to come.

Bibliography
1 Baker, Beth. "Ethicist Callahan: Set Limits On Health Care." Kaiser Health News Ethicist
Callahan Set Limits On Health Care Comments. Kaiser, n.d. Web. 17 Nov. 2014.
2 Nancy Hammerle (1984) Private Choices, Social Costs, and Public Policy: An Economical
Analysis of Public Health Issues. Westport CT Prager Publishers
3 Feldstein M, Hall D, Kass L, Leffler K, Lindsay C, Pauly M, Phelps C, Schelling T, Seldon A
(1976) New Directions in Public Health Care: An Evaluation of Proposals for
National
Health Insurance. San Francisco California
4 "NHE Fact Sheet." Centers for Medicare & Medicaid Services. N.p., n.d. Web.
5 "Cost of Assisted Living." Assisted Living & Senior Living. Alfa.com, n.d. Web. 17 Nov. 2014.