When my father went back to the hospital a year ago, he was clearly close to the end: His lungs and liver were barely functioning, his abdomen was filling with fluid, and he could no longer lift himself out of bed. The hospital’s doctors nonetheless treated him aggressively, punching a hole in his chest to insert a drainage tube, which quickly led to uncontrolled bleeding, an infection, and a plunge in blood pressure. Within 12 hours, my father was in a coma, with no chance of recovery, sustained only by a ventilator and a tangle of multiple IV drips. He spent four days in the ICU, until I overcame the resistance of two doctors and had the machines turned off, as per my dad’s living will. Medicare paid upward of $20,000 for these last days of my father’s life, during which he received little comfort, moments of agonizing pain and fear, and all the medical care in the world, and then some.
In the historic debate over health-care reform now beginning in this country, we will hear much talk of “rationing.” If health care is rationed, we’ll be told, we may be denied drugs or surgeries or treatments based on cost, effectiveness, or the patient’s condition or age. It sounds cold and heartless, except when you consider that the only real alternative to rationing is unlimited medical treatment—including a refusal to “lose” the battle with death even when death is near. Unlimited care, of course, requires unlimited spending, which is not viable. Rationing in some form is inevitable; the only question is when we’ll finally be able to admit to ourselves that even in America, there are limits to everything.
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