Deck 4: Should We Ration Health Care for Older People

Question 1

Medical costs in the last year of life amount to about 30% of the entire Medicare budget.

Answer 1

True

Question 2

"Backdoor rationing" refers to which of the following?

A) Rationing health care on the basis of age without public acknowledgment of the practice.
B) Implementing a waiting list to replace a market system for allocating some types of medical care.
C) Implicit or indirect methods of rationing that limit access to the health care system, such as through case management.
D) Setting up special committees to decide which patients will have access to certain services.
E) None of these.

Answer 2

C

Question 3

Ubel argues that health care rationing amounts to an egregious crime against humanity.

Answer 3

False

Question 4

Throughout industrialized countries, health care spending increases with age, and it accelerates at advanced ages, especially for the oldest-old (85+).

Question 5

Medicare beneficiaries who are near death are the primary cause of large Medicare payments.

Question 6

Alternative approaches to rationing health care that would improve the efficiency of the health care system include which of the following?

A) limit medical procedures based on effectiveness
B) implement cost-benefit analysis
C) assess individuals' quality-adjusted life years and limit health care accordingly
D) implement cost-effectiveness analysis
E) all of these

Question 7

According to Callahan, people should be allowed to live out their "natural life spans," after which time they should be allowed to die.

Question 8

"Managed care" refers to which of the following?

A) Age-based rationing of health care to control costs.
B) Hiring managers to oversee health care providers in various hospital departments to control utilization of services.
C) Combining insurance with health care providers and facilities in a unified network to control costs.
D) Avoiding unneeded care or treatment that prolongs dying.
E) Using cost-benefit analysis to select the most cost effective treatment options.

Question 9

A "tolerable death" is one that can occur at any age due to causes that are beyond the control of medical care.

Question 10

Health care expenditures for the older population have outpaced general economic growth in recent years.

Question 11

Public entitlement programs for the health care of older adults should be used to relieve suffering but not to extend life through the use of life-extending technology.

Question 12

Callahan's proposal for age-based rationing assumes that care for older patients in their last year of life is expensive because of high-technology, life-sustaining medical treatment.

Question 13

Increasing the age of eligibility for Medicare from 65 to 70 would save approximately ______ percent of total Medicare costs.

A) 5
B) 15
C) 20
D) 30
E) 50

Question 14

According to Perry and Butler, scientific research should be focused on which of the following activities?

A) reduction of frailty
B) improvement of health status
C) increasing independence
D) a and b
E) all of these

Question 15

Callahan argues that it is acceptable to withhold treatment from older persons, but it is unacceptable to collaborate with patients who want help in ending their lives.

Question 16

Daniel Callahan argues that people should live out their "natural" life spans of approximately 80 years, and then they should be allowed to die.

Question 17

How much money would be saved by Callahan's proposal to ration high-technology medicine on the basis of age?

A) $5 million
B) $500 million
C) $5 billion
D) $500 billion
E) none of these

Question 18

Callahan argues that the primary role of elders is to serve the young and the future.

Question 19

According to Ubel, the need to ration health care resulted in managed care; in other words, managed care did not create health care rationing.

Question 20

Which of the following factors is responsible for rising health care costs?

A) increasing longevity
B) increasing intensity of services
C) fraud, waste, and abuse
D) all of these
E) a and b

Question 21

According to Brody, in the United States, ethical debate is now shifting from rationing health care to the avoidance of waste.

Question 22

Brody asserts that there are two principal ethical arguments for waste avoidance in medical interventions and health care. What are these two arguments, and what are your thoughts about their implications, if taken seriously?

Question 23

Perry and Butler argue that a more effective way to control health care costs than age-based rationing would be to eliminate the afflictions of old age.

Question 24

Hentoff argues that Daniel Callahan's proposal to ration health care on the basis of age is class-biased.

Question 25

Do you agree or disagree with Callahan who argues that health care should be rationed on the basis of chronological age? Explain.

Question 26

Hentoff predicts that as more individuals survive to old age, the public will vehemently oppose Callahan's proposal.

Question 27

Describe precedents for rationing health care that have taken place in other countries. Would there be support in the United States for rationing health care on the basis of age? Explain.

Question 28

According to Hentoff, several influential individuals and numerous bioethicists support Callahan's proposal in spite of individuals' "equal protection of the laws" under the Fourteenth Amendment.

Question 29

Is Daniel Callahan cruel and hard hearted, or is he instead courageous and far-sighted in his willingness to advocate a controversial idea? Discuss.

Question 30

Explain Daniel Callahan's proposal for rationing health care on the basis of age. What assumptions does he make in his argument? What evidence is there to refute his assumptions?

Question 31

Brody asserts that interventions that prolong life and those that relieve suffering are not easily made at the bedside.

Question 32

On what bases does Hentoff criticize Callahan's proposal to ration health care on the basis of age? Do you agree or disagree with Hentoff's criticism?

Question 33

What do Perry and Butler mean by an extended "health span"? How do they propose extending not just the life span but also the "health span"?

Question 34

According to Perry and Butler, approximately 10% of the money spent on health care for people over age 65 is spent on research that may lead to lower health care costs for chronic diseases and disabilities.

Question 35

What is Ubel's position on rationing health care? Do you agree or disagree? Explain.

Question 36

According to Ubel, we should be concerned with effectiveness analysis rather than rationing so that everyone has access to the same services.

Question 37

Ubel argues that health care rationing is already a widespread practice in the United States and elsewhere, even outside of managed care organizations.

Question 38

For Hentoff, Callahan's proposal becomes a "decent proposal" when Callahan suggests that age-based rationing won't go into effect until all older adults have access to long-term home care or nursing home care.

Question 39

What are the arguments for and against rationing health care on the basis of age? As the number of Medicare enrollees is projected to increase dramatically in the years ahead, what changes to Medicare would you propose in order to contain costs? Explain.