Examinator,

Even if we ran the most efficient healthcare system possible, cutting costs, and profits, to the bone there would always be case where a patient could only be kept alive at very high cost. The example quoted in the NY Times article is just that; an example.

There is, THERE HAS TO BE, a difference between the subjective value we place on our own lives and those of our loved ones, and the amount Medicare can spend on prolonging that life.

I place infinite value on the lives of my children. If the cost of saving either of their lives consumed Australia's entire healthcare budget for the next ten years I would consider it money well spent.

But would you be willing to see a decade's worth of healthcare expenditure devoted to saving the life of one person no matter what subjective value I place on their life?

Obviously not.

Therefore we need to set some sort of boundary. My question is this:

How much should Medicare be willing to spend to prolong life for one year?

You want to ask an equally valid but DIFFERENT question:

Are the pharmaceutical companies screwing us?

The short answer is "yes".

See:

http://www.mingbaima.com/2009/06/a-reply-to-peter-mansfield-of-healthy-skepticism-part-1/

http://www.mingbaima.com/2009/06/what-is-wrong-with-jupiter/

But resources are finite and we still need an answer to my question. Would you like to suggest a number?

John D

My grandfather, a heavy smoker, died of lung cancer. My aunt finally died after 10 years of Alzheimer's. Both are horrible ways to die but if I was compelled to choose I would take the cancer.

Reality Check:

On average prescription medications account for only about one sixth of lifetime healthcare costs. See:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1361028

So even reducing these to zero would do little to tame the seemingly inexorable rise in healthcare costs. The biggest villain is probably unnecessary procedures. See:

http://www.mingbaima.com/2009/07/the-most-dysfunctional-group-of-doctors-in-the-world/

*The question should be why we allow the pharmaceutical industry to make huge profits from our health problems.*

Antonious, Govts are free to put their billions of $ on the table
and pay for the development of new drugs. Its up to taxpayers really.

Given that Govts are not doing this, I'm happy to see investors
plough their money into these companies and take their chances.
If I might need what they discover, it will then be my choice.
I'd rather have that choice, then not have that choice.

SM, you ask a valid question and indeed, its one of these emotion-
reason dilemmas which we face, without easy answers.

Personally I think that age should have something to do with the
answer. These days, huge amounts of money are thrown at people
in their late 80s and 90s, anything to keep them alive for a little
bit longer.

A friend of mine in his late 80s, was involved in a severe car
smash and was a mess. He was in a bad way, in alot of pain and
pleaded with his doctors to lend him die with dignity and peace.
He decided that he'd had a great life, enough was now enough.
Despite his requests, they kept throwing resources at him, to
prolong his life for a few more days. All he really got was a lot
more suffering and a few more weeks, only to die anyhow.

Perhaps the patient's own choice, should come into significance a
little bit more, despite the Catholic Church preaching that it
is noble to suffer.

Dear Steven,

"Let's have a number?"

I assume that your premise is to balance the
provision of treatment with the money available to
Medicare. That public funding can't be a
bottomless pit.

I can't give you a number
because I'm not an expert in the field. How on earth
would I be capable of reaching a figure? How would I
do the calculations? They at best would be extremely
narrow - and probably misguided.

My concern is - we need to address the real needs of
suffering patients.
I'd like to know how are the figures reached?
And who does the calculations? What group approves
the drugs and are there experts in the field they
are evaluating?

By the way - I read that Sutent (also known as Sunitinib)
prolongs the survival not by 12 months but by 24 months.
And it does help ease the pain and suffering.

It is time these sort of decisions were debated in Parliament.
Surely the numbers involved are low and the overall cost
to Medicare wouldn't be that great compared with cheaper
drugs used for non-life threatening purposes by millions...

I have a mother-in-law - who was diagnosed with Alzheimers
a few years back. Her GP referred us (for her) to a specialist -
who prescribed the very expensive drug - Aricept for her.
This drug normally costs $300 a month, but with the referral
of a specialist - we're able to get it for her for $5.00 (approx).
The Government pays for it.

It's made a world of difference to her life - her condition
has not deteriorated for the past three years. It's not a
cure - but its given her a better quality of life. She still
recognizes us - and even though she has memory lapses - overall
I don't know where she would have been without the drug.

I'm sorry Steven - I can't put a price on the real needs
of suffering patients - it's up to the experts to decide
what drugs should be available on Medicare - and for whom.
I'm not one fo them.

Examinator: I was thinking about heart attacks vs alzheimers rather than cancer, however, having a cousin die of cancer with her mind intact vs my mother in law die of alzheimers I would tend to agree. Alzheimers has the added dificulty that it creeps up. If she had chosen to my cancer victim cousin could have made a rational decision about whether to continue treatment.

My mother in law could not have made that decision. Sure, she could have made a decision and left instructions but I have this vision of old people who suspect that their mind is going wandering around in fear that someone was going to act on the instruction. It is hard to decide what we are going to see as "the right time to die" when we are closer to what we thought the time should be. I remember when I thought that being fat and forty was over the fence.

stevenlmeyer,

You ask for a number. I think it is pointless providing you one. Sure, I have a number in mind, but it will be different everyone else, but I can't provide a good reason why mine should be chosen over anybody else's. I guess it all hinges on how much value you put on a human life, and that is a personal thing.

Between us we have already come to some sort of muddled compromise via our political system. The way we arrived at it may not be perfect, but it seems to be a number most of us can live with. Since ultimately that is what matters most - that we all go peacefully along with that single measure of how much effort a government must put into preserving our life, in effect making the final determination on when we die. There is more justification for that particular number than any I could offer for mine.

Your link to FAT SMOKERS being the cheapest to support was great. I always wondered about that.

Dear Belly,
Are you happy with the way of the world. Trouble, strife, poverty, division, sickness, stress, drugs, coruption, greed, polution, mismamagment and the like. Religious strife and other mindsets all leading from dead mindsets. Ideas of dead men.
I am not and as I know the road to paradise, I will shout it from the rooftops. Jesus is Alive follow him not ideas of dead men. Behind almost all good ideas is somebody with a lust for money and power kingdom, building for this world and that is what is the problem.
When you have a better answer than Jesus gives, I might choose to listen. While trouble and strife is the only fruit of your world don't expect me to partake. I will be off line for some time for medical reasons so God bless and may love, joy, and peace be the order of your day. I have missed you old friend.