At a town hall meeting in Portsmouth, New Hampshire, on August 11, 2009, in response to a question from 11-year-old schoolgirl Julia Hall of Malden, Massachusetts, on the matter of healthcare, President Obama made the following statement: “The rumor that has been circulating a lot is the idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma.  I am not in favor of that.”

It’s reassuring to know the nation’s chief executive disavows any intention to deprive the elderly of the care required to keep them percolating on into eternity.  Let’s now take a realistic look at how grandma will fare under the health program the president referred to, HR3200 approved by the House Ways and Means Committee July 17 on a 23-to-18 mostly party line vote.

A fundamental requirement of the legislation is that everyone in the nation must be insured in some way and no one can be denied coverage because of a pre-existing condition.  It’s true those currently insured will be permitted to retain their policies, but if a private for-profit plan cannot compete with the government’s subsidized program, it may well be driven out of business.  Those persons unable to pay an insurance premium will receive coverage, compliments of the taxpayer.  The plan also specifies large employers who do not provide coverage for their employees will pay a penalty, with smaller employers assessed on a sliding scale.  Another provision in the bill includes establishment of community health centers designed, in some vague way, to encourage healthy lifestyles.  As to where the trillions for all this will come from, we’re to believe that increased governmental efficiency and more taxes on the rich will somehow do the job.

Despite differences in opinion as to whether the plan is economically viable, or even desirable, one thing is perfectly clear: If the program is to deliver even a portion of what it promises, its cost must go through the roof.  Short of the federal government simply printing money at an ever increasing rate—the sort of operation which resulted in the economic collapse of Germany’s Weimar Republic in 1923—there will never be enough dollars to fulfill the promises.  This gets us down to a fundamental question: With an aging population, many with limited resources, and an increasingly complex and costly medical establishment, can we as a nation afford to provide even marginal health care to every American citizen—and possibly every non-citizen as well?

Perhaps it’s time to think about the unthinkable: Is there any circumstance when grandma’s plug should be pulled?  Before I address this question, I’ll offer a couple of third-hand testimonials for your consideration.  The first concerns an 82-year-old woman who in 1993 suffered a stroke leaving her largely paralyzed.  With the help of a shrewd attorney and the twisting of a few rules and regulations, this woman’s assets found themselves transferred into a trust for her husband, and for the next 11¾ years she remained hospitalized on breathing and feeding tubes, mostly unable to move or speak, entirely paid for by Medicaid.  In another instance, in 1995, a feeding tube was inserted into a hopelessly senile 98-year-old woman, billed to Medicare and supplemental insurance, with no meaningful consent by any family member.  If left up to the hospital personnel who ordered the insertion, the patient and tube would likely have remained in place as long as remuneration continued to flow in.

I’ll now address my question: Is there any circumstance when grandma’s plug should be pulled?  Let’s take this out of the realm of ethics and morality by changing the word should to will: Is there any circumstance when grandma’s plug will be pulled?  This now becomes a matter of hard, cold reality.  Consider the instance where an 87-year-old grandmother with advanced Alzheimer’s is being kept alive in an institution, thanks only to the 24-hour care received, at a cost of $20,000 monthly.  As long as the expense continues to be picked up by a governmental agency or an insurance company, most families will be perfectly willing to let Granny live on in perpetuity.  However, if her care becomes a financial responsibility of the family, attitudes will rapidly change.  In this case you’ll most likely look long and hard to find a willing family member to pick up the tab.  With cash flow at an end, the 24-hour care becomes a thing of the past, and Granny will quickly succumb to her ailments.

The public dispute rages on, with the current controversy now centered on the benefits and drawbacks of private versus government-run healthcare.  Understandably, America’s aged citizens favor the status quo, claiming to oppose socialized medicine as they receive preferential treatment through Medicare at the expense of the general public.  I’ve seen no finer illustration of this incongruity than an August 20 cartoon by Mike Smith of King Features.  It depicts an elderly man saying to his doctor: “What this country doesn’t need is government-run health care.”  The physician replies: “So, shall I send my bill to you or to Medicare?”