Illustration by Bloomberg View

By the Editors 2012-06-03T22:00:06Z

Average life expectancy is one of two statistics commonly used to compare the health-care systems of different nations. (The other is infant mortality.)

One of the puzzles about the U.S. system is that we spend far and away the most money per capita for health care, but we rank 50th in average life expectancy -- after Macau, Malta, and Turks and Caicos, among others.

We are all familiar with statistics about how much of health-care spending takes place in the last year of life, and with stories about old people who are tortured with costly treatments they dont want and which prolong dying but dont extend life in any meaningful sense. (Michael Wolffs confessionary tale about his mother in New York magazine is a vivid example.)

Certainly, ailing old people should be allowed to die in peace, if thats what they want, and not be subject to excruciatingly painful surgeries and drugs that will do nothing for them. These are more the fault of lawyers than doctors. In our experience, doctors can be all too cool and rational in their thinking about the end of life. Its fear of lawsuits (or, in a few cases, trolling for customers) that prevents doctors from behaving rationally when prescribing treatment for the old and terminally ill.

But not providing treatment to people who dont want it wont save enough money to rescue the U.S. health-care system. Nor will eliminating new and expensive pills, and other therapies, that do no good at all or are no better than existing therapies.

So what do we do about old people who, on balance, would rather get even older -- whatever that means in terms of quality of life -- than give up? This is one of the indelicate, unmentionable questions in the health-care debate.

The slope here is slippery indeed. You start by obeying the wishes of someone with at best two months to live, who wants to trade them in for one month with no pain and no intrusive treatments. Next youre assuming that this is what someone who had expressed no preference (and is now demented or sedated) would have wanted. Then you are subtly, or not so subtly, pressuring her, or her children, to get with the program. Or you are even enacting regulations that deny Medicare reimbursement for treatments that dont meet some criterion of benefit.

In short, all the Republican talk during the health-care- reform debate about death panels was melodramatic and unfair, but not ridiculous. One way or another, holding down health-care costs will require policies that deny treatment to people who want it. And want it because it will extend their lives.

See more here:

How ’Death Panels’ Can Prolong Life