What Will Happen to the Elderly under New Health Care System Proposed By President Obama?

By Richard G. Fessler, MD, PhD “If the experience of other countries is any guide, the elderly have the most to lose under a national health insurance system. In general, when health care is rationed, the young get preferential treatment, while older patients get pushed to the rear of the waiting lines.”1

Since the president has often praised the health care system in Great Britain, perhaps that system would be informative of what elderly Americans can expect with a single payer system. One in ten patients in Great Britain reported noticing a difference in the way they were treated by the National Health Service (the single payer administration of Great Britain) after they turned 50.2 One in twenty people over the age of 65 said that they had been refused treatment.3 The British newspaper The Observer reported that elderly patients received a lower standard of care and were treated less respectfully than younger patients.4 Although more than 1/3 of all cancers occur in people over 75, most cancer screening programs in the NHS do not include people over the age of 65.5 Only one in fifty lung cancer patients in Great Britain receives surgery.6

Denial of care to the elderly seems to be sanctioned by the British government. The NHS cut the number of geriatric hospital beds by over 50% between 1985 and 2004.7 Critics of the NHS have accused the policies toward care of the elderly as involuntary euthanasia.8 That may explain why deaths from pneumonia among people over the age of 75 are three to four times higher in the UK than the US.9 A more extreme example of rationing of health care can be seen in New Zealand, another “single payer health system.” Guidelines for treatment of end stage renal failure state that, “under usual circumstances, people over seventy-five should not be accepted” for renal dialysis.10 Since there are no private dialysis facilities in New Zealand, that amounts to a death sentence for an elderly person with renal failure!

So what can the elderly American look forward to then, under a government controlled single-payer system? Although there is little overall correlation between the amount of money spent on health care and longevity in the developed OECD countries, it is clear that among the elderly, there is a direct correlation between the amount of money spent on health care and life expectancy.11 Unlike other countries, the American elderly currently have relatively little difficulty accessing health care. However, as the population of elderly Americans continues to grow, simultaneous to decreased funding for senior health care, access to care will necessarily decrease. Proof of this was recently demonstrated by the President’s proposal to partially fund his health care proposal with a $300 billion dollar cut in Medicare spending! Thus, as the federal government uses its “monopsony” power to drive Medicare reimbursement even more below market prices, fewer doctors will accept Medicare patients. More patients with fewer doctors and less money translates into limited access to health care, and health care rationing! As the above data demonstrates, it is the elderly that bear the overwhelming brunt of this rationing, deleteriously affecting their health and life expectancy.

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1 Goodman, J.C., Musgrave, G.L., Herrick, D.M.: Lives at Risk, Roman & Littlefield Publishers, Inc. 2004. pp. 147.

2 Beecham, L., “Patients Say the NHS is Ageist,” British Medical Journal, April 24, 1999, pp 1095.

3 Hall, C., “Campaign to Halt Ageism in NHS”, Daily Telegraph (London) November 8, 1999.

4 Ahmed, K., “Elderly Suffering Ageism in NHS”, The Observer January 27, 2002.

5 Turner, N.J. et al., “Cancer in old age: Is it inadequately investigated and treated?” British Medical Journal 319:309-312, 1999.

6 Partridge, M.R., “Thoracic Surgery in a Crisis”, British Medical Journal February 16, 2001, pp 376-377.

7 Rao, J.N., “Politicians, Not Doctors, Must Make the Decisions about Rationing.” British Medical Journal, April 3, 1999, pp 340.

8 “Pensioners a Burden to NHS”. BBC News, December 6, 1999.

9 Redwood, H. “Why Ration Care?” (London: CIVITAS, Institute for the Study of Civil Society, 2000).

10 Feek, C.M. et al., “Experience with Rationing Health Care in New Zealand”, British Medical Journal 313:1346-1348, 1999.

11 Schoen, C., et al., “The Elderly’s Experiences with Health Care in Five Nations”, Commonwealth Fund, May 2000.

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Richard G. Fessler, M.D., PhD is a professor of Neurosurgery at Northwestern University in Chicago, Illinois.