QUALITY-OF-LIFE RATIONING

From Ting and I: A Memoir

Some people argue that it is a waste to spend our resources on the disabled, especially as they get older. I disagree. It is a dangerous philosophy.

We value things on the basis of their usefulness and their scarcity. Water is useful, but widely available, thus generally inexpensive. Silver has practical and monetary uses and is relatively scarce, so it is much more expensive than water.

We do not know how long we will live. As we get older, we know there is less time left; it is scarcer. If we can make good use of it, enjoy it, be helpful, whatever, then the scarcity enhances its value. Even if what we do is not as good as it was years before, the years we have left can be quite precious. Tina’s life is precious, as is my own.

Some social planners come from another perspective, viewing public funds for medical care as “investments.” Babies who are unwanted or unlikely to survive do not merit investment, in this view. Your productive value goes up as you grow up, become educated, enter the work force.

Toward retirement, your productivity may decline. When old, at the very least, you have only a few more years in which to produce. These planners are reluctant to “invest” much more in you. Time to “pull the plug” on Grandpa or Grandma. Get that DNR order signed, and let them expire with the next heart attack. This approach is “rational” from a public-expenditure viewpoint, though it takes no account of the value of the ill person to himself and to those who care about him. It is part of a slippery slope that goes from not treating to euthanizing.

Notice that none of these calculations take into account gratitude for past actions. Some people have not done merely what they were paid for on the jobs they had. They have done more than required, better, cheerfully, cooperatively on the job, at home, with their families, friends, neighbors, community, country. Shouldn’t this all count, too? A good Granny deserves better treatment than a bad one.

Tina’s care has been expensive. We’ve spent money. IBM has spent more and Medicare has had a share. We certainly expected to help pay our medical costs. IBM recruited me partly though the attractiveness of its medical benefits program, which I knew we might someday need. When IBM wanted to cut its work force, I volunteered, again considering future needs for medical coverage. That leaves Medicare: decades of withdrawals from my paychecks have gone to this program, with the notional “locked-box account” for coverage of my family and me. As with other insurance, some people end up needing more and others less, a lottery of sorts. Fair enough, we thought. Now, some suggest we are “selfish” to be getting “more than our share” of medical coverage. We are not exactly winners of a lottery, but no one argues that winners of lotteries are “selfish” for collecting “more than their share.”