'60 Minutes' Segment Explores the Ideas of Rationing, 'Pulling the Plug on Grandma'

Considering how fond liberals are of "teachable moments," it was surprising that CBS's "60 Minutes" missed one on its Nov. 22 broadcast.

"60 Minutes" correspondent Steve Kroft took an in-depth look at one of the most expensive aspects of modern health care - the cost of end of life care. However, he didn't highlight the federal government's culpability in driving up those costs, or what it might mean for health care reform.

"Every medical study ever conducted has concluded 100 percent of all Americans will eventually die," Kroft said. "This comes as no great surprise. But, the amount of money being spent at the end of people lives probably will. Last year, Medicare paid $50 billion just for doctors' and hospital bills during the last two months of patients lives. That's more than the budget of the Department of Homeland Security or the Department of Education. And it's been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact."

Despite those costs, Kroft said Congress and the President aren't addressing this "explosive" issue in the current proposals on the floor.

"Most of the bills are paid for by the federal government with few or no questions asked," Kroft continued. "Now you might think this might be an obvious thing for Congress or the President to address as they try to reform health care. But what used to be a bipartisan issue has become a politically explosive one - the perfect example of the costs that threaten to bankrupt the country and how hard it's going to be to rein them in."

However, Kroft ignored what's on the table now: a public option or some type of  Medicare coverage for all, and how that alone could drive medical costs up to levels that end of life care has risen, spurred on by the easy availability provided under government-funded Medicare.

Dr. Ira Byock, past president of the American Academy of Hospice and Palliative Medicine, had a solution - subjectively choosing what patient deserves what end-of-life medical treatment.

"I think you can not make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say we simply do not put defibrillators in people in this condition - meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now again, that's going to outrage a lot of people."

Kroft proposed that this stance was a version of "pulling grandma off the machine," one of the key ethical and moral dilemmas dismissed by the current detractors of health care reform as fear-mongering. But what he proposed has a real chilling effect for those on the verge of needing such health care.

"You know, I have to say, I think that's offensive," Byock replied. "I just - I spend my life in service of affirming life. I really do. To say we're going to pull grandma off this machine by not offering her a liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous and it's certainly scurrilous when we have 46 million Americans who are uninsured."

David Walker, president and CEO of the Peter G. Peterson Foundation and the former Comptroller General of the United States and head of the GAO, weighed in. According to Walker, other countries ration health care when it comes to taxpayer funds, so why not the United States, he proposed.

"Every other major industrialized nation but the United States has a budget for how much taxpayer funds are allocated to health care because they've all recognized that you could bankrupt your country without it," Walker said.

The report ignored the much broader point - more government control of the health care industry would create a scenario where the individual has less choice and the government would have the power to ration. Walker wasn't making the case that employers and individuals should ration, but if the government were to seize control of one-sixth of the U.S. economy, the argument for rationing would gain strength.

"Listen, we ration now, we just don't ration rationally," Walker continued. "There's no question there's going to have to be some form of rationing. Let me be clear - individuals and employers ought to be able to spend as much money as they want to have things done. But when you're talking about taxpayer resources, there's a limit as to how much resources we have."