Mike Bloomberg’s presidential campaign is over, but I want to return to something Bloomberg once said that was brought up by reporter Peter Hasson during Bloomberg’s most recent campaign that speaks to a fundamental issue in healthcare issue:
Billionaire and Democratic presidential candidate Michael Bloomberg said in a 2011 video that some elderly cancer patients should be denied treatment in order to cut health care costs. He drew on a hypothetical example of a “95-year old” with “prostate cancer” to signal an openness he would have to reform how Medicare provides treatment.
“All of these costs keep going up, nobody wants to pay any more money, and at the rate we’re going, health care is going to bankrupt us,” said Bloomberg, who was then New York City’s mayor.
“We’ve got to sit here and say which things we’re going to do, and which things we’re not, nobody wants to do that. Y’know, if you show up with prostate cancer, you’re 95 years old, we should say, ‘Go and enjoy. Have a nice [inaudible]. Live a long life. There’s no cure, and we can’t do anything.’ If you’re a young person, we should do something about it,” Bloomberg said in the video.
“If those of us in positions of power, from our perspective, decide your life isn’t very valuable, then we’ll lie to you and let you die from a curable ailment,” to put Mike Bloomberg’s point more directly.
I’m grateful for Bloomberg’s candor, even as I abhor his moral indifference to distinctly vulnerable persons, because he’s saying what no other politicians can say so bluntly: their plan is to constrain costs by denying care—even care that works and would save lives. Hello, death panels.
When politicians advance rationing in healthcare, and especially when they advance rationing of care that would work, they’re stigmatizing particular types of patients and warping a medical phrase called “futile care”.
“Futile care” once referred to situations where specific medical interventions no longer achieved their purpose of sustaining human life. If a person’s body is failing, and, for instance, can no longer metabolize food and water, then the specific intervention of food and water by tube would become “futile” as the patient nears death. No amount of food and water will help a person who can no longer metabolize it. That intervention is no longer efficacious, although the person herself remains equally valuable and retains her basic dignity even as she approaches death from natural causes.
To put it simply, care becomes “futile” when it stops working. This is the traditional and medical understanding of futile care. It’s simple and it makes sense.
Bloomberg was advocating categorizing certain persons as “futile”—i.e. medical discrimination based on invidious categories such as age. Making matters worse, Bloomberg endorsed lying about it: Tell older patients facing a curable disease, “There’s no cure, and we can’t do anything,” and tell younger patients we can “do something about it”. What would that do to trust in medical professionals?
“We have the best healthcare system in the world and simultaneously the worst healthcare financing system in the world.” I’ve heard some version of this from many people. It’s helpful for thinking about the true challenge of American healthcare.
We should be working to achieve accuracy and transparency when it comes to the problem of the inflated and inscrutable prices associated with healthcare delivery. The answers cannot lie in sanctioning professional mendacity or creating disposable categories of patients to be abandoned because we think their lives have less value than other patients. Certain cures are worse than the disease.