As the health economist with President Reagan’s Council of Economic Advisers from 1982 to 1984, I was upset when I learned that a large percent of spending under Medicare is for people in their last 6 months of life. I understood even then that going in you can’t always know that it’s the last 6 months of life. Still, it made sense to me, assuming we’re stuck with socialized health insurance for the elderly, for the government to give the elderly who are clearly terminal a choice: If the cost of treatment is x, you can get treated at the government’s expense or the government will give you 0.5x and you don’t get treated at government expense. That would give people an incentive to husband those dollars. They could go without government treatment and spend the money on other things, including a bequest to heirs, or they could try to find cheaper treatment, possibly in places like India. People who took the money would gain and the government would say taxpayers’ money.
That still makes sense to me.
But something in my thinking has changed. It’s not that the proposal above doesn’t make sense. What’s changed is my view on the percent of people who would likely take the money rather than the government expenditure on their health care. I used to think it was high. Now I think it’s lower than I thought. I can’t easily put numbers on it, but it’s lower.
And what led to it has been my wife’s and my experience in the last few weeks with our cat Joey. That’s his picture above. He was the sweetest cat and he was more like a human in his interaction with us than any other cat we’ve had–and we have had a lot of very good cats.
A little over 2 years ago, we found out that Joey had small-cell lymphoma and that he had probably had it for at least the previous half year. We put him on chemotherapy; I posted about it here. The chemo seemed to work–and then didn’t. So our vet put him on a different chemo. It seemed to work and then stopped working about 8 months ago. We should have been aggressive and gone to a cat oncologist–yes there are such people–for a third kind of chemo that, we learned too late, did exist. We started him on it about a month or two ago, but lost about 6 months of valuable time.
Even with the chemo not working and Joey’s weight having dropped from over 16 pounds before his disease to under 9 pounds recently, Joey seemed to be Joey. We agreed that we wouldn’t keep him alive just for us if we thought he was miserable. But we saw enough signs that he wasn’t miserable.
Last Tuesday, though, we thought we had seen enough to take him to the vet and euthanize him. But the vet did enough checks on him that we still held out hope that he would live maybe a few weeks more with a reasonable quality of life. At each stage that day when they did tests, they asked our approval and gave us the price tag in advance. We left there with some hope–and a bill of just a hair under $1,000.
Yesterday, it was clear that Joey was miserable and so we took him to our regular vet to be euthanized.
Do I regret spending that $1,000? Yes. But that’s because I know now that he lasted only 2 extra days and was miserable for almost the whole 48 hours. If I had thought that Joey could have a quality life for an extra 2 weeks, would I have regretted spending that $1,000? No.
And that’s my new insight. The value of keeping Joey alive for a few extra weeks–and remember that he’s a cat, not a person–was at least $1,000.
So now I’ve altered my prior view of the value of keeping a human alive for a few extra weeks or months.
Of course, the issue is: value to whom? In the case of our cat, the value to us. For a human, the value to the human and to those around him or her. I’m not arguing for government subsidies. I’m saying simply that the value is likely higher than I had expected.
Two additional points.
First, the late Gary Becker and co-authors Kevin Murphy and Tomas Philipson have written on this issue for humans and come up with high numbers based on different considerations.
Second, when bloggers discuss health care, they often point to Robin Hanson’s claim that people spend so much on health care because they want to show that they care. The slogan might be “health care shows I care.” That’s not what’s going on here. We weren’t tying to demonstrate anything to Joey and I’m pretty confident my wife and I were on the same page and not trying to impress each other. We simply badly wanted another few weeks with this precious, precious cat.