Live and Let Die

A schoolmate of mine, a Christian conservative, once insisted that the reason our public school teachers informed us about Eskimos leaving their aged on the ice to die was to prepare the way for doing something similar to our oldsters.

That seemed like quite large dose of paranoia, to me. After all, also in public school we learned that Aztecs cut the hearts out of those they sacrificed to their gods. The pyramid steps of Teotihuacan ran red with blood. We were told this, I thought, because it was true. Could there have been an organ harvesting agenda behind the history lesson?

Seemed unlikely.

Before asserting a major conspiracy, it strikes me as worth addressing, openly, all aspects of the problem that might give birth to such concerns. Was euthanasia of the elderly in the future? Probably only when I get old, I thought, darkly. But seriously, why would it be considered?

Because of the expense, of course.

But whose expense?

This is lightly touched on in Thomas Sowell’s recent column, “A ‘Duty to Die’?”

This is how Sowell begins:

One of the many fashionable notions that have caught on among some of the intelligentsia is that old people have “a duty to die,” rather than become a burden to others.

This is more than just an idea discussed around a seminar table. Already the government-run medical system in Britain is restricting what medications or treatments it will authorize for the elderly. Moreover, it seems almost certain that similar attempts to contain runaway costs will lead to similar policies when American medical care is taken over by the government.

Sowell then goes on to regale the reader with the heart-warming tale of his “Aunt Nance Ann,” who, penniless, moved from relative to relative in the days of his youth, without ever once being left on an ice floe.

Poor as we were, I never heard anybody say, or even intimate, that Aunt Nance Ann had “a duty to die.”

Sowell goes on to say that he only heard such talk years later, “from highly educated people in an affluent age, when even most families living below the official poverty level owned a car or truck and had air-conditioning.”

Sowell ends his column on a moralistic note, and though it is not completely out of whack with my sentiments, there is something missing in his analysis. Something important. What could it be?

Sowell is an economist, so it may come as some surprise to his readers to realize that what Sowell does not venture on the topic is any economic insight whatsoever. He makes a historical comparison but without drawing on the relevant forces at work.

Something has changed since the time of his poor Aunt Nance Ann. Expenses of medical care have gone up — way, way up — and the expectation that every person must be given the limit of medical care possible is now a dominant, almost unshakeable notion.

And, surprise surprise, government intervention is largely responsible for both developments.

The institutions of the state have taken over paying for medical care for oldsters, since the inception of Medicare in the ’60s. This apparently “free good” (little or no cost at “time of purchase”) has increased the demand for medical services, and with this increased demand costs have risen. None of this is shocking to an economist. But you might think it worth mentioning in a situation where costs must be borne.

When the Aunt Nances of yesteryear experienced, say, a failing kidney, and expensive treatment was briefly mentioned, how many relatives pooled their resources together to get that $10,000 treatment, considering that she was due to die “any year now anyways”? In the house I grew up in, two sets of great grandparents expired in the bed downstairs. A number of years ago, my mother died not in that same bedroom, but in the hospital. Why? Because she was on Medicare, and it was just a natural thing to do to send her to the hospital. The price tag for her last week of life was many thousands. (I’ve blocked the exact figure out of my mind. I remember writing out one check in installment payment for my father to sign, and then his never receiving another bill. This is how many huge medical expenses are handled in America: By writing them off, without ever even seeking legal recourse.)

The issue is not a “duty to die.” The issue is the keeping of failing people alive at gargantuan expense. Withholding major expenditures from one’s relatives was treated as a matter of course when economist Tom Sowell was a child. Nowadays, granting major expenditures without thinking of the costs is the matter of course.

In the old days, if you didn’t have money, you didn’t demand the expensive services. Nowadays, people without money are routinely given services without talking much about expenses.

But the system cannot just go on having hospitals eating costs (“writing them off”) and the government writing blank checks (“Medicare” and similar programs). Somehow services purchased must be paid for.

No one seems to want to confront this as a major problem. The people talking about a “duty to die” (I’ve actually never heard an intellectual really and honestly advocate such a duty, by the way) are at least confronting an economic issue. Thomas Sowell is not.

I’m sure he does elsewhere . . . for Thomas Sowell is an honest man.

But still, this column of his bugs me. It makes cheap moralistic points while ignoring huge swaths of reality.

It also neglects to place the blame for the development of the current situation squarely where it lies: at government, and political demands for same. Worse yet, it plays into people’s idiotic expectations of freebie care. We hate intrusive government! said in the same breath as Politicians are taking away our Medicare!

Ridiculous brain-dead Republicanism at its worst. And Sowell seems to be fanning the flames.

Innocent people should not be foisted with “a duty to die.” The right to life means, for adults, a right to liberty, which protects them from people with knives who wish to take away their lives.

But, to balance the point, this right to liberty prevents one from claiming the wealth of others to keep one’s life going. If one hasn’t prepared (by savings or insurance or a combination of both) to pay for future needs — for, say, end-of-life medical maintenance — then maybe you have a duty not to demand services. At most you may beg. Others may offer, but a beggar wouldn’t want to stretch the budgets of his or her benefactors.

Trouble is, this looks an awful lot like the duty to die that Sowell excoriates. But this sense of duty-not-to-ask-too-much was a given, an understood notion before Medicare. And because medical care was so primitive then — and the expectation that the service provided to millionaires would not be offered to aging people two steps up from mendicant — kept this moral sense just below the surface, just below the gaze of young Tommy Sowell’s attention.

But we’re adults here, right? Today, the live question is this: Is there any chance this ethos can be reinstated in a society that now demands everything but liberty and responsibility?

Not if thinkers like Sowell won’t confront it, and continue to feed the frenzy of those who still refuse to face reality.