(Community Matters) To those who cheer “let him die” if a 30-yo man chose not to purchase health insurance but subsequently needed intensive care, I want to say something really bad & ugly but instead I think I better stop and listen. It’s more important that we heal what divides us than it is we shout back at each other.
Does this sentiment extend to your best friend’s son who’s a musician, was the cutest most respectful kid you knew and was always otherwise healthy but, admittedly made a bad decision? Does it extend to his children because dad chose not to purchase health insurance? And, what if the 30-yo had just lost cobra coverage after being laid off in a 2008 plant closing?
I agree we need more responsibility and accountability, though I don’t go as far as letting someone die if public healthcare could save their life, we can afford the treatment, and there’s a reasonable expectation for a long term, quality life.
(I’m told almost half of healthcare costs are incurred in the last 6 months of a patient’s existence. I’m not in favor of incurring these sort of public costs when we know this – in high probability – will be the case. I also don’t believe we can afford a Cadillac level of public healthcare; it’ll be Chevy. I believe those with the means can supplement what services are available).
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Community Matters 
A big problem here is, of course, who decides that the patient has no realistic hope of survival beyond six months (or whatever time span) and when does the decision get made? If you look at the standard language in living wills, which are invoked when death is considered imminent, and try to back that prediction up by six months, who will dare to make the call? I absolutely don’t want heroic, expensive, futile efforts expended only to delay the moment of my death–but if there is a reasonable possibility of returning to sentience, with effective pain management, and continuing interaction with people I love, I want that!
Possibly we could declare certain super-costly treatment options off limits based on actuarial prediction of length/quality of life post-treatment (e.g., no heart transplants for patients over 70 [I’m 74] with other major life-shortening conditions). Some insurers may already be doing this. What politician do you know who would advocate this?
A few years ago I was called upon to make the palliative care: heroic survival measures decision for my 95 year old mother. Knowing what she wanted, I had little difficulty making the decision. But what if the decision point had come 20 years sooner and the prediction was “We can keep her alive, but we can’t predict what she’ll be able to do”?
Lord have mercy!