Why California’s new “Death with Dignity” law will save billions in healthcare costs and eventually make suicide common and expected.
On October 5, 2015, Governor Jerry Brown signed legislation making California the fourth state, after Washington, Oregon, and Vermont, that will permit terminally ill patients to obtain medications that will enable them to end their own lives. The legislation was opposed by disability and senior rights groups that were concerned that people would choose to end their lives because of financial worries or depression.
In May, this website expressed concern about the legislation, warning, “California’s proposed assisted-suicide bill does not require psychiatric evaluations which would rule-out depression or anxiety as a primary motive for requesting assisted suicide, and does not provide adequate checks and balances to ensure that the disabled and elderly are protected, as reported by the local guide at HMHB.org. It could also lead to an increase in non-therapeutic suicides as it becomes socially acceptable. Since it costs only $35-50 for life-ending “medication” as opposed to hundreds of thousands of dollars for terminal healthcare the cost-saving incentive is significant.” [pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The generation that welcomed Roe v. Wade with open arms in 1972 is the same generation that is clamoring for the “right to die” in 2015.[/pullquote]
While most of those discussing the issues have primarily focused on the emotional issues involved, the elephant in the room is the fact that financial incentives to terminating life will be tremendous in coming years. According to the Centers for Disease Control and Prevention, the population in the United States continues to grow, and by 2030, one fifth of all Americans will be over 65 years of age. At the same time, life expectancy is expected to increase, and by 2050, life expectancy will reach 86 years for women and 80 years for men.
At the same time, health insurance costs are rising. In March 2015, CNBC reported on a Healthview Services study that found that the average lifetime retirement health-care premium costs for a fit 65-year-old couple retiring this year will be $266,589 including Medicare parts B and D and supplemental insurance, and anticipates a life expectancy of 87 years for men and 89 years for women. That’s just for the basic coverage insurance costs. If dental, vision, co-pays, and other out-of-pocket costs are added, it comes up to $394,954. A couple that is now 55-years-old retiring in ten years will face a projected coverage cost of $463,849.
Again, these numbers are just the baseline. For cancer patients, according to IMS Health Informatics and reported in U.S. News, the treatment costs of newly approved drugs are $10,000 per month and some therapies cost over $30,000 per month. Of this, patients typically pay 20 to 30 percent out-of-pocket, meaning that patients will be paying $24,000 to $36,000 per year for the new drugs themselves. That does not include other provider and facility fees as well as lost income if they lose their jobs.
If suicide reaches a critical mass of social acceptability, and is no longer viewed as having religious implications, it is not hard to conceive of a situation in which many cancer patients or elderly who suffer from diseases that require serious medical treatment may decide out of a sense of obligation to society or to their heirs that they will simply commit suicide rather than incur these kinds of fees. Eventually, those who decide to take the medications may be considered selfish or even immoral by others, and their continued lives as an ongoing waste of resources. While doctors may be loathe to “push” suicide pills on their patients, the option of “death with dignity” will be made readily available and be seen as the “honorable” thing to do.
In twenty years, it is likely that hospice care, which currently costs between $284 per day in a nursing home to $1,756 in a hospital, will be a rare anachronism if not gone altogether, and the number of patients seeking nursing home care for Alzheimer’s, paralysis, and other conditions requiring 24/7 treatment will decrease to the point where a number of facilities may shut their doors.
It not without irony that we can note that the generation that welcomed Roe v. Wade with open arms in 1972 is the same generation that is clamoring for the “right to die” in 2015.
The legislation began the year as SB 128, was tabled in July, and revived during a special session. The legalization will automatically end in ten years unless the legislature specifically votes to extends it.
A California group, Seniors Against Suicide, is seeking to put a referendum on the legislation on the November 2016 ballot. The group has until January 3, 2016 to gather 365,880 signatures to get the referendum on the ballot.
“Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.”
- Dylan Thomas