Ramblings: The Ethics and Economics of Days Lived

I remember, like it was yesterday, sitting around a table in a graduate course on medical ethics. We would have these scenarios presented, and then we would have to make an ethical decision on the best course, as an ethics panel. Many hospitals have such panels.

For example, on your floor you have; a) 25 year-old woman, prostitute and drug user with liver failure related to drug abuse, b) a 75 year-old retired banker, who is quite wealthy and in good health before a virus destroyed his liver, c) a 30 year-old mother of 2 who liver failed from a genetic flaw, but who has to insurance and no private means of payment. Then the hospital has one liver that matches all three. The one who gets it, lives, and the other two will certainly die. You can just imagine how hard these decisions are to make.

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Okay, I’m going to talk about money, but, before I get started on this thought, please know that this is not some type of set up where I end up discussing financial needs and a “Go Fund Me” account. There is no hidden agenda here. I have no plans to do that. I have no idea what my health care bills is going to cost us, and how much the insurance will cover. My out-of-pocket costs is not supposed to be more than $2,000 year, but insurance companies have a way around that.

So, I have received our basic bill from my hospital stay. This bill does not cover many procedures or physicians’ bills for their services. That bill is $135,000. We will see how much the insurance company is going to pay.

On top of that are several other visits to ER and physicians’ offices, not to count dialysis three times a week. I have no idea how much dialysis cost, but it would surprise me if it was $500-$1000 each time.

We are looking ahead to the treatment that will have the best chance of saving my life for a number of years, stem cell transplant. There is no cure, but this could buy up to 5-20 years, before it will eventually fail. The cost of doing the stem cell transplant, will probably approach $500,000. Now one has to stop and think about, is my life work that much?  It is very hard to put a price on someone’s’ life or years of life. It is very hard to put a price on your own life.

When you step back and look at the money, it is true that you could take that same amount and save the lives of 1,000 kids in Yemen, who are starving from the war. Or, save the lives of hundreds of people who have things like malaria.

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It is not that easy just to take the money and switch it to such a noble cause. I mean, if we were paying the amount, out-of-pocket (and we couldn’t do that) you could re-designate the money to those more noble causes.

If I were alone, no wife, no kids, refusing treatment and sending the equal amount of money, or putting something like the work in Yemen in my will, that would be a good option for me. But I’ve promised my family that I would fight this disease with all I have, and that includes my (and the insurance company’s) money.

When you look at the real picture, either you spend the insurance company’s money to extend your life, or the money remains in the insurance company’s coffers, allowing them to pay their CEO (many who get 50-90 million dollars per year in salary and stock options) more and their stock holders more. So, if I do not get the treatment done, they buy yet another vacation home or Lamborghini.

I do feel some guilt and the guilt will worsen if I start to deplete our savings, leaving Denise in a more precarious retirement situation.

But these things are not easy to figure out. How do you put a price on your life or the years added to your life? These are the thoughts going through my head today. They are often questions that people never talk about, but are real.  Mike


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5 responses to “Ramblings: The Ethics and Economics of Days Lived”

  1. Yes, this is an in-your-face reality. At the time of my pancreatic troubles 4-5 years ago, my ‘Obamacare’ policy (thank God for Obamacare as I had been denied coverage by two private insurance companies a couple of years earlier because of pre-existing conditions) was 80/20 coverage. My part was around $22K–money I didn’t immediayely have, but was later able to pay off (retirement funds). Somehow that was a bit under the 20%. Because my hospital stay and procedures ended up being a one-time ‘fix’–not a chronic or terminal disease–with a severals months recovery with a fixed end, I was able to get back on my feet financially. I appealed another $4.5K that I didn’t have to pay; they tried to bill me for an out-of-network hospitalist that they never told me was out of their network. I won that one. You have to pay attention to everything even though you are very sick and out of it. I must say that I believe I received very good care and am thankful 3 specialists saved my life as my pancreas was not working when I arrived at the ER. But…yes, I am almost as frightened of the financial wreck as a result as of the disease itself. Make sure you have decent health insurance by all means. And that may not be enough.


    • As far as developed countries, America is about the only one where people with means goes bankrupt because they “made the bad choice” of getting sick. When I mentioned being single and without kids, I certainly didn’t have you in mind, but I can see why choices in that situation may or may not be tougher. I’m glad you survived that and I think the money was well spent.


  2. Imagine you are making the same choice for one of your children or your grandchildren. Then the decision becomes so.easy and so clear. There is not any amount of money you would not spend to save their lives or prolong their life for even one day longer. They and we all feel the same when it comes to saving your life. I am getting tested tomorrow for stem cells for our brother despite his lifelong choices and his gross failings as a human being most of his life. He’s lied cheated and stolen from the family he is now dependent on for more days on this earth. While you, my baby brother would be a multi millionaire if every person and their families that you have helped during your lifetime gave you only $1. So the question you ask can be answered by so many so differently for so many reasons having to do with personal feelings for that individual. Who deserves to live longer for whatever reason usually has to do with who you ask. You are both my brothers but because of the goodness of your heart and everything you have given of yourself to everyone who’s ever been in your life, asking me that question if I had to choose would be a no brainer. And I will make sure you get a copy of my test results so if I can give you my stem cells, they are yours! I’m sure I have enough for whomever needs or can use them…Love you Bro.


  3. I am going to the Holy Land next week and I know the prayer I will put in the wall. Would love to talk to you before I go. Sis


  4. Something occurred to me— Check to see if you’re eligible for Medicaid. When my son went on dialysis, (in MT V at DaVita, then here at PSKCenter) they explained that anyone with on dialysis automatically qualified for Medicaid and once it started ALL of his meds & medical procedures were paid for… It couldn’t hurt to check. I suspect your dialysis clinic (PSK Center OHarbor) staff has all the paperwork, FYI- his kidney failure was caused by diabetes- and there was no “pre-existing condition” problem. Sadly he passed before a donor kidney could be found.
    Onward and Upward.


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