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What the Elderly Know about Health Care

By Dr. Jeff Mirus (bio - articles ) | Sep 11, 2009

The things Newsweek will print! The September 7th issue featured a column by Jacob Weisberg under the provocative title “Death, Republican Style” and with this tag line: “It’s the GOP that’s out to get Granny.” The thesis of the article is that Republican policies which fail for whatever reason to make the elderly happier and more comfortable are morally equivalent to death panels, to “do not resuscitate” orders, and to euthanasia. To grasp the enormity of this distortion, note that it is exactly the same as saying that supporting a transportation policy, which does not have the side-effect of improving pre-natal care, is the moral equivalent of direct abortion.

Any Image that Works

Granted, one does not expect reasonable bipartisan analysis from someone who has authored a book on the Bush presidency entitled The Bush Tragedy. (Both the title and the book might possibly be a tad dramatic. If Bush’s presidency were a tragedy, then the same must be true of any presidency characterized by significant failures, which very probably includes all of them.) I also grant that Newsweek has published the column under its “The Take” heading, which (perhaps) alerts the discerning reader to the presence of distinctive opinions designed as much to entertain as to inform. Nonetheless, Weisberg monumentally distorts moral truth throughout his column, which culminates in an image he wishes to set before the elderly:

And do not be surprised if you experience something like the following nightmare: You’re in a hospital bed, hovering in a state of partial consciousness. Beneath the mask, that surgeon has a familiar face…wait, isn’t that…Dr. Grassley? And who’s that with the syringe—Nurse Palin? At which point, if you are lucky, you will wake up in a cold sweat.

[Note: Charles Grassley is a Republican Senator from Iowa who has both criticized rationing in the Democrats’ health-care proposals and authored tax cuts which, as we will see, Weisberg regards as morally equivalent to euthanasia. Sarah Palin, as probably everyone knows, was the Republican vice-presidential candidate in 2008 and remains a vocal critic of federal health-care plans from a pro-life perspective.]

What annoys me about Weisberg’s image is not its sublime creativity (like God, Weisberg is apparently capable of creating out of nothing) but the false moral equivalency it represents. It may well be true, as Weisberg asserts, that adjustments to estate taxes affect the death rate. Studies show that the death rate increases among the elderly just before taxes are raised and declines just after they are lowered. Everybody understands that people hang on or let go (and some heirs may help them to hang on or let go) for all sorts of reasons. Nor do I dismiss Weisberg’s claim that social security has caused a lowering of suicide rates among the elderly (he reports that the rate is down 56% since 1930), though here he is on shakier ground, as there are so many other variables over the past eighty years. Still, it is reasonable to presume that suffering of any kind, including lack of adequate financial support, would increase the temptation to commit suicide—for anyone.

But it is another thing altogether to suggest, as Weisberg does suggest, that it was clearly a Republican goal in Bush’s attempted privatization of Social Security to put the elderly at the mercy of the stock market so that—in the bad times that have followed—the elderly would have died younger and committed suicide more often. Weisberg similarly faults Republican estate tax policy because the death rate for the elderly is likely to go up just before recent tax cuts expire, which the Republicans must clearly intend.

Then there’s Weisberg’s take on stem cell research, which he describes as having been limited by Bush to prevent the “most promising avenue for new treatments of diseases that afflict the aged”. Weisberg neither discusses the morality of embryonic stem cell research, which Bush did indeed limit, nor distiniguishes it from other kinds of unlimited stem cell research, which are vastly more promising. Or consider Weisberg’s use of clean (not to say thin) air. Because the elderly suffer more from air pollution, the tendency for Republicans to proceed slowly with clean air legislation is the moral equivalent of a positive decision to murder an estimated 23,000 persons.

Moral Rules

The huge, gigantic, enormous, gargantuan, overwhelming problem with all of this verbal sleight-of-hand is not that we are morally obligated to carefully consider the impact of public policies before implementing them. Of course we are. The problem is simply this: The prudential evaluation of a policy’s potential unintended statistical outcomes is not the same thing morally as the deliberate decision to commit an intrinsic moral evil.

All public policies (at least all those sincerely proposed as beneficial according to any reasonable understanding of the common good) will have both positive and negative effects. Some of these effects can be and are foreseen more or less correctly; others are foreseen incorrectly, are not foreseen at all, or cannot be foreseen. It is the business of politics to provide for ample debate over the pros and cons of various policy ideas and then to arrive at a prudential decision as to which policies will best serve the common good. In making this prudential judgment, we are not morally bound to favor only one statistic, or only one weighting of the values in question, or only one educated guess at the overall outcome. Statistics and guesses may shed some light on the discussion, but they rarely make anything certain, and still more rarely do they impose a moral obligation.

But we are morally obligated both personally and politically to avoid direct participation in intrinsically evil acts. Neither personally nor through public policy may we help to procure or commit an abortion, or withdraw ordinary care in order to hasten another’s death. Neither personally nor through public policy may we deliberately terminate a person’s life based on an analysis of the financial benefits, nor may we choose when to end our own lives (though various circumstances may well hearten or dishearten us, affecting our will to battle disease, and these factors are nearly always at work in how long we hang on). In short, to oppose or support any given piece of pollution legislation based on a reasonable assessment of the requirements of the common good, is not the same thing at all as to deliberately murder those who might in some ways be adversely affected by that legislation.

To reiterate the key point: Public policy decisions sometimes do involve direct, absolute moral issues. You can’t institute a moral policy in favor of euthanasia any more than you can institute a moral policy which supports abortion, because it is always wrong to institute a policy that directly violates the moral law. But apart from this direct moral concern, all policies have “costs” and “benefits” which must be balanced in what we commonly call the art of the possible. It is generally not evil for a person to prefer one balance of positives and negatives to another in accordance with his own evaluation of the many vexing questions which affect the common good. Preferring one policy, unless it is directly immoral, does not put a death order in Dr. Grassley’s hand. Nor does it put a deadly syringe in Sarah Palin’s.

What the Elderly Know

Ours is a graying culture. The political clout of the elderly is growing steadily. That’s not insignificant politically, though its exact significance may be hard to predict. I can certainly attest to the fact that my own personal priorities are not entirely the same as they were thirty years ago, though it is true that my moral values haven’t changed. In any case, the elderly are a growing voter bloc (if they are a bloc), and at the very least they have had more experience and more time for reflection on political reality than their younger counterparts. On the whole, they should have greater practical wisdom. Predictably, then, it is seldom the elderly who get swept up in the cause of each new political savior. They have seen too many come and go and amount to nothing; they know that, while political dangers are very real, every Messianic political hope is bogus.

As a case in point, it was not the elderly who most recently swept Democrats who think like Jacob Weisberg into power. In fact, to preserve his image of Nurse Palin with the syringe, Weisberg must gloss over the fact that the elderly were the only significant group to vote predominantly for Palin and the other Republicans he despises. There are many reasons for this, but one of them, surely, is that—despite Weisberg’s astonishing creation ex nihilo of false moral issues—the elderly are not worried primarily about their own inability to cope with the pressures of air pollution or global warming, nor their own temptation to commit suicide if things get tough economically, nor the potential moral weakness of their own family members. Rather, like the handicapped, the elderly are worried primarily about the one real, direct, personal and absolute moral issue that Weisberg trivializes: laws and governments that will both permit and encourage real doctors and nurses to prematurely end their lives.

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