Medical Ethics and Managed Care
The Exit Interview
Lawrence R. Huntoon, MD, PhD
The year is 2025. In an attempt to understand the tragic demise of American medicine in the tradition of Hippocrates, we look back on the course of events around the turn of the century.
The concept of Euthanasia Centers actually developed rather insidiously, yet over a relatively short period of time. It began with the widespread acceptance of managed care as a means of reducing health care expenditures at any cost. Once society as a whole became accustomed to the bottom line driven form of health care where savings accrue and HMO profits are made by withholding medical care, it was only a series of short steps to the formation of the Euthanasia Centers. The precedent of judging "quality of life" for those in the earliest stages of life had already been set, and given the unrelenting financial pressures of government and managed care, it took very little to gain acceptance of applying the same judgments to the older population.
Shortly after physician-assisted suicide was legalized on a national basis, Regional Euthanasia Centers (RECs), run by large managed care corporations, began proliferating throughout the country. The for-profit managed care companies, driven by pure greed, collaborated with key government officials to enact landmark legislation which would benefit both the government and the managed care companies by reducing health care expenditures, those incurred by the most expensive segment of the population --- the aged and infirm. These government-sanctioned Euthanasia Centers became not only socially acceptable, but actually quite popular among the growing number of young people in the country who were tired of being stifled by over-taxation brought on by years of overly generous entitlement promises made by politicians in generations past. In the years that followed, if you were old and sick, you had to be prepared to defend your continued existence to a government which had embraced the managed care philosophy so completely that past a certain age, you automatically appeared as a liability on the government's balance sheet.
Voluntary euthanasia became viewed as the "moral" and "right" thing for aging family members to do, and for those too selfish to do the "right" thing for their family and for society, involuntary euthanasia became the only rational choice for a society that had overspent its budget for so many decades.
It was in one of these Regional Euthanasia Centers that the following conversation, entitled "The Exit Interview," took place. This conversation was typical of interviews conducted at these centers around the turn of the century. It is often said that those who cannot recall the past are doomed to repeat it; but it is also true that those who cannot reasonably foresee the future, may be doomed to live through it...if they can. Is it real or only an illusion? Submitted for your edification and pleasure...another time and another place...only you can decide in the "Lampoon Zone."
The Exit Interview
"Welcome to the WEDONT CARE Managed Care Regional Euthanasia Center. We trust that you found the parking adequate and the waiting room experience accommodating. My name is Hillary, and I will be your counselor and guide through your final experience with us here today. If you could just take a few minutes to fill out our client satisfaction survey, I would appreciate it. We all work on commission here at the Center, and every kind word helps you know. We also like to be able to show others that we truly do provide a quality service to our clients.
"We, of course, encourage your family to participate in your final celebration of life with us here today, and we are happy to see that your spouse and all of your children could make it. Family are a great comfort in trying times like this, and they can also help make some of those difficult decisions with which we are faced. If all of you will have a seat around the conference table, we will begin with a review of the facts in your case.
"According to central database records, you were born in 1920 which would make you exactly 80 years old. You have done very well Mr. Jones. That is five years longer than the average male life expectancy. We also see that you have been a loyal WEDONT CARE managed care client since its inception in 1995. Our national risk database file indicates that you were diagnosed with cancer one month ago. Our individualized risk profile that our computer has generated indicates that you have a mean life expectancy of 7 months with an estimated end-of-life suffering index of 8. That means that you will likely be experiencing a lot of pain during the last month of life. Pain, of course, is one of the things that we work hard to prevent here at the Center. Our work is 100 percent guaranteed, it's painless, and to date, we have had no dissatisfied clients at all.
"Turning now to your individualized cost profile, we estimate that your medical care during the next 7 months will cost us $60,000 more than you will pay to us in monthly premiums. Total acute care DRG time for your type of cancer is only 3.2 days. That means that if you are unable to return home and care for yourself after 3.2 days of hospitalization, you will require nursing home placement at an estimated cost of $27,000. That amount is prorated, of course, based upon our best estimate of how long you will live following discharge from the hospital. Since your managed care plan does not cover nursing home costs, that will be a burden which will be placed on whatever remaining finances you have, thus lowering the amount you will be able to leave to your spouse and children. That's a grand total of $87,000 that both you and WEDONT CARE anticipate saving as a result of your decision today.
"No suffering, no burden on your family or on society's limited resources and we are prepared to offer you a very generous Exit Package to boot. In fact, we think we are going to be able to make you an offer that you will find hard to refuse. After our nominal 10 percent processing fee, we are prepared to rebate 15 percent of our remaining savings to your spouse and surviving family members based on your decision to exit today. Should you choose to donate any usable organs to the WEDONT CARE Organ Market Network for resale, we could probably rebate an additional 5 percent of our total cost savings after processing fees. You are, of course, entitled to keep your organs, but it would be a benefit to society not to mention a financial benefit to your spouse and family. As your personal euthanasia counselor (PEC), I want you to know that you have made the right decision in coming to see us here at the Center today. We are also very happy that you have come to us on a voluntary basis instead of waiting for the State to issue an involuntary euthanasia order. That's always an unpleasant experience for all of us, and for those unfortunate individuals who wait too long, the State confiscates the entire client rebate.
"We have a number of attractive options to offer in terms of rebate utilization. Your family can keep the cash rebate, less the State Euthanasia Tax (SET) and estate tax which in this state amounts to about 50 percent of the total rebate. You can avoid the State Euthanasia Tax and estate tax, however, by rolling the rebate over into government-approved WEDONT CARE HMO premiums for surviving family members based on an amount of 50 cents on the rebate dollar. Also, for your convenience we offer comprehensive funeral and crematory services right here at the Center, and we would be willing to provide your family with a fully approved memorial service for the cost of your rebate. Our final service DRG will permit a full hour long service with no out-of-pocket expense to your family or estate, and no taxes to be paid. Everything is covered. This has been a very popular choice for many of our clients.
"And finally, we come to the actual termination service itself. Here at the WEDONT CARE Regional Euthanasia Center, we want you to know that you have REAL choices. We have a total of 10 board-certified obitiatrists on duty for you to choose from 24 hours a day, seven days a week. We're here when you need us. You are guaranteed a full fifteen minutes of your favorite music, scenery, and flowers in the Euthanasia Room (ER) prior to your obitiatrist rendering the final service. And, although our outcomes-based protocol may not be original, suffice it to say that sometimes good ideas really do come from Hollywood.
"If you have any questions, I would be happy to answer them for you. If not, please make your final selections, leave a copy of your will at the front desk, sign the various forms, and we will be ready to proceed with the introduction to your very own obitiatrist who will see you the rest of the way.
"Speaking on behalf of all of us here at WEDONT CARE Managed Care, we hope that you have enjoyed the services we have provided to you today, and we hope that your family members will keep us in mind when their time comes to do the "right" thing for the good of society as a whole."
Dr. Huntoon is a neurologist in Jamestown, New York, president-elect of the AAPS, and serves on the Editorial Board of the Medical Sentinel.
Originally published in the Medical Sentinel 1999;4(1):38-39. Copyright©1999 Association of American Physicians and Surgeons (AAPS).