Saturday, July 10, 2010

Dying at Home in the UK

Britain's Health Secretary, Andrew Lansley, has announced that more people should be allowed to die at home, a phrasing that gets at the challenges of end of life care, from The Telegraph:

Speaking at the International Carers Conference in Leeds, he said: “Having a terminal illness is a very distressing time for individuals and their families. People should be able to choose where they are cared for – most would choose to be cared for at home, surrounded by their friends and family – and be certain that the care they receive will be of the highest quality.

“This review will look at how we better deploy the money we spend on palliative care – so those in need are better supported. We intend that whatever care patients choose will meet their needs and wishes.”

In the U.S., as I've written before, about 80% wish to die at home but only about 20% do. I've been interested to see how attention to end of life care changes when the issue of assisted suicide (in all it's nomenclature) is discussed. Britain has been in the midst of a public discussion of end of life care, assisted suicide and the legal challenges of such laws thanks to the Purdy case last summer. I wonder if this elevated level of awareness there has had any effect on Lansley and the proposed study?

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Dying to Avoid the Death Tax

James Parke at Colorado Planning and State Probate Blog writes this in response to yesterday's Wall Street Journal article, "Too Rich to Live":

As a refresher, there is currently no estate tax in 2010. Thus, if a person dies this year, they can pass an unlimited amount of wealth to their heirs without paying a dollar of federal estate taxes. In 2011, however, the estate tax reappears with a top marginal rate of 55% and an exemption of $1M. For example, if a person worth $20M died on December 31, 2010, they would not pay any federal estate taxes. If that same person lived a few hours longer, and died on January 1, 2011, they would pay almost $10.5M in federal estate taxes. Seems a little arbitrary, doesn't it?

People have been speculating for years about the perverse incentive that this creates for wealthy people and their families. Will this result in a string of suicides? Or even worse, homicides? Until recently, I thought that these speculations were simply ridiculous hyperbole masked as legal analysis. The Wall Street Journal has taken this discussion to a new level by listing jurisdictions that offer physician assisted suicide. The one thing that kept going through my mind as I read this article is: are you serious? Why would they go through the trouble of doing that research and publishing that information? It almost seems like they are encouraging this ridiculous behavior.

Of course the WSJ is the paper of money and inherently conservative but before they give the partial details that get Parke upset, they make the obvious point:

Of course, there is a "death incentive" whenever Congress raises the estate tax. But it hasn't happened in decades; the top rate has held steady or fallen since 1942, according to tax historian Joseph Thorndike of Tax Analysts, a nonprofit group.

How is it that the inheritance tax has remained steady for 68 years? A concerted, organized and devious effort by conservatives to brand it the "death tax," thanks to Frank Luntz, get-one-over-on-the-people-for-the-sake-of-the-stinky-rich extraordinaire. (In part, Luntz is also responsible for the horrendous health care bill we've got. All that socialism talk, death panel stuff can be traced back to him.)

Disparaging taxes is easy. Nobody wants to pay more than they have to. But that's only part of the story -- the part that the WSJ, folks like Luntz, and, well, the wealthy, have worked to spread. The wealth disparity in the US -- and the world -- is greater than it has ever been. If the poor were poor because they just didn't care to earn money -- as if that desire to be rich were golden! -- then we'd have another issue altogether. But wealth disparity is created by taking advantage of the disadvantaged. Shaming project-born children, giving them futile educations, keeping them out of college. Allowing corporations to treat their low income workers any way they want. Preventing restructuring of health care. Spending more on infrastructure in wealthy areas than elsewhere. We've got a national system of keeping the down down. Any time you hear entitlements, socialism, natural law, and the like, pay attention to who is saying it and what privilege they're speaking from. Those that have wealth have employed our American mythology to make sure they keep it. And yet, greater equality means a brighter future for the nation.

And that's why the estate tax has remained unchanged for so long. Common Americans were hoodwinked into believing that the increase of death taxes would grossly affect them. And yet, I'd like to see the numbers on how many Americans are going to suffer unsurmountable penalties. The WSJ uses the case of an estate worth 50 Million to demonstrate the taxes cost. How many U.S. estates are worth that? Why doesn't it give us real statistics on how many Americans have 1 million and do the math from there? Because the WSJ -- and Parke -- have a clientelle to protect. And its most likely not me or you.

To Parke's other point: that the WSJ is irresponsible to publish information regarding legal assisted suicide. Pure rubbish. There are currently three states and the battle in those states was so pronounced that residents and their lawyers and doctors couldn't have missed it. Instead he should be concerned for the end of life tragedies that abound because of lack of health care, poor finances, few resources and abuse in the U.S. Assisted suicide laws make states accountable for their ill and elderly. And besides, it's a hell of a lot easier to buy a gun than to get a lethal dose of anything from your physician. Parke's is a moot point, misdirected.

In fact, because of the sad economic state of the U.S. right now, this is probably the best time to reinstate the inheritance tax. I can think of some other policies we could change too.

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