Healthcare Goals, Remix

This article at Salon.com says, from perhaps a slightly different angle, what I was trying to get at in my post earlier this week. Although I would differ with Ms. Moore on several issues of approach and purpose, I must agree that there times–many times, in fact–when we must simply accept the inevitable decline of our health and allow ourselves to pass from this world:

At the end of our long and increasingly longer lives, when we are terminally ill and in the last months of life, we must accept our bodies’ decline, face our own mortality, gather our families and say goodbye. Say no to feeding tubes, ventilators, resuscitators, the isolation of ICU.

So much of our healthcare today, regardless of the proposed “reforms,” is focused on holding death off a little bit longer. I am young, it is easy for me to say that we should be able to let go when our time comes (and presumably my time is not for a long while yet). Modern medicine has further enabled our ‘escape.’ But there is a dignity that comes with death that we’ve lost, rather than simply face it as so many of our fathers or the steely old men one reads about in novels, we call 911, do another transplant or infusion, squeezing whatever drop of life possible out of our bodies. We go with whimpers and screams, not peace and grace. This is not to say I reject life and modern medicine, nor do I advocate proposals for ‘humane’ euthanasia; I merely note that life has a natural order and that natural order must eventually be allowed to come to its proper end. Moreover, such choices are inherently of a personal nature, not to be made by any board or policy.

The impact this understanding has on the healthcare debate is huge. The economics of putting death off are, and probably always will be, extraordinary:

End-of-life care eats up 12 percent of U.S. healthcare dollars; next year, we’ll spend $135 billion on it. That’s not money spent getting well and extending life, that’s money spent preventing and easing death in terminally ill patients. Indeed, 40 percent of Medicare dollars are spent in the last 30 days of life.

The great danger is the utilitarian view that such figures could inspire. Currently doctors, individuals, families and insurance companies together make such decisions about near-death care. Under a single-payer system, as is being proposed, such flexibility would likely be lost in the name of cost-effectiveness. It’s a frightening scenario and choice that no one wants to face, but no one wants to be made by someone else. Any society or government that feels qualified to decry one’s medical worthiness to live h assumed an entirely new power its citizens and their very lives. James M. Kushiner at Touchstone described the problem very well:

what worries me most is that the conversation and decisions about all these matters will be made by politicians and bureaucrats who do not have a fundamental respect for the sanctity of human life in the first place. From that foundation, all manner of mischief may come. It’s a small step from one imposed form of hospice to the duty to (voluntarily) die to the loss of the right to live (involuntary euthanasia).

Healthcare and Freedom Rant, pt. 1

The following is what is commonly called ‘a rant,’ and should be taken as such. It may contain many truths but also many exaggerations. — The Editor

On of the arguments we frequently hear in the current debate about healthcare is that of choice and freedom. We seem rather confused about the exact meaning of these words as they apply to health care, however. FDR and a progressive would view healthcare “freedom” as access and treatment for all; while a more traditional use would mean one has the right, according to his ability, to seek the best treatment available. Complicating the discussion is the traditional, near sacred view we give to the practice of medicine. A doctor’s first duty is “to do no harm,”  with the doctor bearing a moral obligation the doctor-patient relationship is granted a special place of privacy and trust within society and law.

Consider how in this normally works: a patient has a problem, and goes to his doctor seeking advice. The doctor, taking the entire situation into consideration, advises the best course of treatment. The patient receives this treatment and pays the doctor back as he is able–in the history books, many times that was in chickens, eggs or some other commodity rather than cash. The doctor has always preformed charity work, but has always been well paid as well. In modern times the landscape is quite different. The doctor still sees the patient and advises treatment, many times involving modern technologies and methods that he himself does not oversee. Marvelous as technology and modern medicine is, the costs associated with involving multiple layers of treatment–physician, x-ray, technicians, lab tests, advanced drugs and so forth–is fairly large. Fundamental to our debate is the understanding that health care is expensive.

Since the 40s and 50s, we’ve developed  insurance plans, HMOs, shared-cost plans and other forms of spreading the cost that also add several layers of cost and bureaucracy to the final bill. A visit to my doctor may only cost me a $20 co-pay, but my doctor has to submit a claim which must be reviewed by an insurance company which must write a check to pay my doctor for services I received. Meanwhile, I and my fellow insurance plan members are paying into a giant bucket of money that is being spread around to cover the various doctor bills each of us accrue. Currently employers subsidize much of this cost, helping to hide the true cost of a doctors visit or surgery.

Now is a system like this free choice? Many would say yes, but realize that ultimately the insurance company is calling the shots on your treatment so as not to bankrupt itself and its members. Cancer patients usually find this out when they hit the $50,000 or $100,000 cap on treatment many companies impose. I’m not bashing the companies for being heartless, they have to make their ends meet and provide the best standard of care they can to all. I am saying that insurance is not a means of treatment, but merely a cost-sharing mechanism within a certain group of people. When everyone uses it too much, however, the system breaks down. And when a single night in the hospital can cost upwards of $1000, even the little things can easily break the bank.

Healthcare costs are out of control, and the current “system” of third party payments cannot bear the rising costs much longer. As babyboomers retire, reducing the ratio of worker to beneficiary to nearly 2:1 levels, something has to give before doctors stop practicing and hospitals close down. The problem is that it takes money–and lots of it–to have true freedom in health care. People who say they merely want to keep their current plan or doctor are right to want that–but they cannot expect someone else to pay for it. The careful balance of the past that gave relative freedom and choice along with lower costs won’t last much longer.

There are lots of things that can be changed. Medical providers can reduce costs, simplify their payment structure, medical malpractice tort laws (“lawyer enrichment”) can be severely curtailed, bureaucratic paper work can be cut down, people can live healthier. But health care is fundamentally expensive, and if you want true “healthcare freedom” you need to either pay for it yourself or have a completely subsidized and generously funded state-system of doctors and hospitals that treats all regardless of condition or practicality. Neither is likely to be fully the case, but I’d prefer a system where I maintain the responsibility of decisions and costs over a government system hamstringed unsupportable burdens. The traditional practice of medicine left few untreated, perhaps we should stop seeking a system and instead turn responsibility back over to those who know best how to use it.

Healthcare Goals

I hope to post more fully on the issue of health care reform tomorrow, but in the meantime an important point to consider.

In all our debates about healthcare policy and reform, what is our end goal? “To provide better care to more people” seems to be the obvious answer, but that doesn’t necessarily break down as cleanly as one would like. Most people would probably agree that treating breast cancer is good, but what about the rare cancer victim who only has six months at most to live, even with $50,000 drug treatments? By providing those drugs do we provide better care, or simply give him a little bit longer on earth before he has to say a final goodbye? It’s a fine difference, and I’m not arguing cost effectiveness (an important topic in its own right). What I’m saying is that modern medicine has reached the point where we can extend our lives far beyond their natural legenth, and before we attempt to reform healthcare perhaps we should review first how we view medicine. Many today seem to view it as a means of reaching physical eternal life–and if that is the case, our healthcare policy is going to be radically different .

Palin the Non-President

Gov. Sarah Palin’s sudden resignation as the governor of Alaska without any clear future plans leaves me, as many people, baffled. I had Friday off, however, and spent the weekend celebrating Independence Day instead of reading every pundits thought on the surprise political twist. Looking back after the dust has settled some, we seem just as confused as before. Many such as Mark Steyn says she is tired and wants out of the national stage. It certainly is a reasonable position for any mother (and grandmother) with five children to take–life is stressful enough without the relentless attention, scrutiny, and late-night TV jokes. Others say she is stepping back to focus on 2012, but if that were the case she surely would have been a bit more scripted in her approach. Victor Davis Hanson says it is a long-term strategy to prepare for 2016 or beyond, an argument I find plausible but not fully watertight.

When John McCain announced Sarah Palin as his running mate, I grudgingly consented on the basis of novelty and last-minute campaign boosts. She has impressed me since then, but generally comes across as somewhat naive and in need of more experience and training, but with the right ideas and energy. The sudden pullback seems to me either a very carefully thought decision or a very hasty one; both likely inspired by a need pull back for the sake of her family and consider what the future holds.

She could leave politics for good. This seems doubtful, given her sudden rise and popularity with many Republicans. More likely in my mind is Victor Davis Hanson’s suggestion, that she spend the next several years developing herself into a candidate more ready for prime-time and with credible exposure. People who hoped Gov. Palin would lead the GOP to victory in 2012 are sadly delusional–Sarah Palin’s popular anti-establishment with homegrown doses of conservatism has many appeals, but would be hopeless against a black president who won on the platform of “change.” As an instrument of conservatism, she would fall easily. If, however, she determines to strengthen her positions and knowledge in the next several years, she could easily come back as an articulate, intellectual and punchy answer to the Left  in 2016.

That is a big if. But it is the only way for her to have any presidential aspirations in my mind. Perhaps after a rest she will return, either to Alaska state politics or the broader national scene, but Republicans should give her time to think and consider the costs to her family and the high-states she will be playing. She is not ready at this moment, and if she is ever to be ready the GOP should look elsewhere until then.

Michael Who?

The sudden death of Michael Jackson has taken many people and the media by storm. I was walking around D.C. when the news hit, and people were yelling it to each other as they got the word, through cell phones and Blackberries, or even police radios. Some where stunned, others tearful; many, like myself, merely shrugged.

The newscasts tell me Michael Jackson was a pop sensation and icon. I cannot deny it. Who can forget the cute little kid singing “Easy as A-B-C,, 1-2-3, Doe-Rae-Me, You-and-Me,”? or the crazy excitement of the Thriller album? And yet, the Michael Jackson that I tend to remember most is the incredibly disturbed and confused man that seemed unable to face reality or himself. The Michael Jackson of debt, of two long-drawn court trials, of dismal tabloid headlines that I remember most.

In part this has to do with my own age and generation. Michael Jackson is the same age as my mother, someone cool but not as contemporary as the Backstreet Boys or whatever other boybands we adored in the 90s. He was old news by then, a part of the so-called Generation X that we never really fit into. And when he made the headlines, we knew who he was but many of us, I suspect, did not care (I could be entirely wrong, of course). Thus his death brings to us no emotional power, except perhaps for a fond memory of the high-pitched kid of the Jackson5.

For Generation X, Blacks, and many others, Jackson was a star that transcended reality. He certainly did much to ease the post-60s racial tension, by appealing to both blacks and whites. His music was fun, his concerts alive with energy, and his appeal somehow charming. But it seems that for Jackson himself as much as any body, the dream he promised and the ideas he preached lead to a dead-end.

I’m not quite sure how to take the emotional reaction I’ve been seeing. He was in my eyes a talented figure gone horribly astray, someone who discovered that all the glitter and golds of fortune and stardom offered nothing, but couldn’t find any place else to hide. If I mourn for him it is for his sorrow in the last few years, not because we have lost a great leader or icon. He influneced many, but how many will take his life as a greater lesson than his words?