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.