Tuesday, November 24, 2009

Why We Must Ration Health Care

I don't normally get so serious on my blog, but this is where my head is, so please bear with me.

Yesterday, I drove down to pick my DH up at work and caught part of a rather chilling discussion on our Boston PBS radio station. It was about the need to ration health care based on the patient's lifestyle choices. The expert on the radio posited that smokers might not be treated for lung cancer. Chronic alcoholics shouldn't be surprised when their livers fail and if you're obese . . . well, you've sort of dug your own grave with your fork and spoon, haven't you? No extreme life-extending measures for you. And when they began saying a person with a disability must have his/her quality of life called into question, I was completely horrified, not just with the thoughts expressed, but by the even tone of the speaker. He was bloodless, like the disembodied voice of HAL in 2001, dispassionately separating the healthcare sheep from the goats.

While I'm all in favor of personal responsibility, I think they are missing an important piece of the health care question. It's part of the old nature/nurture debate. You might even argue that the writers of Greek tragedies got it right. All their heroes carried within them a "fatal flaw."

So do we. It's called our DNA. Look at your family tree. Is there a predominant recurrence of heart disease? Stroke? How long did your grandparents live? The insurance companies know these sorts of questions are the best predictors to use for their actuarial tables. It's also why your doctor asks for a detailed family history. When I was diagnosed with cancer last year, part of me wasn't surprised. Both my parents are cancer survivors, different types, but the same disease.

When we lived in Wyoming, our neighbor (who was a neurologist) was a fanatical walker. Every day, snow or rain, we'd see him and his Tibetan mastiffs (gorgeous dogs--think of a Pyranese only black) hiking their 3 mile trek around our hilly neighborhood. He maintained a healthy weight and lifestyle. Bud had good reason for such discipline. At 60, he'd already outlived every male in his family. Yet by the time he was 61, he was still having a quadruple bypass. Like a hero in a Greek tragedy, he couldn't outrun "the seeds of his own destruction," the proclivity for heart disease he carried.

Back to the original premise of blaming people for their illness. I think it shows more about the PBS speaker's philosophy than science. He's obviously of the opinion that humans are perfectable if only we could get them to make the right choices. Toward the end of the discussion he piously said he'd be happy to have his taxes raised to provide universal healthcare. But apparently, his universe doesn't include those who make choices he disagrees with.

As a fiction writer, I believe people are basically flawed (part of what makes them so interesting!) and unfortunately our DNA is too. Lifestyle choices make a difference, but they aren't the total reason for illness. And I fear the mix of those two things is far too complicated to reduce to a formula that will allow the health care arbiters to delegate responsibility for disease.

I promised myself I'd never get political on my blog and I'm trying very hard not to, but when I heard the PBS discussion yesterday it set me thinking about this very complicated knot. I have no answers, but I'm interested in your thoughts.

What do you think? Is rationed care the answer to the cost question? Who decides?


Booklover1335 said...

Rationed health care is NOT the solution to our problems. It is a slippery slope, where do you draw the line. You could take it so far that everyone could be excluded for one reason or another and completely goes against what health care is supposed to be about. MAKING YOU WELL.

For instance: What about sexually transmitted diseases? If you have unprotected sex do you deserve to suffer from an STD because of a bad decision, or it's a lifestyle choice. If you ration health care say goodbye to AIDS treatments.

It's unthinkable and unconscionable to even think this way. People always deserve the chance to change and life full and complete lives. Countries to have managed health care like England and Denmark don't place these types of stipulations on health care, but they do pay higher taxes. I say it is time we invest in ourselves and pay what needs to be paid for healthcare...and encourage industry reform to reduce costs and unnecessary procedures.

That's just my 2 cents worth

EmilyBryan said...

Thanks for sharing, Booklover.

Once my DH was offered a job in England and part of the package was private insurance so we wouldn't have to deal with the public system there. It was considered quite a benefit at the time (1988). What they had was a two tiered system with those who had private coverage getting speedier and more comprehensive care. I could see that happening here.

Also there is the issue of delayed care. I've heard breast cancer survival rates are much lower in England and Canada because of delays in treatment.

Jane L said...

Oh this is a sore subject for me, so I am going to be a very graceful guest. My daughter is 28, she came home here to Minnesota in October, for her first flu shot,(she lives in Jackson Hole Wyoming, limited medical care) here at a clinic she had went to growing up. She has an autoimmune disorder and we wanted her close to us in case she had any complications. She made the appointment, two weeks before she was coming home, told the app scheduler she didnt have insurance and was told, thats ok, then the lady quoted her the cost. She flew in the day before her appointment and the clinic called her and said her appointment was cancelled, she was distraught, The clinic staff person told her and I quote, because we have the transcript of the call "Since you dont have insurance, you dont fit the criteria for a flu shot at our clinic at this time" end quote! They would NOT budge and would not give it to her! My youngest son called the same clinic the same day and got in and got a flu shot, he has insurance!!! So she did end up getting one at another clinic, but this is where we have gone for over 30 years!!! Also like my husband said we could afford to pay for it ten times over if need be. If people do not think there is biased medical care I have written documentation there is! It is now in the hands of the attorney general. My daughter is furious as are we! A FLU shot, this was not anything major, can you imagine if she needed cancer care, would she be denied there? I agree we need to do something about people being denied medical care or lack of care, I dont have the solution either, but I agree Emily, there are genetics involved and why should one be punished per say for a genetic condition! Or lack of insurance!

EmilyBryan said...

Jane, I'm so sorry that happened to your daughter. How very odd.

It's strange that people who don't have insurance and "self-pay" for health care pay more than an insurance company would because the ins. co has negotiated the prices down. And if the payee is a government entity the price is different (usually lower) yet.

Common sense would dictate that a particular service should cost a certain amount no matter who receives it or who pays for it.

Unfortunately, common sense isn't all that common.

LuAnn said...

I agree with your DNA argument whole-heartedly! My own doctor told me once that he's had patients who never smoked a day in their life and developed lung cancer. Likewise, he's had patients who smoked for years and never got it. So, yes, I believe your genes have a lot to do with your health. On that note, should health care be rationed? Not in a million years. How would you explain to someone who is, say, obese due a thyroid problem that you won't allow them to be treated for heart issues when it's clearly not their fault?

librarypat said...

We are lucky to have good health insurance, but I have been anxious as our children moved out into the world, hoping they would get jobs with good coverage. Unfortunately our son works for himself at odd jobs and there is no way he can afford health insurance. He has been going to a public health clinic, but that is an iffy thing.
As for charges, if a doctor or hospital can charge an insurance Company a certain amount for a service why can't they charge an individual the same sow price. It makes no sense that they would charge someone with a goo income and good insurance $50 for something, but if you have no insurance and are probably making much less, you pay $300 for the same thing. If they charged the lower fee, it wouldn't take as long to get their money and o many people wouldn't be facing financial ruin. It is no wonder that people put off seeking medical care and as a result have high costs because they get sicker.
It is a disgrace that a country as wealthy as ours can not provide good health care for all of its citizens. We send billions overseas every year. Just the cost of the war in the middle east for a few days would be enough to finance a very good health care system.

EmilyBryan said...

Luann--Thanks for sharing your thoughts. The expert on PBS argued that health care is a finite resource and therefore has to be rationed.

I've never believed compassion is finite.

EmilyBryan said...

Pat--I hear you. We too enjoy excellent health insurance but our oldest daughter didn't until just this month. She started a job 3 months ago with decent coverage, but had to work there 90 days before it kicked in.

Now the younger one's hours are being cut back at her job and we're not sure if that will make her ineligible for the health insurance she'd signed up for.

Maryland is the one state that dictates the price of each medical procedure so there is no cost-shifting from one patient to another.

When I was a kid, hospitals were run by churches and charitable organizations, not as money-making enterprises. I don't remember ever hearing about anyone being turned away.