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?