Tuesday, May 20, 2003

Rationing health care

Adam Smith discusses one key exchange in the Dean Town Hall this past Sunday that dealt with the question of rationing health care, particularly to those with fatal illnesses: In Sunday’s forum, Gov. Dean had a frank discussion with a questioner about making the hard decisions on how we will have to decide how to spend limited health care dollars. In it, he discussed how important family/doctor discussions about plans people should make about quality of life at the end of their lives are and the need for encouraging those discussions as a part of the national discussion on health care. Most people run away from listening to these “morbid” discussions. I started paying attention to the issue of death with dignity after having briefly been knocked into a coma after an act of random violence that ended up putting me on Social Security disability for the past decade. The idea of being hooked up to a rack of machines and tubes to lengthen lives isn’t just distasteful for most Americans. It’s horrifying. It’s that image that started the “death with dignity” movement in the first place. I thought this moment was the most powerful of the entire town hall because it was obvious that Dean really cares about this issue. He had the entire audience spellbound while talking about a very tough issue. He made the point that the very thing that makes America great is the very thing that makes our healthcare so expensive: our innate belief that we can fix anything if we just apply ourselves hard enough to the problem, including death. I think Dean's point in bringing this up was to say that the biggest flaw in our health care system is not the cost, per se, but the fact that fewer and fewer people have a close enough relationship with their health care provider that they can feel comfortable talking to them about this issue. Instead, many people are treated like defective parts on an assembly line run by managers who are convinced that they can fix anything that is wrong with them (the America way!) The doctors and nurses in industrialized medicine simply don't have the time or the training to deal with the human side of medicine. The result is that the most expensive treatments are ordered even in those cases where the recipients, if given a choice, might actually decline them. It's a tough to sell the proposition that one way to reduce health care costs is to encourage people to think about NOT getting medical care and I applaud Dean's courage for bringing it up. Of course the Wurlitzer will probably try to distort his statements and make it sounds like he is advocating cutting off medical care to the aged (Grannies health care eating through your budget! Pull the plug and save today!) Nothing could be further from the truth. If people want the care, even if the prospects are hopeless, they should have access to it. But they should also be fully informed and be allowed to make the decision NOT to proceed with the care. I wonder what the good Doctor's position is on Oregon's Death With Dignity law.

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