Not to read too much into a typical tearjerker type of "news" article, but as we head into the morass of health-care "solutions," you are going to be seeing more and more of these sorts of things, even though they have been there all along.
All the fear-mongering about "death panels" ignores the obvious situation, one that anyone who has had the misfortune of falling into the system knows all too well -- there are already death panels, insofar as there are individuals and groups of people, faceless, distanced from the emotional impact of the situation. They're called insurance companies, HMOs, or in this case, doctors who have to make difficult decisions with scarce resources, and may even be providing less-than-optimal palliative care.
The dirty little secret about health care costs is not really much of a secret at all -- nearly half of all costs are expended on about 5% of the overall population, while half the population use little or no resources of the system at all. (This in itself is something of a potential future problem, as the success or failure of (sigh) health care reform is predicated to a huge extent on what is euphemistically known as "prevention and wellness," part of which is the usual eat-less-exercise-more exhortations, but part of which is getting at least semi-regular checkups. The thing about doctors is that no one visits them until they're already ill.)
Even without knowing all the gnat's-eyebrow statistical specifics, most of us intuitively understand that this is very much an 80-20 deal, that most of the costs and expenditures are being directed at a very small portion of the population. What that hammers out to is that the public ends up subsidizing very expensive procedures for a variety of conditions, some of them catastrophic, some of them chronic, some of them by-products of lifetimes of poor impulse control and decision making.
That is part and parcel of risk-pooling, of the vaunted social compact; we take care of those who need it now, with the understanding that it will eventually be our turn. Of course, as with Social Security, there are groups of people who statistically pay into the system, yet never collect what they put into it -- smokers, drinkers, African-Americans, and other demographics with relatively less-than-average life expectancy. And yet, at some point, somebody -- or somebody else -- has to foot the bill for all these great machines and techniques and doodads and optimized revenue models. We could always look into more efficient systems, but what's the fun in that?
As a kid, I read tons of sci-fi, and watched more than my share of Twilight Zone and such. So I have, let's say, an enhanced appreciation for the somewhat ironic notion that humanity's capacity for technological innovation consistently surpasses its ability to adapt its social systems to accommodate those improvements. We saw this in the recent Iraq War -- wounded military personnel sustained catastrophic injuries that would have killed them instantly even ten years earlier, so they came back to a dead economy with no jobs in the first place, but with the added obstacles of frequently having to relearn how to walk, or use prosthetic limbs, or deal with the psychological trauma of disfigurement, or just being in combat at all.
The comments section in the CNN article is as interesting as it is predictable -- polarized, diametrically opposed camps of "so sorry, gotta let the cripples die" hard-nosed realists and "every life is precious and invaluable" super-idealists. Of course every life has value, of course you want to save everyone. Most importantly, of course we all want to believe that cost is not a consideration, or at best a tertiary consideration. But -- and this seems particularly to be an issue in the organ-transplant arena, where there simply aren't an abundance of suitable matches to be had, thus a scarcity in viable resources -- it is a consideration all the same. If the heart-transplant surgeon has one heart to work with, and two suitable recipients, chances are (all other factors being more or less equal) they'll go with the more viable recipient -- that is, the one that has the best shot at living a longer, more healthy and complete life.
It's easy to slam the "who made these people God" card when it suits them, but when they need someone to remove their kid's brain tumor, that's exactly the sort of person they want nosing around in the hippocampus. In the meantime, these issues of cost and allocation are only going to get more pronounced. Aside from "eat less, exercise more, relieve stress, take up yoga," it's difficult to impart any real advice on how to prepare for it. Don't get sick. Get a better job so you can afford the higher premiums.
If we're not going to address the elephant in the room -- that maybe hosing a captive market with $77 gauze pads and usurious geographically-based pricing models, so that insurance/pharma/HMO CEOs can get the eight-figure salaries they're entitled to, as enshrined in the Bible and ratified in the Constitution, isn't the most efficient way to run a system -- then this is what you get, forever and ever amen. Is anyone surprised by any of this?
All the fear-mongering about "death panels" ignores the obvious situation, one that anyone who has had the misfortune of falling into the system knows all too well -- there are already death panels, insofar as there are individuals and groups of people, faceless, distanced from the emotional impact of the situation. They're called insurance companies, HMOs, or in this case, doctors who have to make difficult decisions with scarce resources, and may even be providing less-than-optimal palliative care.
The dirty little secret about health care costs is not really much of a secret at all -- nearly half of all costs are expended on about 5% of the overall population, while half the population use little or no resources of the system at all. (This in itself is something of a potential future problem, as the success or failure of (sigh) health care reform is predicated to a huge extent on what is euphemistically known as "prevention and wellness," part of which is the usual eat-less-exercise-more exhortations, but part of which is getting at least semi-regular checkups. The thing about doctors is that no one visits them until they're already ill.)
Even without knowing all the gnat's-eyebrow statistical specifics, most of us intuitively understand that this is very much an 80-20 deal, that most of the costs and expenditures are being directed at a very small portion of the population. What that hammers out to is that the public ends up subsidizing very expensive procedures for a variety of conditions, some of them catastrophic, some of them chronic, some of them by-products of lifetimes of poor impulse control and decision making.
That is part and parcel of risk-pooling, of the vaunted social compact; we take care of those who need it now, with the understanding that it will eventually be our turn. Of course, as with Social Security, there are groups of people who statistically pay into the system, yet never collect what they put into it -- smokers, drinkers, African-Americans, and other demographics with relatively less-than-average life expectancy. And yet, at some point, somebody -- or somebody else -- has to foot the bill for all these great machines and techniques and doodads and optimized revenue models. We could always look into more efficient systems, but what's the fun in that?
As a kid, I read tons of sci-fi, and watched more than my share of Twilight Zone and such. So I have, let's say, an enhanced appreciation for the somewhat ironic notion that humanity's capacity for technological innovation consistently surpasses its ability to adapt its social systems to accommodate those improvements. We saw this in the recent Iraq War -- wounded military personnel sustained catastrophic injuries that would have killed them instantly even ten years earlier, so they came back to a dead economy with no jobs in the first place, but with the added obstacles of frequently having to relearn how to walk, or use prosthetic limbs, or deal with the psychological trauma of disfigurement, or just being in combat at all.
The comments section in the CNN article is as interesting as it is predictable -- polarized, diametrically opposed camps of "so sorry, gotta let the cripples die" hard-nosed realists and "every life is precious and invaluable" super-idealists. Of course every life has value, of course you want to save everyone. Most importantly, of course we all want to believe that cost is not a consideration, or at best a tertiary consideration. But -- and this seems particularly to be an issue in the organ-transplant arena, where there simply aren't an abundance of suitable matches to be had, thus a scarcity in viable resources -- it is a consideration all the same. If the heart-transplant surgeon has one heart to work with, and two suitable recipients, chances are (all other factors being more or less equal) they'll go with the more viable recipient -- that is, the one that has the best shot at living a longer, more healthy and complete life.
It's easy to slam the "who made these people God" card when it suits them, but when they need someone to remove their kid's brain tumor, that's exactly the sort of person they want nosing around in the hippocampus. In the meantime, these issues of cost and allocation are only going to get more pronounced. Aside from "eat less, exercise more, relieve stress, take up yoga," it's difficult to impart any real advice on how to prepare for it. Don't get sick. Get a better job so you can afford the higher premiums.
If we're not going to address the elephant in the room -- that maybe hosing a captive market with $77 gauze pads and usurious geographically-based pricing models, so that insurance/pharma/HMO CEOs can get the eight-figure salaries they're entitled to, as enshrined in the Bible and ratified in the Constitution, isn't the most efficient way to run a system -- then this is what you get, forever and ever amen. Is anyone surprised by any of this?
Heywood J,
ReplyDeleteSpecifically on the organ transplant arena I don't know if I agree with your analysis. Money also plays a role. For instance two very famous liver transplant recipients, Mickey Mantle and Lou Reed lived only a few short months.
They could have been denied the transplants on the grounds that they engaged in harmful drug and alcohol abuse which lead directly to their destroyed livers but yet they did get them.
However, I'm not saying they should have been denied and turned out into the street, I'd just ask if the livers they received could have gone to other people.
And this cuts to the nature of the exploding healthcare costs.
The Right-Wing Model is basically: If You Were Wealthy You'd Be Healthy.
Very true. The same was said when Larry Hagman, a former alcoholic, got his liver transplant as well. Hagman lived many years with his replacement liver, but it was widely assumed that he got to the front of the line based on his name and fame. Money does indeed talk, as always.
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