Humane or Cost-Effective?

My wife recently suffered a very serious stroke, She spent two weeks in the hospital and is now in a nursing home. I share this personal information as background for some observations on the current health care debate.

There is ongoing an intense artillery duel of words, claims, accusations, statistics and anecdotes from both sides of the debate over national health care. (Come on, you know that's what it's really about.) One side claims that care will be rationed, especially for the elderly. The other side vehemently denies this. This is in fact the case in the UK and, to a lesser extent, in Canada, an inevitable result as costs spiral upward and politicians and bureaucrats are caught between the rock-and-hard-place of confiscatory taxation versus service.

This rationing is quite subtle and not absolute. There is much debate, but expensive life-extending medical procedures for folks over 60 are frequently withheld or delayed. The testimonials from Britons happy with their health care are overwhelmingly from younger folks, as witnessed by the interviews in Michael Moore's movie Sicko.

I witnessed the crux of the problem during this past two weeks. The great majority of folks in beds that I saw were elderly. No question that our bodies deteriorate as we age--all of us. The assertion that most of the health care costs in the U.S. are incurred by old folks is, as far as I can see, completely valid. This is a major factor in the high cost of medical care and insurance. Other countries with nationalized health care employ--often subtly--policies that reduce these costs, hence the claim that "their" health care is less expensive. One structural problem is that doctors (in the U.K.) are salaried and work a normal work day with little incentive to put forth extra effort.

There is no magic formula regarding cost. Today's medical technology is expensive. The only way to substantially reduce the cost is to reduce expensive procedures like transplants. (No, the insurance companies are not staffed by robber barons! Their rates are based on payout statistics.) Some savings are achievable by eliminating duplication in facilities and drugs, which should be done--regrettably--via government intervention. I'm afraid that would result in fairly modest savings when compared to organ transplants and joint replacements.

Dr. Ezekial Emanuel, health policy advisor to President Obama, likely czar of any "government option" and brother of Chief of Staff Rahm Emanuel, has repeatedly and publicly advocated rationing of health care dollars based on fiscal principles. He has suggested restricting expensive health care procedures for the elderly and the very young! His reasoning is that society has not yet invested much in the young so not much is lost by their departure. Conversely, the elderly have little or nothing more to contribute to society, so they too are expendable. Best to invest scarce health care dollars in the lucky folks in the middle who are worth more to society, i.e. will provide a ROI (Return on Investment).

I'm sure Dr. Emanuel also opposes dripping water on the faces of terrorists to elicit information as constituting inhumane torture. (Liberals seem to have little difficulty with inconsistencies.)

 The decision regarding national health care is straightforward, if not easy. Either ROI or humane; we really can't have it both ways. (By the way, "single-payer" Medicare already does this to some extent by tightly limiting rehabilitation coverage following a stroke. I know this first hand. Those pesky old folks again.) I guess it's our "Hobson's Choice."