Death Panels

No one really wants to think or talk about rationing health care. No one wants to be the one who chooses which country gets hit by the tsunami, either. We call those decisions "acts of God," and we accept them as part of life, even if we don't understand or like them.

But what about in realms, like medicine, where humans get to play God (sometimes)?

In the heat of current debates about health care reform in America, former Alaska governor/vice presidential candidate Sarah Palin caught a lot of folks' attention by spreading the rumor that the House bill contained provisions for the creation of government-run "death panels." Aside from reminding everyone that a vote cast in fear counts as much as one based on reason, this news further galvanized conservatives who already opposed the plan.

Rationing is a fact of life in a world where resources are finite. We ration food, money, time, and lots of other things every day. In health care, rationing decisions are ideally made by the doctor and her patient, with a reasonable assessment of the likelihood of success for a given treatment. But you hear stories about families who prolong the patient's treatment, for lots of reasons, healthy or otherwise (Terri Schiavo comes to mind). And you hear stories about doctors who misjudge the prognosis, informing that someone has X months to live when, in fact, the patient goes on for years.

In a previous life, when I thought I wanted to be a doctor, I had interviews at several medical schools. In one of them, the interviewer posed an ethical dilemma about rationing. In the scenario he described, there were two patients with kidney failure and only one dialysis machine in the hospital. I was in charge: who would I allow to use it? The wife of the town's banker, or the town drunk? He wanted to know who I would choose, and why. What criteria would I use to decide who would get to live--would it be age? social status? financial ability to pay? gender? the fact that one or the other had a family at home? future productivity?  The interviewer grew increasingly frustrated with me because I kept coming up with answers like "fly in another dialysis machine." He then amended the scenario to include a blizzard! This went on and on, comically, because I refused to choose whose life was "more important" than the other's. (I got wait-listed at that school!)

Conservatives can act like rationing will happen with reform, as if it doesn't now. They can pretend that the current form of rationing--folks with money get to live, folks without don't--produces the best results, or the most truly American results. Really it's just the results that favor them, for now.

What if we had town hall meetings about who we value most and why? Or meetings to help us better accept the reality that health care dollars--which represent the time and training of medical professionals, plus supplies, overhead, the unpaid bills of the uninsured, the fraudulent payments to the dishonest, the payments on the MRI machine, the decades of pharmaceutical research, the bonuses of insurance company executives, and so much more--are limited? What if we talked about how life is unfair, but that we--as families, communities, and as a nation--can try to make it as fair as possible, and accept it, with love, respect, and dignity, when we can't? Maybe those meetings should be called "church," or "therapy." Whatever they're called, they're not happening, as far as I can tell.

Pulling the Plug on Grandma

By now, if you're tuned into the debate in the U.S. about health care reform, you've heard the scary predictions about how the proposed changes will affect folks who already have insurance. Conservatives and Republicans believe that offering a "public option" will lead to the following undesirable consequences:

• no private insurance company will be able to compete with the public system because the government will keep raising taxes to subsidize it. The private companies will go out of business.
• corporations who now offer health insurance to their employees will stop offering that coverage, forcing people to move to the public system.
• the public system will be, by definition because it is public, poorly run and will provide worse care.
• the public system will not adequately reimburse doctors for their services. Doctors who earn a lot of money now will not be able to do so once a large number of people are covered by the public plan.
• the best doctors will not be doctors anymore. the doctors who remain in the field, and the people who train in the future to become doctors, will not be "the best" doctors.
• the new plan will not be adequately funded (or something?), so there will be rationing of health care. In other words, someone else--not your doctor, and not you--will be deciding whether you receive treatment for your condition. Most likely, I'm told, it will be a government bureaucrat who knows only spreadsheets and not you. And certainly not health care.
• we will pass on an unmanageable financial burden to future generations with no benefit.
• providing health care to all Americans will cause us to lose our national character in terms of excellence and global competitiveness.
  

I have so much to say about all of these assumptions. First of all, because it's just how I am, I wonder how we know these things are going to happen. Second, I enjoy pondering what these assumptions say about us and our beliefs about human motivation. What do we believe and trust when we imagine about why people become doctors or politicians or bean-counting bureaucrats? And third, why do we act like this is the end of the world? Like we can't go back and adjust and amend things later as all of these "catastrophes" materialize?

Have you ever kept track of your predictions about the future? I'm amazed at how consistently I'm wrong! If I'm reluctant about going on a trip, I end up having fun anyway. If I'm in a bad mood, something good happens that turns my mood around. All of my fears (especially the worst ones) are based on the past. Usually the reality of life turns out to be a little bit of what I was afraid of, plus good things, plus some stuff I never imagined. If I reflect too much on how little I know about what a choice will bring, I might never get out of bed. The good news is that I trust myself, my ability to deal, and the support I have around me. And I trust that I can always re-group and keep evolving.

My bottom line? Health care reform has to start somewhere. Honestly, I don't care where, as long as 1) it does start, 2) it does continue, and 3) it always puts the needs and health of consumers above those of the shareholders of publicly-traded companies.

All of the Poor People Should Just Die

I don't like it that participants in the current Medicare Part B program can get free flu vaccines. I just saw that, on a sign at the grocery store. I don't want to have my tax dollars going to people who don't work as hard as I do. Why should I have to pay for other peoples' bad choices? It's not my problem that people didn't work hard like I did, and like my family did. It's not my problem that they don't have health insurance like I do. I work for a good, solid corporation. We were a plum account for our insurance company. We work hard, so the insurance company negotiates discounted rates with our doctors and hospitals.

If poor people can't afford to pay for their own vaccine, then let them get the flu. But if their kids get the flu, they shouldn't send them to school. They should stay home with them. And if they have to miss work to take care of their kids, they can just lose their jobs. And if their employers have to scramble because their employees have to stay home instead of coming to work, they'll get over it. And if their landlords have to evict them, they will find someone else to move in. If the landlord has to foreclose on the property, someone else who works hard will buy it. Eventually, the housing market will recover.

America is a great country because you can see what you're made of. You can pull yourself up by your bootstraps. That's what I do. Pull myself up by my bootstraps and make good choices. I was once a sperm and an egg, and I made the good choice to get myself together, to grow, and to be born. Then, I made the good choice to grow up in a good home and go to good schools and live in a house with people who had health insurance.

I don't want to have to pay for health care for poor people because it's too expensive, and I work hard. I am in the top tax bracket, and folks like me are the ones who pay for these programs, not the vast majority of people who don't work hard and don't make good choices. If my taxes go up, I might not be able to pull myself up by my bootstraps. If small businesses have to pay for their employees' coverage, then there goes the fabric of this country, entrepreneurship. Let them scramble when their employees are sick, or when their own kids get the flu from those other kids whose parents don't have the good sense to keep them home from school.

Government can't do everything! All I want is to preserve the fabric of this country, what has made us the envy of the world. And that's the ability to make your destiny, if you work hard. I don't want to live in the former Soviet Union. It's a slippery slope. If you start paying for the health care of people who don't work hard, you're just a few steps away from communism, despite the fact that the former Soviet Union was not a representative democracy with term limits, and despite the fact that that country began with a violent overthrow of the czarist system. Still, it's a slippery slope.

Doctors work hard. And hospitals work hard. If poor people can't pay their bills, that's not the problem of doctors or hospitals. They should just refuse to treat them. And then, maybe the poor people will all either die or go away. Or maybe go to college to get a better job.

I don't want to have to pay for prisons, either. I'd rather save up my money for a 15 foot high fence with an alarm system around my house. I'd rather move to a part of town where there aren't any poor people. I agree that health care is a problem, but it's not my problem.