Sunday, August 02, 2009

Calling It As I See It

In the circles of those who discuss healthcare reform, use of the phrase "rationed care" is like dropping a bomb on civil discourse. The idea of rationed care (which implies that we'll have to make decisions about providing care ----- a sort of cost/benefit analysis method of providing medical services) raises all sorts of red flags of the panicked variety.

The implication of rationed care that one's beloved Grandma might not get a hip replacement because some heartless bureaucrat will take a look at the paperwork and say, "Hey, she's 85 and doesn't have much longer to live. No new hip." The canard also suggests that rationing means you wait in line for care, as in: "Well get that heart by-pass on the calendar for next month as we're fresh out of by-pass bucks at this time."

The American political culture of individualism gives no truck to notions that we might have to wait for medical care; that we might have to make difficult decisions in the provision of care. The reality, that our current healthcare system is in the rations business (as in: no insurance, no ration) is typically rejected by critics as an over-simplification of the situation.

That's nonsense, of course, as anyone without access to healthcare can tell you. My biggest concern about healthcare reform is that as we move to a system of national healthcare we must also get in place some cost controls. To cover the 45 million uninsured in our current system will bankrupt the nation because the current system is doing just that without covering all of us. So I'm distinctly in favor of a national, single-payer model with cost controls. The 45 million uninsured would get coverage; the under-insured would get coverage, and employers would be able to buy into a system of insurance that doesn't bankrupt the business. We'd be done with the exclusions of pre-existing conditions and other efforts to keep the sick out of the insured pool. Our commitment would be to provide healthcare for every single person in this nation. End discussion.

And yes, I think that we need some kind of rationing system and I'm willing to use the forbidden phrase. And having come right out and said that, I can already hear the screeching and yelling. I'd been working up an argument in favor of rationing when philosopher Peter Singer did the work for me in a recent NY Times magazine article. Thanks, Professor Singer. Read this article, please, and then imagine me nodding thoughtfully and saying, "yeah, yeah, what he said."

Because Professor Singer is spot-on. Let the rationing begin.

1 comment:

Nichole said...

Great article. My grandma is 80. She has battled what started as colon cancer for 3 or more years. She is now end stage with cancer having spread to her liver and uterus. She is as sick as they get. Instead of her oncologist insisting that she stop treatment, she went to Mayo Clinic for a "second opinion." She started a new chemo which of course makes her life hell. She is on Medicare, of course. Tax dollars are paying for expensive treatments to prolong a life that is basically over. It's not a cure. It's obviously not even slowing down the cancer. I don't mean to be harsh, but isn't enough enough? I know many kids that don't get health and dental care because their parents can't afford it. They have rotten teeth, strep throat, and hearing problems that can't be treated due to cost. I get it. I get why health care must be rationed.