Insurance

If you and your computer don't live under a rock, you would be aware of the current challenges to ObamaCare in Washington. Today, rather than get caught up in the legality and tax implications of the bill, I am going to try to expand on another thought.

Let me establish a couple of ground rules. First, please stop showing me how much more Americans pay per capita on healthcare than other industrialized nations. It is a deliberately false analysis. Most countries do not pay for the services we as Americans are willing to spend on. I don't know if dental visits and braces are included in healthcare expenditures? How about plastic surgery and Botox? Is chiropractic and psychotherapy services counted?  Secondly, stop comparing life expectancy across countries without controlling for things like ethnic differences, socioeconomic factors, diet, vice behavior, accidents, crime rates, etc. It's really a distorted argument?

I personally believe that the vast majority of Americans believe that the healthcare system needs to be fixed. It is broken, but not beyond repair. There are many issues that we could have differing opinions from access to care to emergency room utilization to tort reform, but I'd like to discuss a real controversial issue that is affecting our health care system. Let's generate some real outrage. Here is my proposal: Eliminate end of life care.

Throughout human history, at least until the 1950's, most people who have died of natural causes did so away from the hospital. At the time, the public consciousness saw natural death as a part of life. The aid of medical technology changed that almost immediately and the debate became intertwined with healthcare. Before then the majority of deaths took place at the individual's home, but when death moved to the hospital it suddenly became much scarier. Over the next six decades, the advancement of healthcare technology (combined with health insurance and Medicare) began to extend life beyond what would normally be expected without the implementation of these innovations. Doctors, hospitals, government, insurance companies and patient advocacy began to take charge of the end of life process. Not surprisingly, with healthcare advancement we no longer accept death. How do we cut medical costs? Simple, stop end of life treatment! Are you willing to make that decision for your loved one or for yourself, or would you like just one extra day on the Earth? Hope.

After death, after all the pain and suffering, those remaining believe that if they had to do it again, they might decide differently. We'd want to try to improve the patient's quality of life, but we would not necessarily subject them to the costly, often painful, procedures. Unless we educate ourselves when we are presented with these choices, we'll decide that it is other people's responsibility to be more "frugal" with healthcare. Our case is unique and we can be cured. Hope.

What is wrong with "death panels"? No, not how they have been portrayed in the media and talking heads, but what if there were predictors established that gives us a high probability of knowing if the patient will die within 1 year? 3 months? 2 weeks? Many international healthcare models already place limits on public dollars for terminally ill patients, whereas the US does not. Unlike most other industrialized countries, Americans are more willing to put the 85-year-old with co-morbidities on life support, the stage IV lung cancer patient sometimes receives a hip replacement, we often prescribe costly drug therapy in deteriorating performance status patients. Limiting these procedures could help save up to 25% on our federal healthcare expenditures. I know, your situation is different and we could "cure" your disease. Hope.

Now, are we ready for change? What about the sweet, innocent girl we saw on the evening news, who was diagnosed with a rare form of cancer? Remember, she couldn't receive the experimental treatment because of the evil insurance company (or evil government). Sorry, she's going to die (and so is healthcare innovation). That million dollar treatment, with a 5% chance of survival cannot be afforded by our country. Hope? Not when that same million dollars can be spent for basic, preventative care for thousands of others.

ObamaCare as passed will provide the placebo effect that will placate people for another generation or two. However, real healthcare reform is the only option; otherwise, this will become another entitlement that will help bankrupt our country.

On an earlier post: How did Medicare and medical insurance ruin the affordability of fee-for-service health care? We are relieved of any financial responsibility for our healthcare purchases, thus we destroyed any incentive to shop for the best value. We do not consider the most cost-effective way of dealing with our condition. We no longer know how much a procedure costs and assume it is someone else's responsibility. If we had to personally pay for the final 3 months of life, how many more would choose the 1950 model and not the 2010 model?

Post script: If we eliminate hope, our per capita healthcare cost would be comparable to other European countries. I personally believe that hope is uniquely American and it would do significant damage to our public consciousness if it is mandated to be eliminated. The streets aren't really paved with gold, but I still believe that they are. Hope.