[before i begin, may i point out that while our obama-nation is idiotically occupying itself with rearranging the deck chairs of healthcare and cap-and-trade on the sinking american ship of state, the heathen red chinese are quietly and busily shedding our t-bills and buying up all the oil, gold and copper futures they can get their hands on in anticipation of the coming inevitable hyperinflation of the american dollar?
whatever--if healthcare is the current shiny object the criminal bankers are using to distract the cattle from what really matters, then fine, i'll talk about healthcare. just remember--mkf never takes his eye away from the real ball.]
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in my last post, i cited (1) the insurance industry, (2) the american medical association, (3) the american bar association and (4) the pharmaceutical industry--four of the most powerful lobbies in existence, which collectively have bought and paid for every politician in washington--as not only four of the main reasons for the ridiculously high cost of healthcare in america, but the reason why true healthcare reform is not possible.
maybe i'll elaborate on what seems so screamingly obvious to me in a future post--but not today.
today, i'm gonna talk about the fifth reason why healthcare is so expensive in america. and it has nothing to do with lobbies or partisan politics; on the contrary, it's an issue so deeply ingrained in the american ethos as to transcend simple ideology.
you ready?
(5) sanctity of life.
it's a concept all pampered americans embrace--for conservatives, it's all about the unborn fetuses; for liberals, the death-row inmates. but whatever the political stripe, everybody comes together when it comes to protecting babies and old people.
and that's where the issue of healthcare really gets interesting--and expensive.
see, back in the old days, if a baby was born flawed or premature, its mother or midwife simply held it until it died.
if an old person suffered a heart attack, stroke or other inevitable affliction of old age, his/her family gathered round their bedside until they limped off to join jesus in heaven.
today? technology has changed everything--we have developed the ability to preserve, extend and enhance life to a degree that boggles the mind.
consider:
crack-baby or one of a fertility-drug enhanced litter born four months premature and five pounds underweight? yesterday it would've died, but today we can save it.geezer with a stroke, cancer or heart condition? yesterday he/she would've have died, but today we can keep 'em alive indefinitely with surgery and chemo and bypasses and pacemakers and shit.grandma falls and breaks a hip? no need to put her on an ice floe and push her out to sea--today we can give her a new one.
in other words, the definition of "sanctity of life" has expanded with our man-made ability to preserve and extend life.
problem is, all this miracle-shit costs money--lots and lots and lots of money.
whereas in the past we'd have just let these people limp off and die and be ok with it because that's all we could do, today we have granted ourselves the ability to play god at both the beginning and end stages of life.
and today, we demand that such technology as exists be brought to bear in every case, because life is sacred, goddammit--"should we preserve or extend life beyond what should be normally expected?" isn't even the issue anymore; instead, it's become all about "fuck the cost--we can't let them die!"
[which, btw, is the main reason why these days so many americans' life savings are wiped away in their final six months of life--but i'm getting ahead of myself.]
the ugly truth is, between all the preemies borne of uteruses that by all rights should never have supported life, and the multitudes of baby-boomers about to enter their healthcare-sucking golden age who should've died six months ago, there will soon be an infinite pool of need for our healthcare resources, versus an ever-shrinking supply.
and who's gonna decide who gets what?
ultimately--and yeah, it'll take us awhile to go from a to z--it'll be the idiot sarah palin's death panels, of course. and anybody who thinks otherwise is deluding themselves.
this will happen whether we pass "healthcare reform" or not--i don't see any way it can't.
do you?
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the reason this post is appearing so goddam far after the fact of its relevance in the news cycle is because ever since palin made her "death panel" comment, i've been searching far and wide for anybody who would lay out the issue like i just did.
so far? nobody, anywhere.
the fact that this blog doesn't have an audience usually doesn't bother me much--except for when it does, like now.
comment if you wish, but understand: i'm gonna be uncharacteristically merciless in my response if you're even slightly off-point.
5 comments:
Excellent post.
As I understood the proposed in the House, doctors would talk to patients about what they wanted to do at the end of life -- be put on a respirator? Have extra ordinary steps taken?
Republican take that and say that we are pushing grandma in to her grave.
So, as I understand it, guttermorality is the Republican distortion made good: Hell yeah to death panels.
Although extreme, there is a lot of statistical data that large amounts of health care money is spent on a person's last year or even last few months of life.
Often, it does not dramatically prolong life, comes at a great cost, and the quality of that life is often significantly diminished.
Most nationalized health care nations (oh, that means every other industrialized country except the United States) just does not pay for all of that care.
The problem is often that people want to take extra ordinary measures at the very end of their life also because they are not paying for it either.
If you told a person you can go through another round of chemotherapy for late stage brain cancer, or just go home with a morphine drip, many people will try the chemo despite the long odds...unless you tell them that if you choose option A, you will leave no inheritance to your kids.
That may change people's minds, it might not.
As it stands, the problem that guttermorality so aptly notes is that no patient has a stake in lowering their overall costs of healthcare...so we have old people demanding enormous amounts of treatment with little to any real benefit.
But the larger point that guttermorality misses is that the health insurance companies do have an incentive to lower their overall health expenses.
But, too many insurance companies have chosen to give the people what they want and save money by trying to kick out anyone who is not healthy by a pre-existing condition exclusion.
Why aren't the health insurance companies saying, no, you can't have that treatment.
Whenever an HMO says to one of its members (who pays a fraction of what people with PPO insurance pay) that you can't have that experimental treatment, we are outraged.
People want everything modern state of the art health care can provide, but aren't willing to pay for it when they actually have to clear out their savings and sign over the house.
One of my colleagues said about the American legal system, we have a Rolls Royce legal system, but we cannot afford to use it very often.
The same is true here.
It might be better to have a Volkswagon health care system that
we could actually afford for everyone, instead of these unrealistic goals for people who won't pay for them.
I work in the health care field I actually am responsible for trying to get medical equipment paid for by ins companies so the patient can be at home, the vast majority of ins companies are also saying "no we don't pay for that" for 75% of items or treatments that patients really would benefit from(and this is not new they have been doing that for the last 10 years I've been working in this field). Or they are making patients pay a premium then meet an catastrophic out of pocket before they will pay, meaning patients pay $200-$300 dollars a month in premiums, $200 - $5,000 in deductibles then another $2,000 - $5,000 out of pocket at the beginning of every year. I know that some people have great/decent programs through work and don't see those kinds of numbers but the majority of my patients do including those with secondary ins plans to medicare. Every year my company has to decide if we can continue to serve our patients as Medicare adds more items to the list of things they don't pay for and cuts back the amount the pay on things they do pay for, then the rest of the ins world follows suit to the point were it costs us more to purchase an item for use then we will ever be reimbursed. This bill affects my career completely I've read it to the best of my ability and while there are a few things in it I disagree with the vast majority of it is needed reform. I agree that politicians should be forced to be on it as well but I think there are lots of things politicians should he forced to do and no one is asking my opinion on those either.
Haven't read your post yet, so maybe this is "off-point"...
From Bill Moyers Journal latest show (Can be seen at pbs.org):
Bill Moyers:And remember that television ad Barack Obama made as a candidate for president?
BARACK OBAMA: The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game-playing in Washington. I don't want to learn how to play the game better. I want to put an end to the game-playing.
BILL MOYERS: Now look at this recent story in the LOS ANGELES TIMES. Lo and behold, since the election, the pharmaceutical industry's $2 million dollars a year superstar lobbyist Billy Tauzin has morphed into President Obama's pal. Tauzin says the President has promised not to pressure the drug companies to negotiate with the government for lower drug prices and has agreed not to allow cheaper drugs to be imported from Canada or Europe - contrary to the position taken by candidate Obama…
rg: thanks; i thought so too.
noblesavage: we agree, we disagree--sometimes i find it hard to find the dividing line.
it's not about agreeing or disagreeing with the rightness of death panels; rather, merely acceding to their inevitability.
and as for pre-existing conditions, how could i in good conscience demand of a for-profit insurance company that they take on somebody with cancer or hiv for the same rate that they accept a disease-free twentysomething? it makes no sense.
and me? yeah, i'd say we have a rolls-royce legal system--a rolls-royce that has 800,000 hard miles on it due to frivolous, litigious, undue wear-and tear, but a rolls-royce nonetheless. needs a serious overhaul, though.
anonymous: thanks for taking the trouble to give me the benefit of your hard-earned experience. but i've gonna be honest: if i were running an insurance company, i'd fight every intrusion on my company's bottom line tooth and nail, too. tell you the truth, this is the leg of the four-legged stool i have the most trouble with--how do we reconcile equitable healthcare for each beneficiary with a private insurer's right to a reasonable profit? i wish i knew the answer.
chuck: no, this was totally on-point, and thanks for making my point; i.e., that the government's plan has far less to do with what's good for us than what's good for it.
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