Rationalizing Rationing – Health Care Reform Exhausted
Before you sigh in exasperation, roll your eyes with irritation, and perhaps even let out an almost audible groan in sheer agony, I promise that in the remainder of what I am about to say, the words “health care” and “reform” will never appear adjacently. This has become the new MJ.
Having just graduated with a Masters in Health Management and Policy, I may seem an unlikely candidate to wish that my field received less media coverage, but my head might just combust if our president continues to appease the greater public with pledges of “no socialized medicine”, “no rationed care”, and “if you like your plan you get to keep it”.
By now we are well acquainted with the 1 in $6 that is sure to become the 1 in $3 in 30 years. We know it’s urgent, it’s dire, and the fiscal future of our country depends on it. We are also aware of the fact that in our current system 90% of health care dollars are allocated to 10% of our population, and nearly 28% of the Medicare budget is spent on patients’ last year of life. This is hardly an equitable appropriation or efficient utilization of scarce resources.
Wait, did I just say efficient? If it seems that I am making a judgment about the value of one’s last year of life, it’s because I am. But the monetization of American lives is not new. The EPA allows drinking water to contain 7 million Asbestos fibers per liter because they could not justify the amount of capital would be required to achieve a lower or zero fiber count. We tolerate a level of risk, chance of injury or death in all that we consume (e.g. bacteria on produce) and do (e.g. working in a factory), because to eliminate them would be exhaustive. We have, for everything else, allowed our government and various private industries to valuate human life and set standards accordingly. Why not for health care? Why not establish a standard guideline that excludes non-cost-effective treatments and procedures? Do I stand alone when I say that I’d rather receive a course of treatment endorsed by an elite team of medical experts rather than rely upon the knowledge of one physician I randomly encounter?
The 11th floor of St. Joseph’s (a community hospital in Chicago) is filled with elderly cancer patients, many of whom have lost most of their cognitive functions. They are confused and in pain. It may sound callused to say, but they are also consuming an exorbitant amount of resources. I am almost positive that the care they receive would not meet the QALY (Quality Adjusted Life Years) per $X standard many are proposing. I am okay with that. And I suspect that they would be too.
I realize that my life (as well as the lives of my loved ones) adds a certain amount of value to society and I feel comfortable knowing that this society may not choose to exhaust its resources to preserve it. So I extend this question to everyone, can you make peace with health care rationing?
