This article on health care is definitely worth sharing. My wife is a health care professional who deals with the sickest newborns, and she has had to wrestle with this issue many times – medicine can do a lot, but that doesn’t mean that it always should.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little…they know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
I’ve watched the debate over the ACA/ObamaCare closely, but I don’t really have a dog in the fight – I’m in the military, so my immediate health care prospects aren’t impacted. As a concerned citizen, the issue is so fantastically complicated that even experts are probably only guessing at the best way to fix it – I’m quite certain I don’t have a chance of knowing who is right and who is wrong. That said, this article highlights what is, to me, one the biggest issues that we have to deal with in order to right the health care system – end of life care.
Here’s a couple things that seem right to me, and should guide our decision making when it comes to health care:
1. Health coverage should be decoupled from employment – the current system of employer paid coverage seems to be an anachronism that has outlived its purpose.
2. Competition is good – capitalism specifically and competition in general has proven again and again to be the best way to design a successful system. Our health care system should have some aspect of competition between providers.
3. Change the incentive structure. In a perfect world there would be straight line between patient health (in a holistic sense) and profit. Right now, that line is so twisted that it’s essentially nonexistent.
3A. Change the malpractice law structure so that doctor’s decision making is not based solely on avoiding lawsuits. I don’t know what the right balance is – people who are legitimately harmed by medical errors should get their day in court, but it seems like the current system results in more expensive and lower quality of care for everyone.
4. Rationing is necessary. The government can’t afford to pay for everything for everybody – but we don’t want to live in a society where the poor are simply left to die in the gutter. If government is going to play a role in health care (and I believe it should), that means that we need to come up with a rational standard that delineates “Here’s what everyone gets for free; here’s what you have to pay for if you want it.”