Elkhorn Creek Lodge

Socialized Medicine; More Snuffing

Posted in medical by Eugene Podrazik on May 31, 2009

Let’s start with Clive Cook’s commentary about medical care in the US being far too expensive for the results is obtains; as compared to statistics of such things as longevity when compared to other countries around the world.

The cost differential is the cost of treating patients out on the margins.  But, before we discuss that more specifically, we need to explore some fundamental concepts that animate our attitudes about the worth of the individual.  The United States and its founding documents–Declaration of Independence, Constitution, Bill of Rights–reflect the highest attainment of the ideals undergird the amalgam of concepts and ideas that we call Western Civilization.  And, on its own as well as part of that amalgam is Judeo-Christian morality.  These ideas and the institutions that they spawned all have a common thread of elevating the rights of the individual and preserving those rights.  

These are moral precepts based on a God that created man in His own image, gave him the knowledge to know Him and the free will to acknowledge God.  This is the God of the Ten Commandments; rules that supersede any majoritarian or human authority.  This is a God that will require every human to stand alone, at the final judgement, and be judged worthy of Heaven on his actions alone.  No Nurembergian “collective guilt.”

It is with this in mind, we have developed a sense of individual worth through the ages that is designed to protect those rights conferred upon the individual by his Creator.  And, our secular institutions reflect that philosophy.  Trial by jury of one’s peers; so as to check the power of governmental authority.  The jury stands as the highest officers of the court, who’s decision is final.  Not guilty will stand regardless of the case the state may have made.  Rule of law.  Due process.  Presumption of innocence.  The burden of proof on the accuser, not the accused.  A Constitution and Bill of Rights that acknowledges and secures right; not grants them. 

This commitment to the individual is reflected in all our activities, economic and otherwise.  It is reflected in our medical care and medical system.  Is it more expensive than any other country in the world?  Heck, yes!  But, that’s American Exceptionalism.  Besides, for all the blathering about how much we spend, as a percentage of GDP, on medical care, I’d rather have 84 percent of the American economy than, say, 95 percent of the Canadian economy.

But, medical care today is being fought on the margins.  Just like the defense of our rights secured by the Bill of Rights.  All the easy stuff has been done.  The big gains in life expectancy and infant mortality rates came largely because of public health measures.  Public sanitation; sewers and clean water.  Immunizations.  Better nutrition.  

Medical progress is now being made into rarer disorders.  And, in pushing the frontiers in the care for the critically ill.  Or, neonatology.  It is reflected in the medical economic fact that eighty percent of a group of insured persons consume only twenty percent of the benefits paid out.  And, the sickest twenty percent consume the other eighty percent of those benefits. 

The most expensive year of your life, medically, is your last year of life.  As is your last hospitalization.  About thirty to fifty percent of Medicare dollars fund this phenomena.  

Infanticide is still practice in many portions of the world.  In many of these societies, poverty so rampant, that resources aren’t available to try to salvage these “defective” babies.  Even in the case of a cleft lip/palate baby.  These are otherwise fully functional humans; but the care, rehab and surgery to repair these deformities is enormous.  The US doesn’t fare well in statistics regarding infant mortality rates since we count premature babies in our statistics of live births.  While the field of neonatology has made great strides in salvaging many of those babies, many, more than full term infants, still die pushing up our infant mortality rates. 

To take a completely mechanistic view of human life, to equate life as some many parts that make the machine of society function; you can ask why we keep some many “defective’ people around.  Or, at least, if we don’t immediately discard them outright, why we spend so much in giving them medical care above and beyond those in society who are still working.  Those persons who are still functioning cogs.

All of the above creates hundreds of billions of dollars of temptations to deny care.  Dead people are much cheaper than keeping sick people alive.  In a single payer system this temptation can go unchecked.  Only in a private, market-based system, where 300 million people interact in their own respective self interests do checks exist against such base temptations.

Those temptations are in operation even as we speak.  The British system deny renal dialysis for any over the age of 59.  Your kidneys go out, you die.  Here in America, cigarette taxes are jiggered to maximize revenue, not to discourage smoking.  And, those same said state treasury officials know that smokers usually die at the age of sixty; no state Medicare or Medicaid costs for these folks since they never make it to age 65.  State helmet laws for motorcyclists are being questioned; not wearing a helmet usually kills outright.  That’s much cheaper than surviving and requiring medical care. 

There are lots of illnesses that, at the margins, require very esoteric and very expensive medications.  How about Infliximab (Remicade) for Rheumatoid Arthritis.  It wholesales for about $20,000 per year per patient.  Or, do you just draw the line and let them become cripples.  The Remicade lobby isn’t very big since sick people, by virtue of their debilities, will have very little economic pull.  In the brave new world of government health care all medical decisions will be political.  The sickest will likely be on the margins economically as well.  Unless you have the cash, serious cash, like the amounts to buy a recently vacated Senate seat from Illinois, you’re not going to get some health care bureaucrat to score you twenty grand worth of Remicade.

It’s very easy to fudge the statistics to truly marginalize the sickest twenty percent, create billions in savings and even show, statically, that our new governmental health care system is superior to the old system.  Stop counting pre-term infants as live births.  With no pre-term infants, it becomes easier to stop funding such care.  Those babies die, but, no one’s counting.

Of course, no health bureaucrat is going to order pulling the plug on granny sitting, comatose, on a ventilator in some intensive care unit if she’s surrounded by tons of loving family.  But, how many old folks live, alone, moldering in some nursing home out on the wrong side of the tracks.  Why bother with that last hospitalization, that last year.  They won’t live long enough to matter as a vote.  No witnesses.  No real advocacy.  As mentioned above that last year, last hospitalization is something like 50 percent of Medicare expenditures.  Over 100 billion dollars per year.  That would go a long way to Obama’s goal of saving one trillion dollars over the next ten year.  So tempting.

Fifty bucks of Pentothal is so much cheaper than 100 thousand dollars of hospice care.  And, in Oregon, assisted suicide is legal.  So tempting.

 

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