It’s anyone’s guess as to what will happen to health care in the United Stated over the next few years. Whether Obamacare becomes a reality or not, our healthcare system is unequivocally in dire straits. We have patients who are uninsured or underinsured who put a tremendous strain on the system and its resources. Even among the insured population, many Americans burden the system with diseases they have brought upon themselves through poor choices. Medical knowledge has improved to the point where we can keep nearly anyone alive. But at what cost?
Whenever the topic of rationing health care comes up, there’s always someone with a heart-wrenching story about their Aunt May. Poor Aunt May, who was in a coma for six months and, just before the doctors decided to “pull the plug,” she woke up, completely neurologically intact. I’m not saying the Aunt Mays don’t exist, but the truth is that they are few and far between. The harsh, and admittedly cruel, reality is that if Aunt May hadn’t survived, the amount of money and resources used during the six months she was in a coma would have been wasted.
As we inch closer and closer to being a bankrupt nation, we need to put our emotions aside and make some tough choices. Many other industries already do so, and no one bats an eye. The life insurance companies, for example, decide who is a good candidate and who is not. If you drink, smoke, have high blood pressure or are obese, you are inherently a less desirable candidate. You either get no coverage or it costs a fortune. The pharmaceutical industry rations potentially life-saving drugs every day. If you can’t afford the cancer drug that may give you an extra six months of life, too bad — you die early. But when we put it in terms of affording a ventilator and ICU care for six months instead of a drug, people balk. Don’t forget, the end result is the same.
As a physician, I see our resources going places where it doesn’t make sense. Take orthopedic surgeons, as just one example. I know many who are booked solid with patients scheduled for joint replacement surgery. Many of these patients are poor surgical candidates. For instance, a majority of them are obese. In fact, it’s their obesity that largely contributed to their joint problems. Obese people tend to have a litany of other health problems, including diabetes, hypertension, sleep apnea, and coronary artery disease. Additionally, their sedentary life style does not predict positive physical rehab results post surgery. I’ve personally seen numerous of these patients post-operatively, and many of them do poorly. They have peri-operative heart attacks, they acquire infections, or they develop blood clots in their legs that shoot up into their lungs. Even those without major complications tend to have prolonged hospital stays. In a world of limited resources, is this cost effective?
Another factor to consider in this discussion is that of personal responsibility. As a whole, we Americans seem to have lost grasp of this concept. We think we can do whatever to our bodies – smoke, drink, overeat, not exercise – and there’s a pill or a surgery or some other medical intervention that will fix it. Smoke two packs a day for forty years and end up with a tumor in your lung? That’s okay, just get it resected. Eat like a pig and sit on your ass until eventually you weigh three hundred pounds? No problem, that’s why they invented gastric bypass. Pound down a bottle of scotch every day for years on end and finally wipe out your liver? Liver transplantation to the rescue.
As difficult as it is for most people to accept, effective health care reform will need to include holding people accountable for their life styles. Why should those of us who have the self-discipline to work out, eat right, avoid excessive alcohol consumption and refrain from smoking have to pay to fix those who make less healthy choices? Part of rationing health care needs to take this into account.
The difficult part about rationing health care is that it’s easy to make tough choices, until it’s you or a loved one who doesn’t fall on the “approved” list. Unfortunately, I think until we are able to put our emotions aside and look at the problem logically, our health care system will remain what it is today. A disaster.
