Tuesday, March 9, 2010

Righting the Healthcare Question

Day 21 of 46 c Lenten Season 2010

Have you had enough of the healthcare debate already? No matter where you stand on the issue, you probably agree that our elected representatives have made a colossal mess of it. Granted, the system – or lack of one – that we have now can hardly be called equitable, affordable, or efficient, but every “fix” that has been proposed in Washington has made nobody happy. Not even the President – and he’s pushing for an “all-or nothing” vote to get it over with.

Yesterday, New York congressman Eric Massa claimed he’s being pushed out of office for balking at Obama’s healthcare bill. Never mind that the representative from Upstate has admitted to harassing employees. The fact that he’s a Democrat makes the story that much more bizarre, but hardly any more distasteful than the impression this whole healthcare saga has made on the country as a whole.

Fingers are already being pointed every way but backwards over who is responsible for Washington wasting so much time and energy with nothing to show for it. Democrats claim Republicans have been stalling and bickering, while Republicans say they’ve been shut out of the process. Both are true, aren't they? In the meantime, the problem that started this whole mess – skyrocketing healthcare costs – just keeps growing. New-year premium increases reportedly of up to 30% in some cases are forcing many businesses to consider dropping the benefit for millions more workers, creating an even larger pool of Americans who can’t afford healthcare for their family.

Back when Scott Brown stunned the Senate by winning Massachusetts’ junior seat, I listed some ideas for lowering healthcare costs without much more legislation than we have already. Obviously, they were a big hit on Capitol Hill.

Today, although I’m running the risk of sending you away with a headache, I’m going to make a stab at the heart of the issue, and explore the question of whether or not healthcare is a civil right. That’s one of the elephants in the room, isn’t it? (Besides the Republican mascot, who simply can’t get enough of the spinach dip...) If you'll bear with me, I'd also like to review some of the reasons why healthcare should not be a government program.

Basically, No

First, we have to recognize that although you might like it to be, healthcare is not a civil right. It isn’t like freedom of the press or freedom of religion, where a general permission can be granted, and it’s granted completely and fully with no further obligation on the government to actually provide a religion or state TV station. The degree to which citizens can take advantage of the freedom of the press, for example, depends on whether they live in a town with a newspaper, or have Internet access to online news sites. Media isn’t made available just to satisfy the fact that it’s allowable; media and opinions are allowed, but some publisher or blogger has to take advantage of that opportunity for it to be expressed.

But, it is a Part

However, how one is TREATED within a healthcare system does involve civil rights. A whole scholarly and legal discipline of medical ethics testifies to the need for equity and morality in medicine. If there is one operating room available, and an indigent patient’s operation is cancelled so a wealthy patient can have the same operation for the same ailment, then that is wrong. The ethics of medicine should not operate on the basis of a person’s gender, ethnicity, religion, or even ability to pay. Otherwise, with the most pragmatic of considerations, you open a whole Pandora’s box of issues that, with lawyers involved, can send the cost of medical care soaring. Who decides whose life has more worth? On what basis? Is one's immediate ability to pay for something as valuable as a life-saving treatment sufficient grounds for performing the procedure or not? Woe betide the person who makes these decisions based solely on profit motive.

Good Health is Good for Business

Although healthcare is not a civil right, it is a feature of a civilized society. Obviously, robust healthcare mechanisms make a society be and feel healthier. That means the people in that society can be more productive, safer, and better-suited to contributing to the functions that sustain the society. It is in the best interests of the economy and defense of the United States to have a healthcare system as widely available and sophisticated as possible. Of course, that doesn’t answer the question of who pays for it. The reason for recognizing the benefits of country-wide access to high-quality healthcare, though, lies not in the payment structure but in the acknowledgement that it is worth something, not just to the patient, but to the society as a whole.

It’s Not Rocket Science… But it’s Close

Healthcare involves science. Well, duh… right? But think about what this means. Since medicine is a science, the methodologies by which healthcare is achieved are not necessarily contained, universal, easily-transferable, or immune to wide latitudes of disparity. There’s a lot of trial and error. New diseases are diagnosed and new treatments discovered. It takes a considerable amount of pragmatism to control these variables, but some illnesses and cures may take generations to be explored. In your experience with the federal government, does it strike you as an organization proficient enough to sustain the science of medicine?

Health Science Evolves

Following along the last point, we need to recognize that the spectrum of knowledge and theories of medicine changes constantly, defying immutable, comprehensive classifications. This means that the study and practice of healthcare needs the flexibility in levels of response, treatment options, and other variables to function effectively. Does the federal government think its smothering bureaucracy is well-suited to managing such an unwieldy, organic, and disparate entity? Because of all these various elements that comprise and compound the issue of healthcare, doesn’t it seem logical that while significant levels of bureaucracy and governance may help some aspects of healthcare, heavy amounts of centralized governance could also suffocate the responsiveness, exploration, and application of healthcare?

You Are What You Eat

I mentioned this in my earlier post, but it bears repeating here: Healthcare relies heavily upon personal responsibility. Moreso than freedom of the press, where a rogue reporter can be tried in a court of law for defamation of character, if a patient does not take care of himself, doctors may not have the time or expertise to fix problems the patient has caused himself. This also means that the level of responsibility other people share in the health of individuals can be considered to be limited at best. Corporations are responsible for preventing pollutants from entering the environment and poisoning people, but nobody except the individual is responsible for cavalier weight gain or refusing to stop drinking.

Where is the Real Problem?

Quality healthcare requires a variety of specialized disciplines in order to function effectively. As the science of healthcare continues to develop and the body of evidence contributing to sound principles of providing healthcare continues to increase, it can be tempting to think that the federal government is the only organization that can control how the massive, disparate organism known as healthcare functions in this country.

But has the current system proved its inability to function? Has it broken apart into irreplaceable fragments? Has the doctor-patient relationship just frozen solid in America?

No. You can’t say the system is broken just because emergency room wait times are atrocious, that doctors are leaving the profession because of stress and comparatively low pay, and because insurance premiums are becoming prohibitive for many working-class families. Yes, these and many other problems pose significant challenges to the advancement of healthcare in America. But the overall sophistication and success of America's medical industry remains impressive.

What do all of these “broken” elements share in common? MONEY. Something is broken in terms of how medical components are funded and provided to the average patient.

If hospitals received adequate payments that would cover the cost and nominal profits for running top-notch emergency rooms, staffing could increase so patients could be seen faster.

If doctors were respected by insurance companies and not second-guessed every step of the way, they as a profession could be restored to their rightful place of authority within the medical community. If they were paid properly, doctors would commit to the demanding rigors of medical school and patient care, we would have more of them, and maybe some would be willing to set up practices in parts of the country where they are currently scarce.

Haven’t we reached the point in this debate where politicians should realize they don’t have answers? Haven’t we wasted enough time to realize the solution isn’t in Washington?

So, where is the solution?

I have an idea – and we’ll talk about that… tomorrow!

1 comment:

  1. Here is another article that discusses the same topic of patient responsibility. Seems simple enough...

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