Last Blogger

I wrote about Death Panels already and while the whole idea of them seems incredulous, the thoughts behind them continue to stir within Americans.

The Economist wrote a piece on the politics of death. I have to say that reading through the article felt a little like reading something in a familiar language, but very strange dialect. I could understand most of it, but some parts just did not make sense to me.

First of all, there is an impression that a government plan must cost more because of the millions of uninsured people who must be covered. While that conclusion might be drawn by someone who’s given the situation all of five minutes worth of thought, fifteen seconds on Google presented me with the following health care cost comparison. Now that’s a bit out of date and perhaps not the most reliable source for data, but the numbers match what I’ve been seeing over and over again. The U.S. spends a very proportionally significant amount more on health care than any other comparative nation. So basically, I don’t buy the argument that it must cost more. The rest of the planet (many with much better health care systems) are doing for much less. Pick an example you like, roll with it and you’ll likely end up covering everyone and enjoy a significant overall savings.

The next point that I struggle with is the cost benefit analysis that people believe would happen to help some and send others to their grave. Where I live, the general rule is if you need it, you get it. No sane doctor in Canada is going to look at a 95 year old cardiac arrest patient and think that it will be too expensive to bother trying to help this person. They will do what’s medically sensible to save the person, the same as they would anyone else of any other age. Now in some cases that may mean that the 95 year old won’t get the (insert your favourite risky procedure here) they need to live an extra two years as compared to twelve months without. But that decision doesn’t come because of the cost of the procedure. It comes from the Hippocratic oath. I’d be making up numbers here, but I don’t think it’s a stretch to think that a large proportion of 95 year olds will simply not survive (your favourite risky procedure again). So giving that individual that particular surgery is essentially killing them right there and then as far as the doctor is concerned, and any doctor who believes that won’t perform the procedure.

I also don’t buy the theoretical $1000 to save a child vs $1 million to extend the end of life by a week. Neither is really reasonable. Most life saving treatments for kids are going to cost more than $1000, and I just have a hard time envisioning a $1 million treatment that would only extend your life by a week. Let’s forget reasonability for a moment though. Let’s say there is a $1 million treatment available in the U.S. right now that would extend an American’s life by a week at the end of life. I’ll argue that the very same treatment in a single payer system will cost anywhere from 1/2 to 1/10 of that. Spending $100 000 on something that someone needs isn’t as daunting a task all of a sudden. Secondly, under which current U.S. insurance plan do you think you would be approved for a treatment that would only extend your life by a week. If you’ve fallen ill due to a pre-existing condition, then you already know that you would have a 0% chance at getting this treatment. If not, you’d have to consider how much your hospital care had cost up until this point (probably lots if you’re that sick, $500 000 maybe?) and what’s your lifetime claim limit? $1 million maybe? Denied again. So really, the only way this scenario can unfold is that a perfectly healthy person has something strike them out of the blue and the only treatment available for $1 million is only going to allow them to live for one more week. At that point, you’ve got a 50/50 chance with your insurance company. Either they’ll dispute the need for such a procedure, overriding the doctor’s medical opinion and therefore killing you or they’ll just cancel your policy due to some technicality that they’ll surely find (with $1 million incentive, you’d be looking very thoroughly too).

So looking at the big picture, they’re over-spending on care that may or may not be there when they really need it. No health care system in the world is perfect. They all have their problems and you can always identify situations where someone will not receive the care they need. Most systems though are cheaper, more fair and quite simply more effective. I can tell that fairness doesn’t really seem to matter to many Americans, but they really should be appalled at the cost and lack of effectiveness of their system.

With all this in mind, I simply can’t make heads or tails of the debate they’re undertaking. I understand that the politicians are paid off by the insurance companies so I get where they’re coming from. What I really don’t get is how there can be any sort of debate amongst the average citizen. This stuff seems like a no-brainer to me. But then, maybe that’s the problem right there…