Sunday, January 19, 2014

Health Care Plans Gang Aft Agley

  Few people would claim that our present health care system is ideal.  Much of the argument for government run health care insurance is based upon the disparities in life expectancy among various nations.  The United States is rated somewhere between 40 and 50th in life expectancy among nations according to international organizations.  This argument scrupulously ignores demographic factors. Different demographic groups lead different lifestyles.  The differing lifestyles lead to different life expectancies.  Black men in Harlem have a shorter life expectancy than men in Bangladesh.  Is the health care system in Bangladesh better than the health care system in Harlem?

            The consequences of differing lifestyles were investigated by Ruben G. Rumbaut and John R. Weeks and their findings published in the Journal of the American Medical Association article "Born in the USA: Infant Health Paradox."  The authors found that Vietnamese immigrants had an infant mortality rate of 5.5 per 1,000.  Whites had a rate of 8.0 and African Americans 16.3 per thousand.  They concluded, "the viability of the newborns was harmed more by the unhealthful behavior of the American mothers than by the poverty and late prenatal care of the immigrant women.  The socioeconomic advantages of the U.S.-born women were overshadowed by their medical illnesses and by their psychosocial pathology." 

            An example of this "psychosocial pathology" was provided by the late William Raspberry in his column "The system' can't beat the family.”  Raspberry commented on an NPR program "All Things Considered" which featured a crack addicted mother who was sent home with a hospital-supplied special monitor.  On the way home, the mother swapped the monitor for drugs.  This woman was undoubtedly an extreme example of pathological childcare, but she represents a part of the problem.

            On September 9, 2009 President Obama addressed a joint session of congress and remarked on the subject of death panels.  The President said, "Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."

            Former Labor Secretary Robert B. Reich, a supporter of the President’s plan, has an interesting view of “death panels.”  Speaking at the University of California at Berkeley Reich commented,  "We are going to have to... If you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months.  It's too expensive.  So we're going to let you die."

            Reich was not being cynical and irresponsible.  He was being realistic. A panel of bureaucrats will of necessity make decisions about who will live and who will die.  These decisions will be made of economic necessity.  Barbara Wagner is an example.  She was a beneficiary of Oregon's “Death with Dignity Law.”  When faced with a $4,000 per month cancer treatment expenditure as opposed to a one time $50 expenditure, the state of Oregon chose the latter, sending her an unsigned letter informing her of their decision to allow her to die.

            These bureaucrats are not lacking in compassion.  They will be compelled to make these decisions out of economic necessity.  They will also be compelled to make decisions that most people would consider irresponsible.    If an insured individual believed he requires a sex change operation would our panel of bureaucrats deny this request?  The answer to this question is simple: let an elderly woman die a painful death or indulge a person with a confused sexual identity.  However, the answer may not be simple, once the courts become involved.

            Robert (Michelle) Kosilek, a convicted murderer, sued the state of Massachusetts demanding sex change surgery.  U.S. District Court Chief Judge Mark Wolf ruled that the treatment was, "the only adequate care for his serious mental illness, gender identity disorder."  Is the state not obligated to care for those suffering from "gender identity disorder" even if it means elderly cancer victims will suffer?  This will be determined by the courts.  

            Britain's National Health Service provides numerous examples of what many would consider skewed priorities. Linda O'Boyle was a 64-year old British mother of three sons who suffered from bowel cancer.  Her doctor prescribed the drug Cetuximab.  The NHS refused to pay for the drug on grounds of rationing resources.  When the NHS found that she had purchased the drug with her own funds she was informed that she had broken NHS rules and would be denied all treatment.  Yet these bureaucrats are not totally lacking in compassion. "A British woman hoping to become a model was so upset about being flat chested that she convinced doctors that it put her in a state of emotional distress. Their response was to allow her a $7,260 operation for breast implants paid for by the U.K.’s publicly funded heath care system.”

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