Vox Populi

"The voice of the intellect is a soft one, but it does not rest until it gains a hearing."

Freud, "The Future of an Illusion"

The health care debate is dispiriting, and not only because the Democrats' handling of the issue has been inexpert. The celebrated town hall format is primarily a test of who can yell the loudest within view of the most media amplifiers. More than ever I'm convinced that most Americans are not ready for health care reform.

A generation or more has become accustomed to access to whatever test or treatment they (oops, I suppose I should say "their physicians") want, regardless of the actual evidence for its effectiveness, and for the majority of those who do have medical coverage, the 40 million plus who don't are a statistic, not a tragedy, and certainly not worth endangering the system for.

Shocking, isn't it, that anyone could propose putting a price on life? Life is infinitely precious. We would pour untold billions to treat the loudest town hall crier. No limits--for those brazen enough to seize the wealth that is. If none is left over for those who were too busy or distracted to make the meeting, well, that's the American way.

The Hippocratic injunction to "First, do no harm" is being aired a great deal. True, but if one adheres to this too closely, one never does anything. Any intervention carries the risk of harm. And there would be harm, or at least perceived harm, in the event of health care reform, inasmuch as some people, both patients and doctors, would no longer be able to pursue indisciminate testing and treatment.

Politicians aren't able to highlight this unpalatable fact, of course, just as weight loss programs steer clear of the cruel realities of diet and exercise. We spend too much money on health care, and we do so inequitably. Redressing this would indeed involve lifestyle changes, hunger pangs, and sore muscles from time to time. We're not ready to change--yet.

I get tired of signs saying "Don't touch my health care." In many cases the gray-haired person holding the sign has Medicare precisely because the government does touch his health care in a generous sort of way as it is. "His" health care is being funded by my taxes. And for those with private health insurance, their care may be paid for by my premiums. After all, I'm healthy overall and don't use many benefits. Isn't the whole concept of insurance tantamount to (gasp) socialism? Maybe we should rewind eighty years and stipulate that people can have as much unregulated health care as they want, but only what they can pay for out of their own pocket. Now that would steer well clear of socialism, even if people would be dying in the streets.

Questions of populism also arise from an NPR article describing a website aiming to publish patients' ratings of their doctors. Actually I think this is generally a good thing, but mainly because it would enable patients to avoid the relatively few really subpar physicians out there. Obviously most doctors, as with all human pursuits, occupy a large middle range of good-enough-but-not-great, and patient surveys are unlikely to make fine distinctions here.

I have a certain horror of statistics, but I suppose it may be more accurate to throw out the lowest and the highest ratings of a given physician; the former could just be from a crank who didn't get the Xanax he wanted, while the latter could be from a patient who got on famously with the doctor because their kids go to the same school. Truly bad doctors usually share the same kinds of vices: they don't listen, they are rude and arrogant, and they don't exercise good judgment. A patient should beware of looking for a kind of popularity contest that could reveal the "very best" doctor in his area; he should content himself with finding the good-enough doctor who will do an able job.

There's that idea again: not the best care (at all costs), but good enough.