Friday, August 14, 2009

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.


Cheryl Fuller, Ph.D. said...

This whole process is dispiriting indeed. Staring with calling it the health *care* debate rather than health insurance. And it seems no one on the Democrats side, or at least no one with much clout is willing to speak forthrightly and clearly about what is at issue.

Good enough is indeed a standard worth striving for.

Retriever said...

Good post, and I agree about "good enough". My health insurance provides good enough care for the sake of which I gave up my profession for a job w said insurance. W 4 chronically ill family members (3 psych and one going blind) I am grateful. To get the "best " care for everyone, I spend half my salary and my inheritance and will raid retirement savings on copays and noncovered treatment and mere (in a good year w no one in hospital). I amspendi g the rest of my life savings onthe kids' college. we are lucky to have a choice. When the money runs low, we will spend it on the kids' medical care. We middleaged parents have had our chance. When care is rationed, as it will be (sad and terrible tho that may be), the young should always come first. Most parents feel this. I think.

Anonymous said...

Ah a slight comment. my Medicare is
also being paid by my Social Security Taxes over the last 60 years and yes
I still work.
Don't be so smug ,we who wee around
remember how the Medical community
fought tooth and nail against Medicare and now on hospital would be able to stay open without it.

Physician's have been the very last
to wish to make this system better
usually they pretend to be non political as a group.

Anonymous said...

Excuse my typo's above
..."And now any hospital would be
unable to stay open without it" i.e.Medicare.

Anonymous said...

I remember reading a comment from the UK by a Surgery professor who told his young surgical students- "Perfection is the murderer of just
the good". I think most of us will take just"the good".

What won't be addressed in our healthcare reform is the ugly issue
of longterm nursing home care and
assisted living care that will be needed for we older Americans.
The avoidance of these issues make
it appear that the elderly patients
possible future needs along with
those younger old folks who have
Parkinson's disease, MS or dementia
are being left out of this alledged
health care reform.
Perhaps we should just board old
folks and drop them out of an airplane over the Atlantic ocean
off of Wrightsville beach???

Dr X said...

Dana Gould notices the most bizarre aspect of this debate: the haves are enraged while the have-nots are relatively quiet. Never have so many, with so much, been so resentful.

Anonymous said...

Well put DrX even this Psych Dr. blogger stereotypes The "grayhaired" folks on "medicare".
Many of those on Medicare are also
24/7 caregivers of their spouses saving the Government millions of
dollars in paid home care and or nursing home costs at $15.000.00
dollars a month ,really I am talking
about myself as well with an advanced Parkinson's diseased wife. Yes I do
it all and happily.

caregiving for the elderly said...

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