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Will Healthcare Become a Moral Question? (Are we already there?)

By Jane Chin This morning I was skyping with one of my favorite people, Bhupesh of Ethnicomm, when we began talking about the current state of healthcare. Bhupesh lives in Canada, where healthcare is socialized in a way that has become apparently very attractive to various healthcare “activists” and interest groups here in the U.S.

Right now many people here in the U.S. are tremendously upset with insurance companies because of the way these companies make financially based decisions about people’s lives. The stereotype, for example, is the image of a middle-aged MBA-educated executive sitting in front of a spreadsheet that gets him to conclude that letting a chronically ill patient die may be cheaper than approving for reimbursement certain “non-standard” medical procedures or organ transplants or experimental use of an approved drug.

The government is a bloated bureaucratic pseudo-organization that struggles with its constituent interests but is really focused on its primary priority: keeping itself (the government) alive. Letting the government run healthcare, in my personal opinion, is not going to get us better care than the situation we’re getting from insurance companies.

If healthcare is a question about access best served by the government, close your eyes and flash past to the last time you were at the DMV (department of motor vehicles). How was that experience for you? I assumed you were relatively healthy when you last visited the DMV. Now imagine yourself in a sick condition and trying to deal with the inefficiency and the staff. When I was in graduate school there was a time when I was sick and had to sort out a problem at the DMV. I spent about an hour of the three hours I had to wait there retching in the bathroom. At least the bathroom was clean.

Here in California our state government had done such a great job that the state is hemorrhaging money. In fact, the DMV here has to stop working on Fridays just so the government can stop bleeding as much money as it’s been bleeding. I don’t dare to imagine what a California-run healthcare system is going to look like, but I can guess that the other half of our hospitals that somehow managed to remain open may probably start closing as well.

Then Bhupesh and I wondered about a Darwinian question, to give the benefit of the doubt to a government that may ultimately decide that, for example, once you’re over 65 years old, you should not be eligible for big expensive procedures (like organ transplants) because you’d be cheaper to the government DEAD. If you think that it’s bad for insurance companies dealing with a few million lives to start seeing you as a statistic, wait until you become one in the hundreds of millions of lives to a government-run healthcare system.

Maybe we really should let nature take its course rather than stuffing ourselves with pills and new organs and medical devices to stay alive. Why not die our “natural age” rather than fight to live an unnaturally long life?

I remembered thinking about a similar question recently, when I thought about babies who were born so premature that they were called “micropreemies“. These are babies born before 26 weeks of gestation (normal is at least 37 weeks) and under 3 pounds. A premature baby or a “preemie” is born before 37 weeks. Put Darwin’s survival of the fittest test, and it’s safe to say that most of the preemies and all of the micropreemies won’t make it.

But this is the beauty and the beast in living in today’s technologically advanced society. Babies who might otherwise not survive can survive and thrive when born in this day and age. So too, can the same reasoning be drawn to we adults who might otherwise want to keep living past a heart attack or cancer. We live with these options to fight and win over the diseases that 50 years ago may swiftly kill us. The trade off is that we sometimes end up living a longer, more painful existence until our untimely death. (I’m not going to get into a soapbox about the ethics of having octuplets when you already have 6 kids and are still living with your parents)

The healthcare question when taken into this context, then becomes more of a moral question and conditioned by social and cultural “norms”. How old is too old? How sick is too sick? How much money is too much money to pay to keep a human being alive? It’s one thing to answer these questions as an individual or a member of a family (then we’d naturally say, “life is priceless! at any cost!”), but it is another to try answering these questions as an individual making policies and decisions for hundreds of millions of lives. Then there IS indeed a price for a human life, because there is only a certain amount of money that the government has to use for healthcare of all its people.

Governments are good at justifying collateral damage or “sacrifice a few to save many more”. How do you feel about being a member of “the few” instead of a part of “the many more”?

Updated: June 30, 2013 — 8:06 am

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  1. This is brilliant and exactly why it is incumbent upon us to take charge of our health in the most preventable posture possible.
    Preventive medicine is where we must go. High blood pressure, diabetes, certain cancers…all largely preventable.

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