Reference for the title.
So, the last two posts discussed the concepts of what is free (nothing is) and where the government gets the money to do all this "free" stuff.
Now comes the rub.
If you and I go out to dinner at a nice restaurant, and I say I'll pay, your first reaction is WOOT!, but your second reaction will tell a lot more about what kind of person you are, what kind of relationship you think you have with me, and what kind of manners you may have.
It will also tell you what kind of person I am, what kind of relationship I think I have with you, and what kind of manners I may have.
If you look over the menu and select a moderately priced meal without my prompting, we will find out together that your manners are appropriate, I'm not a freakin' tightwad, and we know each other well enough (or not well enough so that extra polite manners kick in) to not cause a confrontation.
If, however, you look over the menu and decide that tonight is the perfect time to have that caviar stuffed lobster with the $500 bottle of wine, we will probably have some disagreement.
Of course it's obvious why we might come to this point: I'm paying.
My options in the latter case include paying for the outrageous meal or not paying for the outrageous meal (or paying part). Since I'm a one or zero type of guy, we'll leave the "paying part" option off the table.
If I refuse to pay for that dish, either you pick something that I will pay for, or you pay for it yourself (or you don't eat). If you don't have the money or are prevented from paying for it yourself, your options are narrowed to picking something I'll pay for or not eating.
And finally, how does this apply to government run health care? It's pretty simple: Since the government is the one who is paying, they get to decide what they'll pay for. And while most bureaucrats aren't evil or malicious, they will make logical evaluations on what to pay for and what they won't pay for.
I mean, it doesn't take a rocket scientist to see that paying for an MRI, CT, Nuke Med, hip replacement, cath lab work, and other high cost procedures for a terminal cancer patient that's 110 years old just isn't cost effective no matter how compassionate a person you are.
Under our current system, that 110 year old patient can pay for all those things and more if they have the money regardless of what their insurance company may or may not pay ; under a government health care system, where the government is the sole payer, then the patient has no say in what medical treatment they receive.
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5 comments:
I'm British and find the US aversion to public healthcare very strange but then I have grown up under the national Health Service. It's not perfect but when I look at the US system I find it as terrifying as you seem to find our system. Maybe it's the security of what we know best? We do have choices though. If my family doctor needs to refer me to a specialist I can specify which one I want to see in which hospital (that's if I have a preference). When I have needed specialist care I have always been involved in my treatment options and have never been made to feel that I should opt for treatment x because it's cheaper than treatment y. Any recommendation has always been based on clinical issues, not cost.
Private healthcare is also available here too, over and above the NHS - it's not an either/or thing. As someone who works and pays National Insurance contributions (that's what pays for healthcare and social security in GB), ultimately I pay the piper and I feel that I have a lot of say in the tune :)
A question that comes up is: what is your age bracket? The reason I ask is because of recent reports out of Great Britain regarding people near the end of their lives being denied treatment because of their age.
The Netherlands also has had some issues with non voluntary euthanasia (http://www.catholiceducation.org/articles/euthanasia/eu0021.html).
What it comes down to for me is in America, we have enjoyed a long history of freedom to choose, which in and of itself implies risk and reward. When some, or all, of the choice is removed, then we lose more of our freedom to live our lives as we see fit instead of someone else making the choice for us.
Having public healthcare doesn't remove the right to choose. You can still have private health insurance on top - many large companies offer it as an employee benefit. In a system where there is little public healthcare only the wealthy or the well-insured can afford to choose. The poor and unemployed also have little choice under such a system.
If you walked around a UK hospital you would see plenty of elderly people there, they are not being denied medical care. On the other hand, an 80 year-old is less likely to be offered major heart surgery than someone my age (40 something :P ). Not because cost issues but because of the clinical considerations, this is particularly relevant with regard to surgical procedures. I used to work as a nurse (many years ago) and the oldest surgical patient I recall seeing was a 96 year-old woman with a fractured femur who had broken her leg falling off a step-ladder while hanging wall paper! She was as fit as a flea and there was no question of not operating on her. Due to complications she actually went to theatre 3 times and after a few weeks practically skipped out of the ward. On the other hand I remember another patient 30 years older who didn't have surgery for her broken hip. She was extremely obese, had congestive heart failure and several other problems, she wouldn't have survived the anaesthetic.
Issues of who pays for it aside, personally I feel very strongly that quality of life is very important and do not believe that life should be maintained at all costs. I think that sometimes people are given inappropriate procedures just because they exist with little regard to what that patient is actually going through or the feelings of the relatives who have to watch their loved ones suffering. Heroic measures have their place and medicine is capable of great things but I think sometimes we are in danger of losing sight of the fact that we all die, and the fact that we do does not mean medicine is a failure. But that's a whole different discussion :)
Oops - just re-read that - the woman who wasn't operated on was 30 years younger :)
I guess for me, it comes back to being self reliant and not depending on the government.
I look at the hospital that I work at (a Veteran's Affairs hospital - gov't run), and the things and attitudes I see are very much a product of being government driven instead of profit/service driven.
I can't help but think that the same culture will arise in public government hospitals or with government medical bureaucracy.
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