Health Care - Is Anyone Asking the Hardest Question?


In a matter of a few days, here are some headlines from the Pension & Benefits Reporter: "Report Says Health Costs Hurt U.S. Firms, Advocates End of Employer Financing System"; "CRS Says Price Transparency May Drive Down Costs"; "Reform Efforts Should Combine Options in Public, Private Sector, Health Group Says"; "Democrats Pounce on GAO Study Finding Taxpayers with HSAs Have Higher Incomes"; "Measure of Family Medical Spending Has Lowest Increase in Past Five Years" and the list goes on and on.

What I haven't seen for example, is a study of how the system will make the hardest decisions about health care: who gets care and who doesn't, especially at the beginning and ending of life, where a large portion of our health care dollars are spent?

In other systems, much of the care we hold so dear is not available to the very young or the very old and sometimes in the middle. Some European cultures take a much more practical view of the end of life and focus more on dying in comfort rather than fighting a very costly, but losing battle using the most sophisticated (and usually expensive) methods to prolong life.

If a nationalized system is so much better, why is it that U.S. hospitals along the Canadian border have so many Canadians getting heart surgery for example? Or why is there a three or four month wait in some areas of Canada to have a hernia repaired, when not emergency status? I can imagine the response of a U.S. parent if he/she were told her/his son could not participate in school athletics because of a hernia and there would be a three month wait to have the repair done on an elective basis. I have 4 married children living with their own children abroad and all of them are provided by their employers' medical care insurance that allows them to opt out of the national system, because they demand more access to specialists and quicker care than is available in the local system. I have a close friend who is a physician who complains that people come into his office having decided they have a certain condition and demand a pill which they have seen advertised on TV. There may be a less expensive alternative but if they don't get what they saw on TV they will go to some other physician down the road who will give it to them. While these examples are anecdotal and by no means scientific, they do represent the reality that I live in.

Most of us remember well the public outcry when the HMOs and PPOs were first introduced and they had strong mechanisms to regulate access to health care. State laws were passed to assure access to certain types of care and plaintiffs lawyers had a heyday. State laws are filled with provisions that guarantee access to certain providers and types of care, at least some which add unnecessarily to the cost of health care.

I believe that without a mechanism to control what care is available and to whom and at what time, costs will continue to be a problem. We have more technology than we can afford. In national health care systems care is rationed by either long waits or guidelines that restrict access. There is no political will in America to suggest that we really can't afford to give everyone everything they want when they want it. As a result, no one asks the hard question, who is going to decide what care and when?