Monday, May 4, 2009

Babies don't vote, babies don't pay

How can we be the "greatest" and "richest" country in the world when we don't guarantee basic health care to all of our citizens?

The cost of health care, in both moral and economic terms, is bankrupting our country. There is no reason why everyone shouldn't receive quality, affordable health care. A healthy workforce makes good sense, but we are really talking about caring for people, the sick--a simple mitzvah, the kind of thing your grandmother would want you to do, but taken to a national level.

But that's the easy part. It's not just who we care for, but how we care for them. Serious reforms are also necessary in how we research new drugs and treatments, and how we make choices about what procedures, particularly at the end of life, are offered to an individual.

I believe these type of complicated decisions regarding public health, preventative care and use of limited resources need to be made by scientific and non-profit oriented (i.e. non insurance and non pharmaceutical) groups like the NIH.

One of the reasons that the United States has the highest infant mortality rate in the so-called "civilized" world, that is to say compared to other places like Western Europe, Japan etc. is that babies don't vote and babies don't pay. So we spend more time and money on finding viagra and cures for social anxiety disorders. This same market logic drives research away from world wide killers like malaria or improving preventative medicine. Screening and teaching better diet and exercise to avoid diabetes just aren't as profitable as insulin.

The system will spend tens of thousands of dollars, however, to extend someone's life by a week or two. If you can call lying in an intensive care unit with failing organs and an artificial respirator down your throat as well as being extremely sedated because your body responds to the respirator as if you are drowning or suffocating as living...

This is why research and health guidelines need to be free of industrial and market bias. Health care providers and individuals need access to good information. Smart national guidelines will help doctors sort out increasingly complicated health choices (drug interactions, comparisons of generic to brand drugs, comparisons of treatment combinations). National guidelines will not tie your doctor's hands, but empower them with information rather than marketing and advertisements. It's a non-issue really, because hands are already being tied and manipulated by decisions about which procedures are reimbursed and for how much.

The next step is encouraging individuals and families to think and talk about critical care and end of life issues such as when and how much invasive care should be given, and under what circumstances. Every adult as part of their electronic and accessible health records should fill out organ donor plans, do not ressucitate orders, file health proxies etc. Schools should have a mandatory health and diet class that teaches proper hygiene, eating and exercise habits and how to become well informed participants in a national health care system.

And participation is the key. Now is the time to speak out and let your elected official know how you see the future of health care in America.


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  2. As part of the stimulus package, Obama is setting aside $1.1 billion dollars to do these type of comparative effectiveness studies, which will surely be a point of contention in the debate on health care reform. Again, what could be wrong with giving people good information based on rigorous studies?

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