This Week’s Clue: Health or Medicine?

Following is the essay you can designate as Volume 10, Number 37  of
This Week’s Clue, based on the e-mail newsletter I have produced since
March, 1997. It would be the issue of September 17.

Enjoy.

Recently I began blogging a new healthcare beat over at ZDNet.

I’m certain their idea was to bring in some advertisers who work in medical IT. I also assumed I would be writing most of my stories about technology — about topics like electronic medical records and medical gadgets.

Instead I’m often blogging basic questions of human liberty.

For most people it’s up to us how long we live, and in what
condition. If you don’t smoke, cut your drinking, exercise, live out in
the country away from pollution, and avoid stress then chances are
you’ll blow by 80 without needing much attention. If you don’t you
won’t.

This is not true for all people. My friend Martin Bayne
is blameless for his Parkinson’s Disease, from which he has now
suffered for 11 years, the last few in nursing care.  Kids with bad
hearts, or cancer, are blameless in their diseases.

And it turns out this is why kids and blameless celebrities are
rushed to the front by the medical community. They’re propaganda. And
they’re being used in the same way General Petraeus is being used by George W. Bush — to keep support high and the money flowing.

Does that sound cynical? For those who work in medicine and deal with the bills, it’s  a common attitude.

From both left and right, we hear this regularly. If we separate health from medicine, we can cut what we spend in half,
without changing the outcome.  Michael Moore says it using the example
of Cuba, which puts its money into prevention and has its people living
as long as Americans. But Robin Hansen of George Mason University says the same thing, using studies in from the RAND Corp.

Both men are pushing completely different agendas. Moore wants
guaranteed check-ups, and early treatment which can save lives. Hansen
wants to eliminate Medicare and private health insurance, forcing people to bear the burdens themselves.

But as you see from the picture to the left, Moore’s own appearance can undermine his argument. When he gets the stroke which is the price of his obesity, should the public pay for his care? Or watch him die?

Sometimes this is even noted in medical shows, like in a recent re-run of Scrubs
I saw. One of lead actor Zack Braff’s omniscient narrations casually
noted that most people who come into Sacred Heart Hospital die. This
was said in the context of the toll it takes on doctors. Don’t get too
emotionally close to the patients.

It’s true. Most of your lifetime medical costs will be spent in your
last year or two of life, probably to give you a rather horrible
quality of life. I have a relative right now who is facing this. He’s
depressed. Some say suicidal. But is he irrational?

Choice. Freedom. Ethics. These are the real questions which drive
our nation’s health care budget. But they are not the questions which
drive the debate.

How much should we restrict human freedom, and economic subsidy, in the name of cost?

• Can you be forced by law to get a checkup?
• Should smoking be made illegal? How about obesity?
• Should we let fat smokers die when they get sick?
• When should my relative’s call to end his costly care be heard, and followed?
• Should Mickey Mantle have gotten that second liver?
• How much extraordinary medical care should the poor get?
• If Dick Cheney wants a new heart and lungs, as I write in The Duke of Oil, should he get them?

Anyone who seeks to deal seriously with these questions sets
themselves up for ridicule, as John Edwards did when he proposed
mandatory check-ups. His proposal represents a slippery slope
conservatives don’t want to consider walking down. Once you mandate the
check-up, do the doctor’s recommendations take on the force of law?
Should they determine whether public money is spent on extraordinary
care?

Tough questions. Made tougher by his wife’s own medical condition. If Elizabeth Edwards were poor, when would our public medical system tell her to die?

This is among the questions posed by people like Mr. Hansen which quickly become just as tough as those he ridicules from Moore and Edwards.
Should wealth determine your lifespan? Should doctors toss their Hippocratic Oath
and simply refuse care to those who can’t afford it? Should the free
market be extended so that the rich can buy the poor for their organs?

These are all real-world questions. The horrors of the rich
sucking-up the living tissue of poor people to extend their own lives,
so beloved of 19th century horror writers, is reality in the private
hospitals of Asia. You don’t think that Mr. Cheney could get a new heart and lungs if he lived in Dubai? You think anyone would seriously ask how the donor died?

Basic questions. Life or death questions. Which become funding
questions, and technology questions. These questions are not really
being approached in the present health care debate, and likely won’t
be, because they make voters squeamish. Yet they’re faced every day by
people on the front lines, by doctors and nurses and hospital
administrators.

Do we concentrate on health or medicine? Where are the limits?
Someday these questions will matter to you. They will be matters of
life and death.

Will we have answers then? Or will you, as Americans do so often, simply live to the end of your fortune?