I have noticed lately that the political left, which most supports health care rationing (and which, ironically, yells the loudest about HMO care restrictions), argues disingenuously for the agenda through the time-tested tactic of blatant misdirection.
Classic example, the fuzzy and reliably emotive Boston Globe columnist Ellen Goodman. In her most recent column, “A Rational Talk About Rationing Care,” Goodman illustrates her thesis by citing the the non-rationing example of President Obama’s late grandmother, who decided to receive a hip replacement after a fall even though she was terminally ill. From Goodman’s column:
I was also struck by the way the president framed Toot’s treatment as one of the “difficult moral issues” surrounding healthcare costs. Indeed, folks on the right saw this story as Obama’s warning about rationing ahead. But aren’t there places at the end of life where ethics and economics, compassion and cost, dovetail rather than conflict?Oh, so wise! I’ll brew the coffee. But what has that got to do with rationing?
There are “difficult moral issues” ahead. But is this one of them? Is a healthcare system that offers “everything” to everyone—hip replacements to terminally ill patients—morally superior? Or suspect? Can’t we decide when more is not more?
I won’t second-guess decisions in those last weeks of Toot’s life any more than I would second-guess my own family’s decisions as the avalanche of choices rolled toward us in my mother’s last months. But I do think that what our system may need is not more intervention but more conversation. Especially on the delicate subject of dying.
Today more than one-fourth of Medicare dollars are spent in the last year of life. Most people want to die “peacefully” at home but 80 percent die in hospitals. So, much of our money goes to the kind of death we don’t want.I am not sure her statistics are right, but even so, what has that got to do with rationing?
It’s true that the financial incentives of our medical system are geared toward intervention, but so are the emotional incentives. Doctors are in the business of fixing, trained to write “hope” on the prescription pad. These professionals are often uncomfortable amateurs in the business of talking about their “failure”: death.I am sorry, but doctors should offer hope. Moreover, Goodman is behind the times about financial incentives. But again, what has any of this got to do with rationing? Ah, here it comes:
In the wake of the Terri Schiavo case, the “living will” became a common document. On websites now, “The Five Wishes” are downloaded as family talking points that go beyond “pulling the plug.” But denial is still the default position. And maybe the destructive position.Read my lips: That’s not rationing. Rationing is when you want care and are refused it due to age, state of health or disability, or perhaps for committing lifestyle crimes such as smoking or being overweight. And here comes the the usual pabulum we see too often these days:
It turns out that end-of-life discussions between doctors and patients do not produce fear and depression. Recent research shows these conversations result in less aggressive treatment, lower stress, a better quality of life for dying patients and comfort for those who will mourn them.
If this is rationing, I call it rational.
Doing everything can be the wrong thing. The end of life is one place where ethics and economics can still be braided into a single strand of humanity.More like a single strand of emotional mush. If and when Goodman really wants to have a direct discussion about the hard and discriminatory realities of health care rationing, I’m game. But this column isn’t it.