Who Will “Just Say No”?

How would you like to be told that a medical treatment that could make your life tolerable or might even save your life is simply too expensive to administer? How would you like to know you will die unless you get a certain treatment? Perhaps you would prefer to be confronted with knowing that the injury you have suffered, which prevents you from getting out of bed and going back to work, is insufficiently life-threatening for moving up the date for the required corrective surgery – you’ll have to wait a few months for the new budget year? Does it matter if you are past a certain age? Does it matter if the life-extending procedure will add one more year to your life? Five? Ten? Does it matter if you have platinum insurance or are reliant on the garden-variety provided under a new national healthcare plan?

As Congress and the President grapple with the magnitude of the cost of national healthcare, these are some of the most difficult questions facing our government. Who is going to decide that “enough” is “enough”? We order five times the MRIs that are ordered in Germany. As I have pointed out in a recent blog, a large portion of the $2.5 trillion of healthcare costs in the U.S. (a whopping 16% of our GDP) are directly attributable to habits and practices that often result from individual lifestyle and dietary choices; obesity and smoking are exceptionally heavy contributors to complex and expensive medical problems.

I’ve recently blogged about the results of studies from the Dartmouth Institute for Health Policy and Clinical Practice, which clearly illustrate that “more” does not mean “better.” High cost urban hospitals that order more tests and increase the cost of healthcare surprisingly do not produce healthier people. But who exactly is going to set those standards? Who makes such “life and death” decisions in a world where rationing healthcare to manage costs seems inevitable?

The July 8th Washington Post presents this exchange of views: “‘The questions of who gets what, these difficult choices . . . really are not posed in the current health reform legislation,’ said Drew E. Altman, president of the Kaiser Family Foundation. ‘The challenge,’ he said, ‘is us, the American people: We want the latest and the best, and we want it now.’

“The Democrats’ caution has not kept Republicans from accusing them of embracing rationing. They raise the specter of the British agency, which goes by the acronym NICE, that decides whether that country's nationalized health-care system will pay for items such as costly cancer drugs that extend lives a few months on average… ‘You're going to be saying to people, ‘We're not going to care for you, because we've decided it's too expensive to care for you,”’ said Robert E. Moffit of the right-leaning Heritage Foundation. … Others retort that the United States already has rationing: The uninsured and under-insured do not get the care they need. ‘We're already doing it,’ said Stanford University epidemiologist Randall Stafford. ‘We're just doing it in such way that it doesn't service societal interests.’”

You’re lying in a hospital bed, you know with the right treatment, you will get back to your life in a few months and without it, well, you won’t make it more than a few more months. You’re feeling vulnerable and helpless. And then somebody “just says no.”

I’m Peter Dekom, and I am worried too.