Health Care Agenda

Like Tyler Cowen, I’m getting tired of blogging about health care. But his quote from Daniel Callahan’s book is provoking. The quote:

I can sum up what I want to say in some simple propositions.  First, ways must be found to return to more basic levels of medical care for ever more patients (e.g., to emphasize prevention and primary care) and to make it more difficult to receive medical care at the higher levels (e.g., advanced expensive cancer treatments or heart repairs).  Second, the priorities for technologically oriented health care should begin with children, remain high with adults during their midlife, and then decline with the elderly.  Third, if the medical care received during those first two stages of life is good, the elderly will have a high probability of a good old age even if advanced technologies are less available to them.  Fourth, health care cannot be reformed, or costs controlled, without changing some deeply held underlying values, particularly those of unlimited medical progress and technological innovation.

Hmm. The implicit assumption is that central planners can determine what is best for us and that an authoritarian state can force us to comply. And what they think is best is slowing medical progress and restricting health care for the elderly.

There is, of course, another view. As Dr. Maria Martins writes:

It is a betrayal of our duty to our patient to use any consideration of some greater social good defined by the government to alter the best course of action for the patient. Our customer rightly expects us in the doctor-patient relationship to have his welfare as our absolute priority. It is immoral to use “average number of years of life a procedure would buy” — or any other government-inspired social utility — as a justification to limit the options we offer our patient.

Health care reform is about redistributing health care, giving better care to some and worse care to the rest. It would be desirable to have better health care for all, but that is not what’s being proposed.

UPDATE: If you think I’m misrepresenting Obama’s intentions, here is an excerpt from a WSJ commentary:

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.


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