I was thinking about government care today, not in terms of dollars and cents, but in terms of the human factor. Government health care imagines that all people will respond to situations in the same way, both physically and emotionally. But that’s not how people are.
The medicine that makes one person feel wonderful has another person retching miserably — yet government health care usually comes complete with a limited list of available medications. While one person responds fabulously to a procedure, another may get no benefit at all — yet government health care, in the interests of efficiency, always ends up dialing down the available range of health care options.
And then there are the personalities. I’m not even talking about the bad habits, whether smoking, drug abuse, too much chocolate, etc. I’m talking about people’s fundamental beliefs about their own health.
One sweet old lady I know is a true hypochondriac, constantly searching for the next illness. Bundled in with that emotional baggage are genuine health problems, so that the doctors always have to take her complaints seriously. She costs her insurance company a staggering fortunate.
Another sweet old lady I know is in complete denial, and that’s true despite her genuine health problems. Because she refuses to deal with symptoms as they arise, everything with her is serious by the time she gets to the emergency room. She also costs her insurance company a staggering fortune.
I don’t see how government health care which, in the absence of competition, inevitably boils down to one-size-fits-all treatments, fixes the problems inherent with these (and so many other) personality types. This is going to be especially true with an aging population, when there are going to be increasing numbers of charmingly eccentrinc sweet old ladies and dear old men.
As you have probably guessed, today I had a run in with the health care system and a sweet little old person. The health care provided was humane, thoughtful — and, but for the personalities involved, should have been unnecessary.
I’m tired, grumpy, and treating myself to my own drug of choice: chocolate ice cream and the love of a good dog.
UPDATE: This article about Donald Berwick, whom Obama chose to head the Centers for Medicare and Medicaid Services perfectly describes how America is being pushed into the “patients as cogs” model. The premise is that Berwick is completely in love with Britain’s National Health Service (something with which those enrolled in and suffer from the NHS might disagree):
Berwick has called NHS a “global treasure,” saying he is “a romantic about NHS. I love it.” It’s no coincidence that this centrally planned, government-run health care system appeals to a Harvard-educated pediatrician who views patients not as individuals, but as members of collective “units of concern” defined by age, disease or socioeconomic status. Berwick has criticized the use of new life-saving technologies and wants non-physician “primary care providers” to ration care by controlling access to specialists and diagnostic tests to reduce each “unit’s” per-capita costs. He has also characterized aggressive interventions in terminally ill patients as “assaults,” not heroic attempts to extend their lives.
This is a radical departure from the focus on individual patients and their private relationship with doctors of their choice that have made American medicine the best in the world. And while Berwick was among the first to introduce industrial-style quality controls in 3,000 American hospitals, which by all accounts has been a huge success in improving patient care, his rigidly ideological view that America’s health system should mimic Britain’s NHS is inimical to the preservation of individual freedom and high-quality care. His nomination should be decisively rejected by the Senate. Americans live longer, healthier lives than Brits precisely because government bureaucrats have not been in charge of their health care for the past 60 years. If confirmed by the Senate, Berwick will define that quality down to British standards. That would not be choosing well.