One topic that has been missed in the ongoing debate about health insurance has been the level of care that is available today. There has been very little discussion about the fact that people are routinely surviving unscathed when suffering illnesses or injuries that would have been fatal even just a few decades ago.
The point that could be made is that our high expectations of medical care today are a lot of the reason for the skyrocketing cost. The frontier doctor who would ride to a home on horseback and deliver a baby for a few dollars wasn’t just kind. He also had less overhead. He didn’t request ultrasounds, have a neonatal team on standby and he knew he wouldn’t be performing a Cesarean section.
Today, if an obstetrician’s fee was covered by insurance, but those other things were not, most people would agree that it was a travesty. It’s an issue that has been addressed extensively in end-of-life debates, but the reality is that the skyrocketing cost of care is also tied very closely to the expanding ability to intervene against even less serious injuries and illnesses.
Certainly, there are innovations that are affordable. Medical conditions that reduced mobility once meant a lifelong need for assistance with a wheelchair. Now there are power chairs that can be operated by people with even the most restrictive conditions. From Quingo scooters for arthritic seniors up to “sip and puff” chairs operated by quadriplegics, mobility has been an advancement that’s realistic and beneficial for health insurance to cover.
So, it’s clear that many of today’s innovations are not only beneficial but affordable. The debate, then, is centered around just how much we can afford to provide coverage for, and whether there is a good enough chance for recovery to make that investment worthwhile. This is of particular importance with a new POTUS in office promising to overhaul health care.
But is a simple cost-benefit analysis a realistic and humane way to talk about life? Many argue that healthcare should pay for any treatment that has a chance of saving a life. Yet the standard for what constitutes “saving” a life has been a difficult one to establish.
It is clear that certain options represent viable methods of saving lives that could not have been saved decades ago. Advanced treatments like implanted defibrillators, insulin pumps and organ transplants have proven to be effective for the world’s sickest patients, giving them both quantity and quality of life. They are expensive, but they definitely work.
But what about other treatments? Many things, like ventilators and pressor drugs, are intended to serve as stop-gap measures, techniques that can keep a person viable long enough for an underlying condition to be repaired. Yet these tools are often employed as last-ditch efforts to keep a patient alive with little or no prospect for a meaningful recovery. Even that term–“meaningful recovery”–is debated.
Still other conditions present a perplexing scenario. Prostate cancer is a good example. It is widely believed in the medical profession that, beyond a certain age, treatment of prostate cancer is pointless. The reasoning is that the disease progresses so slowly that something else will probably kill the patient before the cancer will, and that the course of treatment is so difficult–often leading to incontinence and impotence–it’s not worthwhile. Consequently, blood work to detect prostate cancer is not covered after age 70.
The only thing clear in this whole debate is that a lot of things are unclear. We struggle as a society, and even as individuals, with what constitutes a worthwhile treatment, even without considering the cost. Once financial issues are brought into the discussion, the water becomes even murkier. What is clear is that there will be no satisfactory and effective solution to the national healthcare debate until these issues are addressed with an unanimity that currently seems unlikely.
