Thursday, July 16, 2009

Finally, A Shot Of Reality In The Health Care Debate

There is a terrible reality in the current national debate on health care reform that no one, regardless of whether they're conservative or liberal, wants to admit: too many treatments today are too expensive for the benefits they offer and consume resources that could, and should, be redirected to other patients. In other words, we can spend a lot on one patient or spend smaller amounts on a lot of patients, but we can't afford to spend a lot on a lot of patients. There are hard choices to make when it comes to health care, and we shouldn't pretend otherwise. The only way to afford universal health care will be to deny certain treatments to patients, especially those patients whose long-term survival is already dubious.

Let me give you an example from my own experience. From February to July, 2007, I was administered a chemotherapy "cocktail" every two weeks. It was a potent brew that included several pricey drugs such as Eloxatin, Fluorouracil, and Avastin; I had to go to St. David's Hospital in Austin for the infusion, which took several hours.

And it cost over $50,000 a month for those treatments, which turned out to be totally ineffective. My cancer returned less than two months after the end of the chemo, and that's when I put my foot down and said "no!" to any more chemo. In other words, all those treatments-----all that money-----were a complete waste. I might as well taken that $50K each month and gone to Las Vegas instead; the results would have been the same and I would have had a much better time.

My case is hardly unique. Many very expensive treatments fail more often than they work, and even when they do the net gain is measured in months instead of years. I have to wonder if that money spent for me each month should have been spent instead on programs for early detection of various diseases, childhood vaccination programs, etc. In other words, was my life really so valuable compared to the needs of other people?

Honesty compels me to say "no."

And if we're going to be honest about health care reform, we're going to have to admit we can't afford to give everyone anything and everything that might help them. We, as a nation, will have to reach a point where we say that a patient gets a treatment if there is a 60% chance it might work but a treatment will be denied if there is only a 30% chance it will work.

Some individuals will have to suffer for the good of others. There is no getting around that terrible truth.

That's why I was pleased to see the New York Times publish this piece by Peter Singer, a professor of bioethics at Princeton, in which he openly discusses the hard choices we must soon start making. Read it.

Rationing and denial of certain treatments is inevitable in the health care system. The only question is whether it will be done by the government or by the market. But it will be done, and don't fool yourself into thinking it can be avoided.