Freedom From Choice

Devo sang Freedom of Choice is what we got, freedom from choice is what we want. As I read articles on health care yesterday and today, this seemed to sum up oour current predicament. We have so many choices, in insurance, doctors, medicines, procedures, technologies.

Yet, the US spends more per person and more as a percentage of personal and country GDP. Still, we’re lower in many of the care statistics than most industrial countries in the world.

We find ourselves facing the difficult choices and not able to make then: who is paying for all this care? when do you use life-sustaining technologies and medicines? “At the end of the day, when it comes to controlling health care costs, the enemy is us,” said Drew Altman, head of the Henry J. Kaiser Family Foundation. “Americans want the latest and best in health care technology, and we want it down the street, and we want it now.”

Take one technological innovation: implantable cardioverter-defibrillators, the thing keeping Dick Chaney alive. Three years ago, a team of researchers calculated that putting an ICD into a heart-attack survivor added one to three years to the person’s life expectancy. The cost? Between $30,000 and $70,000 for every year of life gained. In the world of “cost-effectiveness analysis,” that’s judged to be worth it, the convention being that a treatment that buys an extra year of life for $50,000 or less is “affordable.”

Yes, but in whom? Only the wealthiest people? Only people less than 70 years old? We do not want to have to make those kinds of choices and are ignoring the cost factors because we can’t decide.

Still, everyone dies. There are no life-saving medications, only life-prolonging ones. To say that anyone chooses to die is, in most situations, a misstatement of the facts. But medical advances have created at least the facade of choice. It appears as if death has made a counter-offer and that the responsibility is now ours.

In today’s world, an elderly person or their family must “choose,” for example, between dialysis and death, or a feeding tube and death. Those can be very simple choices when you’re 40 and critically ill; they can be agonizing when you’re 80 and the bad days outnumber the good days two to one.

We have a health-care system that reflects our national values. It’s highly individualistic, entrepreneurial and suspicious of centralized supervision. In practice, Medicare and private insurers impose few effective controls on doctors’ and patients’ choices. That’s the way most Americans want it. Patients understandably desire the most advanced surgeries, diagnostic tests and drugs. Doctors want the freedom to prescribe.

There is no major constituency for controlling spending. We could charge the elderly more for Medicare. We could tax employer-provided health insurance as ordinary income. We could create a dedicated federal tax to cover government health costs — if health spending increased more than revenue, the tax would automatically rise. It’s our choice.


3 comments so far

  1. 23 on

    Health Headlines In The News

  2. 19 on

    Great Health Publications Blog…

  3. Mari on

    When I was living in Britian a decade or so ago I remember discussions about limiting access to health care or charging extra fees to smokers as they increased the expenses on the National Healthcare system. I heard less of that on visits in recent days, I’m not sure what happened but I did notice ads for private health insurance. The point of the above is a national universal healthcare system has its own bugaboos that may not fit well with our national character.
    I know people who scoff at strangers judging their personal habits which have health consequences, imagine when the ‘people’ start footing the bill. Don’t think society isn’t going to start demanding that individuals stop smoking or cut out the twinkies…. oh wait we are.
    The other part is the supply side. We don’t produce enough doctors, nurses and other health professionals. There aren’t enough GPs in the sea of specialists. There aren’t enough physicians in rural areas.

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