Tuesday, November 18, 2008

Rationing in universal health care

Rationing of health care is perpetuated in the U.S.A. as a reason not to incorporate universal health care. No one wants their granny to not get a kidney transplant when she needs it, and no one wants to hear "we won't fund this". The American mindset is that each individual should have options for their own life, and this unfortunately does not coincide with the idea of universal care.

Articles similar to this one, which Happy from Happy Hospitalist and Carpe Diem quote to bring attention to cost-cutting measures, often provide sappy stories of people dying without some very expensive drug that is the only treatment option.

As sad as these stories are, there is no 'other-side'. Privacy laws do not allow commentary by physicians to say whether this treatment option would work, or whether the state of the person's illness was so severe there would be no quality of life for the person afterwards, despite them living for a few more weeks. It seems as though the people who are requesting these drugs are in terminal stages of their disease. Although I commend them trying to fight for life, there comes a point when we need to say enough is enough and the person should be allowed to die with some dignity.

Oftentimes health bloggers rage about the 'fruitless end-of-life' attempts where people in terminal disease or the extreme elderly have full code status. It is not uncommon for these bloggers to also disagree with rationing. How is this possible? What they are suggesting is specifically to rationalize. Or is it only for the elderly? How is that fair?

So you know my personal position, after the age of 80, or if I have a terminal illness where treatment benefit is marginal, I will put myself as a DNR. As much as I may have 'good years' left post illness, I can honestly say I would not have advanced measures be taken to continue my life. My decision is based on my own observations and experience. I have seen people intubated, I have personally pounded on chests and broken bones. What quality of life are we offering these people? So they go to the ICU and instead of dying in emerg (or even at home when their family finds them unconscious), they spend another month lingering and then pass in the ICU.

For those who really don't like the idea of rationalized care and promote private insurance as the way to get around it, unfortunately rationing of health care dollars is not uncommon in the private care model. Private insurance places guidelines on repayment and reimbursement schedules, and primary care doctors have to fill out pre-approval forms for patients to get an MRI or CT. The movie John Q emphasizes how John's private employment-based insurance stated they would not cover the cost of his son's heart transplant.

Whereas rationing of health care isn't an ideal situation, I'd rather have that then not have universal coverage for everyone else. There is an impossible triad of health care, you can have two of the three options: Affordable, Quality, and Accessibility.


ArkieRN said...

I assume you meant rationing. Adding "al" to the end changes the meaning completely.

miss-elaine-ious said...

Oh my goodness. Thank you for the correction.

Edited version to come.

miss-elaine-ious said...

There you go. Wow so much for my 'smart' post.