Health Care Options – and Dangers!

As he stood at the spot where seventeen years before he had lain dying after suffering serious injuries during a hike in the Peruvian Andes, Joe experienced a sense of disorientation. He had come back to the place of near disaster to help with the filming of that hiking experience. But as he stood there now, all this time later, his whole being reacted – heart racing, breathing difficult, memories which he thought he had buried pouring back into his consciousness. He was having an acute panic attack. He was still suffering from post-traumatic stress disorder.

As the symptoms persisted, once he returned to England he called for an appointment with a psychotherapist. While he waited for the British health service to grant him an appointment he suffered through multiple panic attacks and a sense of generalized vulnerability. Telling his story in detail helped. He had inadvertently discovered an acceptable treatment for PTSS, retelling the event over and over again in great detail.

Six months after his request the call came. He could at last get his appointment with some unknown therapist. In his words: “I declined the offer with a few choice words about the parlous state of the health service and felt relieved that I hadn’t been suffering from a serious mental illness.”¹

As we in the United States consider the issue of universal health care, we need to do our homework and approach the idea carefully. The idea of providing health care and/or insurance for those who are normally refused due to preexisting conditions and for those who truly cannot afford insurance is morally right and practically necessary. Having clinics scattered throughout the country where people can go and thereby open up emergency rooms for those who need a higher level of instant care is good planning.

However there are inherent dangers in proceeding much further than this. You can say that people will be allowed to keep their present insurance coverage if they wish, but there will be difficulties to this approach. How many employers will still cover their employees when there is another alternative? When they are still healthy, how many people will pay for insurance if “free” coverage is available? When you are already paying higher taxes in order to have socialized medicine, how many people will want to or be able to pay still more in insurance premiums? At that point, as people no longer opt for private insurance, how many insurance companies will still exist apart from the state?

As I understand it, cost is a major concern. When money becomes the motivation for change, rationing medical care comes into play. The very young, the very old, and the handicapped generally suffer the most.

Dr. Leo Alexander, U.S. consultant to the Nuremberg Trials which were held after World War II, cautioned against the dangers of rationing medicine. In a 1973 article in the New England Journal of Medicine, Dr. Alexander commented wisely on a situation where electroconvulsive treatments were limited to thirty-five a year per patient:

Two years ago if a physician performed an abortion he was a criminal, but if subsequently, after his patient went into a severe depression, he brought about her recovery by 48 electroconvulsive treatments, he was a good doctor. Now the situation is reversed: when he performs the abortion he is a good doctor, but if he subsequently finds it necessary to relieve her severe depression by 40 electroconvulsive treatments, he will be a criminal. Such laws, in comparison to our Hippocratic obligation, enduring throughout the entire history of medicine, are merely words written into sand.²

It is dangerous, in my opinion, to set up rigid rules regarding treatment. For example, to stop dialysis arbitrarily at age fifty-five is to make the unwarranted value judgment that an older person has less worth than a younger person, and that the older person can no longer benefit from treatment. In God’s eyes, however, a person’s value is not a function of age.

To stop dialysis because of a well-thought-out decision is another issue altogether. A young man who had cancer entered the terminal state where chemotherapy caused great discomfort and accomplished less and less. At the same time he was receiving dialysis. The day came when he discontinued both treatments because he was in great pain and knew that he would die very soon in any case. I personally do not feel that his decision was wrong, and it was his decision.

Back a few years when Oregon was promising to provide universal health care, examples were given which are probably similar to any such government-issued plan:

1. A person with AIDS would get early treatment but only comfort care in the terminal stages.
2. There would be no payment for so-called heroic treatment, such as life support for babies born less than 23 weeks of gestation who weigh less than 1.1 lbs.
3. So-called self-curing ailments like the common cold and food poisoning would not receive treatment.
4. And, number 588 on the list, spinal disc surgery, would not be covered.³ By the way, number 587 would be covered. Yet not covering 588 could lead to pain and even crippling results, and food poisoning can kill.

Going back even farther, with similar perspective, Robert Proctor once wrote regarding Hitler’s Third Reich, “The primary test of the physician is to discover for whom health care at government expense will be worth the cost.”⁴

Let us not forget that medical help provided at government cost is really a cost covered by the people – us – our taxes! For those of us who now pay a fairly steep price for health care/insurance, if socialized medicine becomes a reality we will inevitably find ourselves paying even more for less. We will exchange our present health care costs for a higher cost in taxes and probably receive in return less choice, inferior care, and long waits. Just ask anyone in Canada why, when their condition is serious, they come here.

Our medical system, and even our judicial system, is flawed. Both could be improved. But let’s not get nihilistic about it. We don’t have to destroy it in order to make it better. And never forget, our medical care and our judicial system are still the best in the world!

In our depersonalization and in the spirit of the greed which has brought us into the danger of aborting our values for a focus on cost, let us never forget the lesson of the Ik.

A caricature of what can occur in a fanatical depersonalization of human relationship is given to us in Colin Turnbull’s description of the Ik, a tribe which may by now be extinct but who used to live in the mountains separating Uganda, the Sudan, and Kenya.

Originally a hunting tribe cooperating in their work, the Ik were forced into becoming farmers by the creation of a national game reserve in Kenya. Drought and lack of technological knowledge about farming defeated them, and they deteriorated into a tribe of fewer than two thousand, isolated from each other in an attempt to survive. Children are thrown out on their own at three. Old people are laughed at as they die. Family members take food from each other, even at the cost of causing death to a husband or wife. There’s no word for goodness left in their language, and there is no apparent desire for love or understanding. Loneliness is a way of life and as such is scarcely felt on a conscious level. Says Turnbull: “There is no goodness left for the Ik, only a full stomach, and that only for those whose stomachs are already full.”⁵

What struck Turnbull with force were the parallels between the Ik and Western culture. Speaking of the Ik, he claims: “They are brought together by self-interest alone, and the system takes care that such association is of a temporary nature and cannot flourish into anything as dysfunctional as affection or trust. Does that sound so very different from our own society…?”⁶

If we take out the “pork” from stimulus bills, the budget, and all government spending, and if we require financial input into our own medical care by those who can afford it, there is no reason why we cannot maintain and even increase the quality medical care which we now have and make it available to anyone who needs it.

In addition, health care providers need to be responsible in providing only needed health care and in making that care fair in terms of cost. In dealing with spending, government needs to eliminate, not just cut back on, pet projects which enhance the popularity of given individual politicians. Patients need to responsibly seek health care for real needs. Reasonable oversight, rather than total government intervention, could help insure that these conditions prevail. Only then will we continue to grow a health care system which will meet all of our needs and still not bankrupt the nation. We the people are this nation. Let’s not forget that!

Footnotes:

1. Joe Simpson, Touching the Void: The True Story of One Man’s Miraculous Survival (New York: Perennial, 2004), 213.
2. Leo Alexander, M.D. “Temporal Laws and Medical Ethics in Conflict,” New England Journal of Medicine 289 (August 9, 1973), 325.
3. Edwin M. Reingold, “Oregon’s Value Judgment,” Time (November 25, 1991), 37.
4. Robert Proctor, Racial Hygiene, Medicine Under the Nazis (Cambridge, MA: Harvard University Press, 1988), 184-85.
5. Colin M. Turnbull, The Mountain People (New York: Simon & Schuster, Inc., Pubs., 1972), 286.
6. Ibid., 290.

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