Rich Leonardi wrote about healthcare today.
One healthcare topic I haven't seen addressed, but which I think we as a society are going to have to address, is the cost of infrequent but high-cost care. I read somewhere, and I don't know if it is true, though my experience tends to make me believe that it is, that the real reason medical costs are soaring isn't those typical office visits for sore throats or yearly checkups. Rather, the reason healthcare is costing so much more is the large amount of money used to treat relatively few people, and often these people are at the end of thier lives and this care does little but delay the inevitable, if that. Premies used to die quickly and cheaply if they were born much before 35 weeks; now they are put in NICU and run up $100,000 + bills before their first birthday--and then often have additional medical expenses to deal with life-long complications of premature birth. My grandmother died of colon cancer thirty years ago. Her only treatment was surgery about a year before she died, and then pain killers. Today cancer patients almost always receive expensive chemotherapy. For some it buys years; for others, months, if that. Kidney failure used to mean quick death; now it means dialysis and perhaps transplant. Not being able to eat used to mean relatively quick death by starvation if nothings else; now it means a feeding tube and long term care. The Terri Schiavo case caused a lot of debate a couple of years ago. Fifty years ago there would have been nothing to debate.
As Americans we want the best. If there is a chance at life, we want it. Pull out all the stops. Spend $100,000 on chemo even though the doctors only figure it will buy me a couple of months. Can we afford it? Should we afford it? Who should get to make the choices? One fear I have of a single-payer government run system is that some computer or faceless bureaucrat will be deciding whether or not I can have the high-priced treatment my doctor recommends. On the other hand, don't insurance companies make calls like that all the time? What are a couple of months of life worth? Are they worth more to a mother of young kids than to a ninety year old nun? If resources are limited, is it better to spend big bucks on one premie whose chances aren't good; or do we provide pre-natal care for lots of women? Do we insert a feeding tube and keep an elderly paralyzed stroke victim alive for a couple of years, even though s/he can't talk or get out of bed; or do we provide blood pressure medicine for a lot of people, so as to avoid strokes? Does quality of life as perceived by society have any place in the discussion of how much we, through either taxes or insurance premiums, should pay to keep someone alive? These are uncomfortable topics and more easily debated when discussing John Doe than my grandmother or myself, but I think we as a society are going to have to address them.