UNDERNEWS

Undernews is the online report of the Progressive Review, edited by Sam Smith, who covered Washington during all or part of one quarter of America's presidencies and edited alternative journals since 1964. The Review has been on the web since 1995. See main page for full contents

August 30, 2009

WHAT'S YOUR COMPARATIVE EFFECTIVENESS?

Sam Smith - I've told my doctor that if I get to the point where I can't argue with him anymore, he can pull the plug. I told one of my sons about this and he promptly responded, "What do you mean, Dad? Don't you want me and my brother arguing about you on national TV?"

(In fact, it's not totally a joke. During the one serious operation I've ever had, the doctors gave me extra anesthesia, explaining later that I was talking so much politics that it was distracting them.)

So I come to the end of life issue from the pragmatic side, but I also respect that fact that many wouldn't agree with me. Further, you'll note that it was - at least in my imagination - my choice and not that of the doctors, insurance companies or the government.

And so, unlike many in the Democratic Party and the media, I don't think the issue is some rightwing plot designed to sabotage the healthcare bills.

But how to discuss it rationally? Well, here's a starting point. The Christian Science Monitor notes that in the "British national health service, a government board approves only expensive treatments that add at least the equivalent of one year of quality life for every $50,000 in spending."

In a time when doctors are being told how many minutes they may spend with a patient, it doesn't help to avoid the issue of healthcare rationing.
Although the Democrats deny they are planning "death panels," they are pushing for studies of the "comparative effectiveness" of treatment plans, a perfectly sensible inquiry, but also one that is just a step or two away from the British system. For example, without any direct government intervention at all, a hospital might refuse a treatment based on a recent government comparative effectiveness study.

How one feels about all this is a much better guide to the issue than most of what you will read or hear these days. What is the comparative effectiveness of another year of your life? And who gets to decide?

6 Comments:

Anonymous Anonymous said...

I can't decide; is it insanity, or is it a sin, or is it both...to be even discussing the unholy horror of witholding any and all care possible for anyone at all...

WHILE THE FUCKING USA PENTAGON IS WASTING TRILLIONS MURDERING PEOPLE RIGHT ROUND THE GLOBE?

The human species is ridiculously sick and totally divorced from good sense.

August 31, 2009 8:02 AM  
Anonymous Anonymous said...

It's all about power, isn't it? Who gets to choose, the range of choices, the parameters for decision. Those unfamiliar with the detailed history of nationalised health systems should be aware that their most zealous supporters have long fought against allowing any pay alternatives - a battle they lost in the UK due to Maggie Thatcher.

The issue is always presented as 'bringing good healthcare to the poor and needy,' but that lack of access to healthcare is more perceived than real - if people seek it out.

No, the real issue is not really about health, or cost, or opportunity: it's about whether the government should use force to try and make everyone subject to the same limitations. That is never, ever going to work in America. You can only waste a vast mountain of resources trying.

August 31, 2009 12:07 PM  
Anonymous Anonymous said...

Give that Ayn Rand nonsense a break for awhile. The lack of access may be more perceived than real to you, but that's because you can't see outside yourself.

What are you? A PR flack? Or do you just watch too much Glen Beck?

You can call access to healthcare a limitation but that doesn't make it true. You act like someone with a gun is going to come and make you visit a quack doctor for some eugenics testing. "Oh no! My beloved HMO! Whatever will I do without it?" The only people who would be negatively affected by a real universal healtcare would be the people who make billions denying the rest of us basic human rights. And they wouldn't even have to attone for their crimes or give back the money. They could still self actualize or at least console themselves with the vast fortunes made doing pretty horrible things.

The issue totally is about health and cost. We have too much of one and not enough of the other simply because we allow a handful of people to rip us all off under the guise of liberty.

Your word games ignore the point entirely.

August 31, 2009 2:33 PM  
Anonymous Anonymous said...

I'm someone who has lived under both systems, seen people I loved treated both well and badly by both systems, been rich and poor under both systems, and is unimpressed by doctrinaire arguments. Polemicists for both sides misstate the truth to protect their own interests - but there is no question in my mind that patient interests are the last thing on the mind of any major players.

August 31, 2009 5:54 PM  
Anonymous robbie said...

how can "extremists" who want single payer universal health care be determined to be uncaring about patient interests?

August 31, 2009 6:59 PM  
Anonymous robbie said...

how can "extremists" who want single payer universal health care be determined to be uncaring about patient interests?

August 31, 2009 6:59 PM  

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