YOU COULDN’T PAY ME TO BE A DOCTOR
It takes anywhere from 11 to 13 years of schooling - including 3-5 years residency - to be able to call yourself a doctor. But as many physicians have pointed out, the process of learning is an on-going effort. Classes, seminars, and fellowships are required over the years so that a doctor can keep current with the breathtaking pace of innovation and increased knowledge.
This is one big reason I never even thought of being a doctor. I have an aversion to book learning, and the prospect of having to go to school until I was in my thirties lit my hair on fire. I find the human body eternally fascinating. But there are limits to curiosity and I have satisfied myself over the years with reading about the incredible breakthroughs and mind bending discoveries that makes the human machine so extraordinary.
Another reason I could never be a doctor is tied up with the debate we are having over health care reform; specifically, the discussion of end of life issues involving treatment and care, and most importantly, who should be involved in those decisions.
The doctors, hospitals, medical ethicists, and review boards that struggle with impossibly complex matters involving morality, religion, and the most intimate and personal desires of the patient, coupled with the pace of scientific progress in medicine that hold out the promise to prolong life, combine to present uniquely painful and wrenching decisions for all of us.
That’s really the bottom line, isn’t it? This is the matter we dance around when talking about “death panels” or “end of life consultation.” I think what we fear most about this isn’t so much that government will force euthanasia down our throats but that “efficiencies” that are forced on government by rising costs will result in a “one size fits all” solutions to problems that are best solved on a case by case basis.
To relieve suffering is the goal of palliative care. Should government - or insurance companies for that matter - force people to accept the end by paying for such end of life care rather than paying for a treatment or procedure that could prolong life but not cure the condition? Let’s imagine the procedure costs $100,000. Should government pay for these treatments when insurance companies won’t?
Sticky, yes? Let’s throw a few other ethical bombs on this scenario. Suppose the patient is 10 years old? Suppose the patient’s age increases the chances for survival but not enough to rationally justify the cost of the treatment? Suppose the treatment will only prolong life for a year or two?
While we’re creating moral problems, let’s try another nightmare scenario. An 60 year old cancer patient with a heart condition has a recurrence of the disease. The cancer can be treated with surgery and chemotherapy. But because of the patient’s heart condition, he won’t live more than a year or so anyway. Without treatment, he will die in six months.
Should Obamacare spend the money to cure the cancer?
These are matters faced by patients, their families, doctors, and hospitals every day. Guidelines in such matters drawn up by government or insurance companies are worse than useless. But in the absence of any good choices, shouldn’t someone be able to make the hard decision and deny payment for experimental, or unproven procedures - or life saving treatment when death from another condition is right around the corner?
Each case is different. Each situation has a human being attached to it, not a slide rule. And I believe this is the fear of old and young alike regarding Obamacare; that in the name of acting for the benefit of the many, government will lose sight of the fact that ultimately, the personal cannot be political in this instance, that there are some things that no government should be able to have a hand in deciding.
The same question can be asked of private insurance companies who would also be inclined to deny the kind of care outlined in both scenarios above. Do we really want those kinds of decisions made based on bottom line medicine?
If I’m confusing you, it’s because there are no good answers. And to my mind, this gives the lie to people who claim that health care is a “right.” Health care is a commodity, bought and sold like any commodity, valued like a commodity, and treated like a commodity by government, insurance companies, and patients alike. True, it is vital to life. But so is food. And I doubt even the most rabid proponent of Obamacare would want to see a government takeover of the food industry.
Every single one of us has already faced these choices or will have to do so someday, whether it affects us, or a close family member. Part of the problem is certainly linked to the miraculous state of medicine today. Our knowledge is growing by leaps and bounds, outpacing our capacity to develop a moral framework to make ethical decisions on life, death and “quality of life.”
Our pitiful attempts to quantify quality of life fall short because in the end, we’re talking about someone else’s life being evaluated based on invented criteria. Even Solomon would have a tough time judging something so intimate and personal. But again, is the current state of our health delivery system so bad that we must empower someone - government or insurance companies - to make these decisions for us? This is the philosophy behind Obamacare and it makes most of us uncomfortable.
I don’t have the answers. I think bringing costs down intelligently should be a priority simply because it’s logical, and because fewer dollars expended per patient would mean more potential dollars to spend on others. There are ways to do this without rationing, or simply paying doctors and hospitals less.
As for the rest, the issues are so complex and fraught with ethical and moral landmines, it would be prudent to make a greater effort to examine what is currently being railroaded through Congress without much thought given to the consequences, so that we can avoid engendering the kind of fear I mentioned above.
It’s been said before by others but bears repeating; Obama is trying to do too much, too fast, and without enough thought given to the real world consequences of what he is trying to accomplish. To claim otherwise is silly. And those fascist, astroturfed mobs of 70-something seniors at health care town halls know it - and fear it.
We have pent-up demand for something to be done. Republicans did nothing useful about much of anything. Their abilities were limited to starting wars they then managed to screw up. So first Obama had to try and fix the staggering mess Mr. Bush left behind, and only then could he get to the agenda he was elected to carry out.
Too much on his plate? Yeah. And most of it put there by the party of no.
But to the larger philosophical issue: we all die. The death rate is 100% But Americans are in denial about death.
Overwhelming numbers of us claim to believe in a magic sky fairy who will whisk us away to eternal life. And yet this “belief” does nothing to stop terrified old and sick people from bankrupting their families (and in the case of Medicare, their government) so they can cling to another month of life.
I don’t believe in an afterlife. I will spend my last nickel and steal yours to keep one of my kids alive. But I’m 55 and I know that eventually I will be gasping my last on some hospital gurney. Maybe the cigar I’m smoking will kill me. Then again maybe it’ll be a truck on the 405.
Either way, when it’s time for game over I intend to accept that fact. Especially if I’ve reached an age where even a miraculous recovery is a matter of a few weeks or months gained.
There is nothing courageous about an 80 year old man clinging to life at the end. It’s cowardly and wasteful and a wretched way to treat your family and your country. When it’s time to go, go.
I’m not talking about a mandate. That would be an abomination. But maybe Americans could think about growing up a little. If you’re 80 and medicare will get you a new hip, how about you just say, “Nah, I’m dying anyway, don’t spend 20k of the taxpayer’s money. Spend the money on some child with leukemia instead.”
This is a pretty horrific attitude you have and it’s obvious you know little or nothing about aging. With average lifespans rising - indications are that children born today may live much healthier and active lives until 120-130 years old - you do not take into account that a hip replacement for many 80 year olds would last them up to 2 decades what with the number of those living to be 100 having doubled in number in the last 20 years alone. People 80 years and older are healthier, more active, than you give them credit for.
We are on the cusp of nothing less than a revolution (another one) in medical technology where the full panoply of technologies (nanotechnology, gene replacement, DNA manipulation and others) will combine with a continued explosion in knowledge of the human body to make the “three score and ten” lifespan a joke.
And at the very moment that this triumph of human ingenuity is about to explode, you think old people should just give up and die. Pretty pathetic, Michael.
Of course, you call it an “abomination” - any thought of euthanasia. All you want to do is deny oldsters needed medical care. How very compassionate of you. Also, what if your child contracts a disease where treatment would prolong her life only a year or two? I would hope you would be equally patriotic and refuse treatment for her so that other kids who might be cured of leukemia or cancer would benefit.
As I say I don;’t know what the answers are. Logically, if the problem is limited medical care resources, those resources should be vastly increased. More doctors, more hospitals, more MRI machines, more nurses, etc.
But if the problem is a bottleneck caused by government already running the health care industry, I don’t know what the answer is. Can’t get rid of Medicare, VA, and the rest. Making health care delivery more efficient is as far as my thinking goes on this, and of that, I have no idea where to begin.
ed.
Comment by michael reynolds — 8/22/2009 @ 11:23 am
as long as it is not you with the bad hip or the leukemia it is an easy matter eh Michael?
Comment by jambrowski — 8/22/2009 @ 12:04 pm
Really Michael So it is all the evil Booshes fault even though Obama has spent more in the first seven months of his term than all previous administrations. The problem with your statement is NO ONE should be able to determine if the 80 year old is done with his useful life. The same 80 year old has almost certainly done more for this great country than you ever will.
Comment by Jimmy Hopkins — 8/22/2009 @ 6:51 pm
“But so is food. And I doubt even the most rabid proponent of Obamacare would want to see a government takeover of the food industry.”
Well, in some ways we do have measures to ensure that people don’t go without food (food stamps, subsidized school lunches, etc). I bet there would be some serious calls for government intervention if food companies were allowed to deny food to people, large numbers of people weren’t able to afford the food that companies WERE willing to sell to them, the food being sold was not in fact life-sustaining… This is another example of a situation where free-market capitalism does not work. Is health care a commodity? Yes, but it can still be a human right, too.
Comment by agt — 8/22/2009 @ 7:43 pm
Jimmy:
I try to avoid responding to people who clearly cannot read what I wrote. But what the hell:
I never said anyone should determine when an 80 year old lives or dies. In fact I described such a thing as an ABOMINATION. See the giant all caps word there? You’ll find it in my comment as well.
Comment by michael reynolds — 8/22/2009 @ 10:02 pm
“Well, in some ways we do have measures to ensure that people don’t go without food (food stamps, subsidized school lunches, etc).”
BINGO! There is nothing in the food industry that requires govt to takeover our private farm - supermarket - refridgerator food chain for 85% who can take care of our food needs in order to supply it to the 15% who cant.
The analogy to food stamps is simple: We need govt subsidized HSAs and insurance. Instead of mandates, rules, insurance boards and ‘public option’, we simple need to provide subsidies for those who cannot afford health insurance on their own.
Comment by Travis Monitor — 8/22/2009 @ 10:50 pm
“large numbers of people weren’t able to afford the food that companies WERE willing to sell to them”
Maybe if we forbade interstate commerce in food like we forbid interstate commerce in health insurance we could get to that point.
Allow people to buy insurance across state lines first and *then* determine hte cost of it.
Comment by Travis Monitor — 8/22/2009 @ 10:52 pm
“This is another example of a situation where free-market capitalism does not work.”
Hardly. This is another example of a situation where an industry hemmed in by heavy regulation ends up being very costly and the regulations end up being counterproductive.
Healthcare and health insurance havent been free-market capitalism for many many decades. Over-regulation got us into this mess and the same approach wont get us out.
“Is health care a commodity? Yes, ”
It’s an economic good. There is no free lunch.
“but it can still be a human right, too.”
If healthcare is a right, our right to be able to *choose* our insurance company, and *choose* what it provides or doesnt - rather than have govt dictate it all - is included. Govt dictation on healthcare is a denial of our rights. If healthcare is a *right*, then rights are denied when single-payer bureaucracies deny care based on rigid rules and bean-counting. If you call yourself ‘pro-choice’ but are ‘pro-mandates’ or even worse ‘pro-single-payer’, you are a hypocrite or a dunce.
Comment by Travis Monitor — 8/22/2009 @ 10:59 pm
We find ourselves very concerned about Obamacare and the effects it could have on folks like my Wife. We recently learned she has Early-On-Set-Alzheimer’s.Shes 59 years old, is that to old for treatment?
God Bless America, God Save The Republic.
Comment by David Schantz — 8/23/2009 @ 2:53 am
Michael makes a good point. Those good christian conservatives who truly believe that their soul will live on after life, and also adhere to the supposedly conservative values of self responsibility and fiscal frugality should have no fear of passing to the next world while saving taxpayer dollars.
It is the ultimate, responsible, patriotic sacrifice to meet your maker while saving money for your country and adhering to your values until the bitter end.
If you truly live by your values and beliefs, you should be man enough to die by them as well.
Comment by Moltenorb — 8/23/2009 @ 6:31 am
michael reynolds Said:
11:23 am
I will spend my last nickel AND STEAL YOURS to keep one of my kids alive.
CZ: Over my DEAD body. Bring it on.
Comment by CZ — 8/23/2009 @ 8:31 am
CZ:
Moron: we already steal your money to keep grandma alive. What are you doing about it?
Comment by michael reynolds — 8/23/2009 @ 8:52 am
Michael Reyonlds,
Moron - you just admitted that you are a liberal THIEF. Pay with your own money to save some one else’s grandma - -if you cannot then admit it that you are nothing more than a useless liberal who steals other peoples money and makes a virtue out of it.
Comment by Nagarajan Sivakumar — 8/23/2009 @ 2:38 pm
The sentiment: “Don’t spend my money to prolong or improve the quality of life of your 80-year-old grandma” is similar to, “Don’t spend my money to sustain or improve the quality of life of your able-bodied relatives on welfare.” It’s the same basic idea of withholding scarce public resources from unproductive consumers.
Comment by Doug King — 8/23/2009 @ 3:50 pm
The federal government should only be focused on foreign policy and that includes border security. The reason the Fed keeps on failing is, because we focus on to many things. We have this liberal nut in the oval office right now that’s trying to fix healthcare,energy, education, and a serious of other things we should leave up to states and the people. If we want to fix healthcare we would let the free market handle it. If we want to fix education we would get rid of the Department of Education and give people school choice and let states run it. And energy is the simplest of all let people drill and use nuclear power. I say get rid of the income tax and replace it with a 25% tariff.
Comment by charles — 8/23/2009 @ 4:45 pm
You know the thing that bothered me the most is when obama said it’s a moral obligation for us to fix healthcare. The only moral obligation we have is to ourselves and our families, because I work hard for my money so I’m going to spend it on what I want. This is why I support a 25% tariff to replace the income tax. All I want the government to do for me is keep me safe at night that’s it. Get rid of the Department of education,get rid of welfare, let what someone gets payed be between the employee and the employer,and get rid of most of the federal government. I want a strong military and strong borders and that’s all I want out of the Fed.
And no I’m not a Libertarian I still vote republican, because that’s what Ronald Reagan would of wanted me to do.
Comment by charles — 8/23/2009 @ 5:02 pm
michael reynolds Said:
8:52 am
CZ:
Moron: we already steal your money to keep grandma alive.
CZ: If your fearless leader commits the same crime, does that make it right?
michael reynolds Said:?8:20 pm 081009
Since I am lucky to be in the top couple of percent on income let me make this very clear: I am willing to be taxed to provide health insurance to the poor. I consider it my duty to my fellow American citizens.
CZ: How thoughtful. Get back to us all with the results of your more than generous personal contributions. You can afford it. Go ahead, you can lie. Again. If you wish. I guess.
Comment by CZ — 8/23/2009 @ 6:01 pm
13:
In the last 15 years I’ve paid in excess of 6 million in federal taxes.
Let me know when you get close to paying as much as I have. I pay YOUR taxes. And I’m volunteering to pay more for the benefit of people who are in need.
Call me a thief? Who’s paying the defense budget? You? Riiiight.
Comment by michael reynolds — 8/23/2009 @ 6:32 pm
Michael Reynolds, I am very happy that you are wealthy. I have never spoken words more sincere. I envy your wealth, but do not begrudge it. I hope one day to be that successful. And you are very noble to volunteer more of your money for those that need it.
However, I would point out that it is very easy for someone so wealthy to be so generous with their earnings. You never have to worry about paying the mortgage, paying for a good school for your kids, buying a new car when your current one goes over the 20K miles mark. You probably go out to fine dinners whenever it strikes your fancy. You have more left over at the end of the month than we do. Good for you (sincerely- unlike you, I do NOT want your taxes to go up. You pay your share).
Most of us can’t do any of that. My wife and I are much better off than most, but she can’t stop working or we can’t afford our current lifestyle (and she should stop working, because she is sick). My kids went to public school- I wanted to send them to a private school, but I simply couldn’t afford it. My car (a Mercedes diesel) has 150K miles, and will be my car for at least another 3 or 4 years. We go out to fine restaurants occasionally, but we have to plan for it.
Increasing my taxes, even a couple of percentage points, affects me- it hurts me. And when I look at the fraud, waste and abuse of every government-run agency, it infuriates me. I know that the government is taking more of my money to waste on projects that are mismanaged.
I acknowledge your sincere liberal belief in giving more of your money to the less fortunate, but I think your philosophy would be considerable different if it affected you more on a personal level.
Comment by lionheart — 8/24/2009 @ 6:41 am
Mike:
Yah! Six million over 15 years big deal.
Comment by charles — 8/24/2009 @ 7:20 am
Lionheart:
The standard GOP dodge is to accuse anyone who wants to raise taxes of being a lazy, liberal thief. That’s why I made the point that I pay plenty.
The vast majority of people who complain thusly either don’t pay any actual tax, or do not face a tax increase. As it stands now only people making a quarter mill or more will face an increase.
In fact, right now I pay less than I did in the Clinton era. What we-re talking about here is jacking the rates back up to Clinton levels. During which many people did very well. (You recall: peace, prosperity, a balanced budget. You know: Democrats.)
This will affect a minuscule percentage of the American population. Those it affects can afford it.
So the question is: why are medicare retirees screaming at townhall meetings about taxes they don’t pay?
Setting that question aside, I understand very well how hard it is for the middle class to get even a 2% increase. Been there. Done it. Most of my life. But the ‘taxes’ that hit the middle class hardest are not income tax but social security and medicare. Those taxes are murder on the middle class and essentially irrelevant to wealthier taxpayers.
But middle class taxpayers will also in most cases be favorably upside down on SS and medicare — they will get back far more than they put in.
And of course one f the reasons we’re trying to reform health care is precisely to avoid having to raise medicare deductions again and again, even as your health care premiums go up and up. (Doubling in the next 10 years is one projection.)
Summarizing: people who don’t pay net taxes, but do suck at the federal teat, are the ones screaming loudest about a reform effort and a tax rate hike that would only help them and hurt me.
In other words: the usual GOP idiocy.
Comment by michael reynolds — 8/24/2009 @ 8:22 am
Charles, your ignorance is STUNNING!!!!
Comment by Mike — 8/24/2009 @ 10:35 am
Michael Reynolds:
First of all, your screed is tiresome. Constant invective doesn’t further the debate, but since I am occasionally guilty of the same offense, I’ll move on.
I could dissect your response point-by-point, but it would be a waste of time- I’m not going to convince you. I only want to make these points for anybody else that is reading the exchange:
1. You have no proof that the “vast” majority of the complaintants don’t pay taxes. Even the retirees at the TH meetings are paying taxes on their retirement income (unless they are Roths). That myth fits into your paradigm, or image of these citizens, so you swallow it whole. Most of the people I work with (yes, working taxpayers) object to the government taking any further control over our lives. The govt. has proven many times that they screw up everything they try to run. I could give you a list, if you wish.
2. It is naive to believe that only $250K earners and up will have their taxes increased. You believe that because… because Obama promised that (rolling on the floor laughing)? You have the resources to absorb a tax increase. If you did not, you would not be so magnanimous with your tax basis.
3. “GOP idiocy”? You mean “American citizen idiocy”, right? Its not just the GOP, my friend.
Comment by lionheart — 8/24/2009 @ 12:04 pm
Michael Reynolds,
Yeah, keep saying that you pay MILLIONS in taxes - surely, you MUST NOT BE LYING ! what’s next, you are faster then Usain Bolt ?
Listen, I pay my taxes - you pay “your fair share”, remember ? And if you do really claim to have paid MILLIONS in taxes, why are you bitching about it ? I thought you had no problem doing so.
You paid it because you would have faced jail time otherwise - you never did it out of your own free will - and if you want to help people, because your heart bleeds do it on your own time - with your own money - you dont need a federal bureaucracy to do that for you.
Dont force your morality on others - we all help people the way we see it fit - we dont advertise to the whole wide world like you do. And we are more effective than any effing Government program would ever come close to - and no we dont do it for getting votes, nor do we use the threat of co-ercion.
If you are dumb enough to allow yourself to be raped, that’s your problem - dont ask people to pity you or expect them to stay silent just like you.
Liberals consistently betray their fundamental intolerance to any idea that exposes the hollowness of their bleeding hearts.
Nicolas Kristof said it best - Bleeding Heart Tightwads
Comment by Nagarajan Sivakumar — 8/24/2009 @ 8:52 pm
Tuesday morning links…
The 400th anniversary of Galileo’s telescope (photo from the article). Related: The Hubble Ultra Deep Field in 3D
Training drone pilots (with attack video) h/t, Neptunus
Photographers’ Rights. h/t, Insty
Rick Moran: Why You couldn’t pay me to be…
Trackback by Maggie's Farm — 8/25/2009 @ 2:21 am
Rick, your analogy of health care to food is an interesting one. Yes, each is a right and a necessity and none of us want to see EITHER industry TAKEN OVER by the government. Yet many of us are quite happy to see the government provide food stamps or other support to avoid people starving or being malnourished. THAT is what we are talking about, providing ACCESS to health care through universal coverage. We are NOT talking about taking over health care at all. Look at Germany’s example in a combination of public and private coverage and service that is very similar to ours while still providing practically universal coverage. No, they do not have a perfect system but they do have a better one than ours with greater, not less, freedom to choose your physician and, more importantly, freedom from fear of financial ruin through illness.
And, as you point out, limitations are a reality of ANY insurance/risk sharing health care payment system, whether public or private. Only the wealthy can assure themselves of unlimited options. . . at least up to their ability to pay. No system removes that advantage.
Comment by Eric — 8/26/2009 @ 8:04 am