The Healthcare Questions We're NOT Asking
Categories: Education | Nutrition | Finance | Leadership | Economics | Ethics | Environment
Posted by
Paul Orfalea
at
9:44 PM
7
comments
From the White House to the Wall Street Journal to the table next to you at Starbuck's, everyone seems to be talking about healthcare. Except that they're not. What people are debating right now is how to pay for healthcare. That's a tough enough question, but society might be better served by asking some tougher questions first.
A friend of mine calls the unintended consequence of Social Security a sort of "generational diaspora," as families disperse and become financially and emotionally estranged, a series of seemingly unrelated nuclear units. He notes that Social Security helps many seniors retain their independence, but in squalor, rather than in the loving circle of extended family. Which raises the question: should society or families be responsible for care of the elderly? We expect society to extend assistance to the indigent, but Medicare and Social Security skew our understanding of indigence and, for that matter, our understanding of family.
How would decisions differ if you, rather than Medicare, had to pay for your 85-year-old father's hip replacement? Would you mortgage your home or business to pay for the surgery, or move into a smaller home? Would you sacrifice your child's college fund to keep a vegetative parent on a heart-lung machine for weeks or months? Some people really face these choices every day; others don't have to think twice, because someone else is footing the bill.
What level of care must society provide? Should we spend millions to treat small numbers of people with rare diseases? Should society subsidize medical treatments for individuals who have not taken care of themselves? Is universal coverage a government bailout for voluntary diabetics and other negligent consumers of processed foods? Is there some constitutional right of irresponsibility that demands government resources to compensate for all of our bad habits?
Do these questions sound cruel? If our resources are finite, we indeed face cruel choices. Avoiding the questions does not make them go away.
16 to 20 percent of the nation's economy is devoted to healthcare, yet we're looking for more money to broaden coverage. Per person spending rises with age (after a brief dip for teenagers), according to the Kaiser Family Foundation's 2007 Health Care Costs Primer.
Are society's limited resources better spent on the elderly or on children? With infinite resources, the answer is simple - we would want to spend on both. With finite resources, we must choose. So far, the balance of resources leans toward the elderly. Is this the correct choice? If we value our children, why do they get so little of society's financial resources? Are we rushing to spend money on the elderly rather than children simply because the elderly can vote?
I don't think we should debate how we're going to pay for something before we have adequately discussed what we are buying. And that will require a harder look not at healthcare, but at health.
For example, in the cost debate, we vilify insurers, hospitals, and the AMA. In the cause debate, we might vilify McDonald's; Budweiser, Marlboro, Coca-Cola and that wimpiest of federal agencies, the Food and Drug Administration, which, in its support for highly processed food products, apparently cannot distinguish between food and drugs.
Real Food advocates, like Michael Pollan, Nancy Deville, and the Orfalea Foundation's own Kate Adamick, make a good case that Madison Avenue and the processed food industry have poisoned many of America's children, and now we expect our neighbors to pay for the poisoned children's healthcare. How much would an investment in real food for school children reduce our future healthcare costs? We won't find out if we spend all our money treating obesity rather than preventing it.
Finally, how much do American attitudes toward death influence the discussion?
The July 9 New York Times featured a story called Sisters Face Death with Dignity and Reverence, about a convent that has turned into a retirement home and hospice center for aging nuns. Their story offers useful perspectives on aging, living well in one's final years, and facing death for what it is. "On average, one sister dies each month, right here, not in the hospital, because few choose aggressive medical intervention at the end of life, although they are welcome to it if they want. ‘We approach our living and dying in the same way, with discernment,' said Sister Mary Lou Mitchell, the congregation president."
Can we approach society's healthcare challenges with discernment? A Facebook group called "I want to punch slow walking people in the back of the head" boasts over 1.3 million members. Over 1.6 million people applied for Michael Jackson memorial tickets. How many people are asking whether our national fear of death is robbing future generations of their lives?
Comments
Mohamed wrote on 07/24/09 8:14 AM
Great macro topic. I grew up as a child in the UK and but for nationalized health care, I don't think I would be where I am today. I was diagnosed with a serious disorder and I needed a lot of medical attention around age 6. My mother did not have any money nor the means to get me to the appropriate medical facility. I think that if my situation where to have been in America today, I would have definitely suffered more than I did then. This is because I think that so long as medical providers are connected at the hip to a major profit motive, the care side will always be tarnished with that hue of green. Yes, big business in this country and around the world has benefited by selling poisonous burgers and fries to many of society's children, but I don't think the debate should be focused on that aspect of health care just yet. That subject is equally important and I think deserves its own venue. A venue that focuses on whether companies should be required to offer balanced menus that offers healthier foods. Anyhow, this is just my 2 cents.
Mohamed Hussein
Sign4Hire.com
Harold Gaskill wrote on 08/16/09 8:14 AM
"If our resources are finite, we indeed face cruel choices."
As a professor for a medical school in the 80's I would teach my students that they had an obligation to use resources efficiently and not waste them. It is very easy for doctors to order extremely expensive and resource-consuming tests that are completely unnecessary.
"On the other hand, we live in a society that has spent more than a billion dollars on Teenage Mutant Ninja Turtle toys. As long as we can afford to do that you should never compromise the life of another human being in the interest of economy."
I believe that is even more true today. Our elected officials delegate vast sums of money to private financial enterprises in the blink of an eye with little debate or accountability. The numbers are so large that the average person has no idea what they mean. How many people realize that the bailout of the AIG insurance company alone cost more than the total cost of America's program to land a man on the moon in the sixties even allowing for inflation?
This country can provide medical care for everyone that is so good that there are no cruel choices. The most expensive care is already paid for now one way or another. Huge savings from increased efficiency of delivery and management are everywhere.
My concern is that our current political process cannot find the way there from where we are now.
Curtis Suda wrote on 09/24/09 11:02 PM
No doubt healthcare is a very pressing and daunting issue today. In many ways, our current political process--along with the special interests--is keeping Americans from facing the reality of their unhealthy eating and unsustainable spending habits. Until we collectively realize that things will never change without bold action on an individual level, the rest of us will be stuck footing the bill of all the health-related issues of the overweight and obese. People need to be held accountable for their own actions and those that affect the rest of society through our tax dollars. Just like education is an investment for a better future, money could be better spent on public health, beginning with our public schools system by eliminating sodas and candy from vending machines and encouraging physical education on a daily basis. To be successful, more attention should be spent on the needs of the student, rather than an overwhelming emphasis on test performance. Teaching nutrition and fitness to the people, both young and old, should be the top priority of the government's plan, even if it can't agree on the financials.
Laura Cimarelli wrote on 10/04/09 8:47 PM
A universal health care bill will never be passed unless the answers to the uncomfortable questions mentioned above are addressed. To deal with the issue of health care, I believe the only fair solution is to instill an insurance program similar to drivers’ insurance. Every person should be legally required to have health insurance, whether it be from the government or private companies. Those who live a healthier lifestyle should receive discounts, much like the “good student” or “good driver” discounts, yet those with preexisting conditions should not receive penalties. Those who take care of their health should not bare the financial responsibility to treat those who do not live healthy lifestyles. Just as reckless drivers pay high car insurance premiums, those who develop conditions resulting from unhealthy habits should pay higher health insurance premiums. The only way to deter bad habits is to make people accountable for them and create incentives for change. By offering discounts to those who engage in behaviors that will positively impact their health, it will cause more people to adopt a healthier lifestyle. Therefore, a universal healthcare system assures that all citizens will have health insurance, but makes each individual responsible for their lifestyle.
Mike wrote on 11/18/09 5:05 AM
If you think McDonalds is causing childhood obesity, your in la la land. Open your eyes to the real world out there.
Carli Tippett wrote on 02/12/10 9:46 PM
The commentors have raised many substantive issues. However, I believe that universal health care like universal education must be approached from a totally fresh perspective. It's true that our current way of "doing the business of life" in this country has relieved many of the responsibility for choices made. Even when an individual wants to take control of an issue, there are too often various hierarchies mired in the "things aren't done that way" mentality.
Fast food has become a way of eating of necessity--the consumer has either no time, no skill or no kitchen. Teachers do their best but are hampered by regulation, pc fears, multiple languages, unprepared students and low self-esteem. Doctors face lawyers and unreasonable expectations on many fronts.
Holding those who make the decisions to the same standards and subject to the rules they make is a first step.
ritchan wrote on 07/21/09 9:31 AM
You may ask questions now, but when the time comes when you can't budge from your rocking chair and your children decide on their own what they shall do, simply because society dictates so, you'll change your tune. An old man's opinion suddenly, unexpectedly disregarded by the younger ones, begets a feeling of unappreciation.
So, ask away. Nobody will dare to answer.