The value of a human life.

Our current American health care debate started out as an uncharacteristically top down mandate. The Chicago Group in the White House declared the need for urgent and radical reorganization of the medical industry in this country. Their take on this matter: a full blown crisis requires that America be admitted through the ER to the Intensive Care Unit and that immediate, life saving measures be instituted.
Probably planned well in advance, these decisions were made in the smoke-free halls of power by people who have waited their opportunity. And the electoral mandate for change NOS, not otherwise specified, has given them the biggest opportunity of their lifetimes. But what is this all about, really?

Well, for one thing, this is hyperbolic speech more than a health care crisis. If the problem with the system is that there are people in America without health insurance then let us add that not having health insurance does not equate not receiving medical attention. Anyone in crisis can present to any ER in this country--citizen or not, legally resident or not, old or young, and so forth and so on. The nurses and doctors in that ER cannot discriminate against anyone coming through the door, either. Black, white, or anything in between; with or without AIDS, insurance, mental disease, other disease, and irrespective of the person's "worth to society" the patient will receive care. And, bet on it, the care will be the same whether the patient pays or not. Lawyers make a good living showing that such was not the case and something bad happened as a result. So do not believe for a minute that large segments of the populace do not receive medical care. But maybe the crisis is not about the uninsured in America. Maybe it is about cost of care.

The costs of caring for three hundred million citizens are immense. Nuns used to administer hospitals and orderlies worked for Charles Dickens wages. Needles were sterilized and used again and again until they were too dull to penetrate skin. Doctors did their work with their hands and stethoscopes were major tools in diagnosis. Not so today. Pathologists and radiologists have splendid equipment and probe everything from the molecules in the specimen to the organs in the patient. People used to have exploratory surgery to establish what was causing their weight loss and abdominal pain. A patient would be opened and closed and told it was cancer of the pancreas with hepatic metastasis. Three months later the family would hold a funeral. Pancreatic cancer is seldom cured even today but it is never diagnosed by exploratory laparotomy these days. Extensive surgery against the backdrop of extensive cancer just speeds the patient on his or her way. Today things are handled differently and the introduction of more knowledge, better technology, more effective interventions, and a more open and honest society (that supports more than shuns the patient with AIDS, cancer, stroke . . .) has made the lot of the seriously ill patient better than ever before. All this comes at a cost. And the consumer has a choice of accepting or rejecting medical care.

Is the bottom line here the high cost of medical care or the high cost of illness? "It cost him his life." Disease was diagnosed late or incorrectly and "it cost him his life." Litigators would establish a value for the lost life and juries would deliberate as to the cost. And it would be high. I leave it to William James and Ludwig Wittgenstein to help out with what it is that we are paying all the money for. But this is philosophy not medicine. And philosophers eschew crises.

Let us discuss how America should improve what she already has. Let us hear a clear statement from the White House as to what the crisis is. Then let us hear from the special interest groups who are pushing the agenda. Americans will make a good decision if it is bottom up. Not so if it is top down.