0617 - MedCare

A warning note, Readers: In the bosom of the OO Staff, to stimulate debate and thought, it is permitted to advance any proposition, whether shocking or not. In today’s column, we follow that practice. Do not be offended, we are thinking, an activity disfavored in political circles everywhere. We start by (1) examining the costs of the fancy medical procedures that careful doctors regularly perform, (2) totting up the annual costs of a list of prescription drugs, (3) totting up the costs for extreme medical attentions, then (4) asking whether there should be any personal responsibility for taking risks, and (5) asking if the very best medical care for everybody, all the time, is affordable, and, last (6) examining the hard market answers to questions (4) and (5). Do not be offended; think.

Ready? (1) The OO goes regularly to a fine and caring doctor here, and to a huge and highly advanced center in the States. The advanced center owns big complex machines, and specialized practitioners thereon: CAT scans, echocardiograms, carotid ultrasounds – the cutting and obviously expensive edge. What does that cost, out of pocket? Pennies – it’s paid by U.S Medicare. Net to the patient for $1200 of examinations, perhaps $11.43. (2) All these doctors prescribe a lot of fancy pills: the OO takes 21 a day. Annual cost, all paid personally, about $9,000. In short, the older U.S. Medicare patient now pays little for service, a lot for drugs.

(3) There are many super-expensive operations these days: open-heart surgery, stents, even transplants. In addition, doctors describe the great costs of the extreme end-of-life efforts now regularly practiced. How many years was the empty body of Terry Schiavo cared for, at great cost? At the very end of life, radical interventions are routine, massively costly, and normally unavailing.

And then (4), there are the medical costs caused by people putting themselves at risk. Smoking is proved dangerous, so does society have to bear treatment for the smoker? How about the race car driver? Must we all pay for his putting his body at risk? And then there is that most currently noted risk of obesity. A current Denny’s ad touts a breakfast of raisin french toast with syrup, bacon, sausage, eggs and a big scoop of butter. Obesity is bad, but over-eating, like smoking, is a matter of choice. Must everybody pay for the costs of self-indulgence? Of heavy drinking? How about recreational drug-taking?

(5) As medical science advances rapidly, so do the costs, and as people live longer, the costs run longer. The limit that society will pay for everybody’s ills is already here. It is plain to our Staff that, in fact, only the wealthy now get the best medical care. That’s hard, but it is obviously true.

So, (6) what are the answers? In Britain there is what a doctor friend calls the Harley Street answer: basic care for all, best expensive care for those that can pay. In Canada, we are told, you’re not allowed to pay. Canadians who can pay go to the States. We do not hear, though, of any system where those (like smokers) who put themselves at risk don’t get automatic Government support.

But what, we ask, about the true market solutions? Insurers, if allowed to do so, would charge those who take health risks higher health premiums. Isn’t that fair? Also, many of the fancy drugs have older and much cheaper siblings which yet work quite well. Perhaps, in a free society, people should be allowed to choose and pay for either basic or advanced care and treatment. And if you want to order extreme terminal measures, sorry, that will be extra. Fair? Ethical? Maybe.

Next time: FreeRanting [OO #618]

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