I’ve just finished reading a litany of responses and a recent post by the Happy Hospitalist, and I want to take a crack at some of the points Happy makes.
The argument/discussion starts when a blogger asks “when it was OK not to take care of patients because of conscience.”
Nurse K’s, who has been around for a while and clearly knows her stuff responds, “maybe we should take care of sick people no matter how they got that way?”
Exactly! OK, reading on…
Happy, on the other hand, argues that it is unrealistic and generally Utopian idea for US health care to take care of everyone. He argues that the concept of free health care, based on the Medicare model, is a sham due to the medical necessity.
Happy argues that Medicare is thus a failing system that is easy to abuse and is costing the US enormous amounts.
“I could make a healthy 65 year old with no medical problems get any test in the world by playing the “medical necessity” documentation game,” posts Happy.
The big decider then between who will be treated and who will not be treated in the US comes down to what things seem to always comes down to…money. Happy essential argues that it is impossible to treat everyone now or indefinitely because there simply isn’t enough money in the system.
After all, argues Happy, why should people be expected to pay for those who choose to do things that harm their own health (smoking, drinking etc.)? And, if the US tries to take care of those people, then there will be no money left for those who may really need the care when the time comes.
The rather dark result of Happy’s argument is that those who take care of themselves deserve care and those who don’t…well don’t, especially since the ones who presumably don’t are the ones who cost so much.
Canada has universal health care that takes care of all of its citizens. Although by no means a perfect system (we do a lot of victim blaming here too), Canada will still care for the COPD patient in room 2 who smoked a pack a day free of charge. Why? Because we all pay into and most of us believe in, a socially supported health system. Still, the financial weight is heavy and the temptation of a privatized and individualistic health system is always present but, ultimately, a failed perspective. Why you ask? Because a health system should be focused on care for all and not just on those who can afford it.
I think that one of the problems in the US then is this incredible focus on individualism. I won’t go into the history, but there are many reasons for American individualism. Still, I think it is also part of why their health system struggles.
Happy posts, “I could care less if someone smokes and drinks themselves to death. It’s their body. Do as they please. Just don’t make me pay for it through my insurance premiums or my Medicare taxes.”
But is it only the individual who is the only culprit here? What about the alcohol companies? What about the cigarette companies? Also, what about context? Why did that person drink themselves to death? What are the reasons beyond individual choice? Is it so black and white?
People don’t live in a bubble. We are all interconnected with and are constantly changing within our environment. Individual choice is a factor but there are also a web of others that influence a person’s life whether we like to acknowledge it or not. So context is the true reality here….
Joe lost his job because of the current economy, became depressed, has a family history of alcoholism. He drinks until he develops cirrhosis. He can’t afford proper health care. Should we, as a society, still treat him for his chronic and costly health problems as a result of his cirrhosis? After all, wasn’t it he who put the bottle to mouth? What if Joe was your brother/uncle/Dad? Would that change your perspective?
My point is, making the all mighty dollar your decision maker above human life and well being is where the system will ultimately fail. That, along with victim blaming for the system’s woes, are generally misguided principles.
The status of one person’s pocket book should not have more value than another’s life, no matter the perceived context.
