Rights and limits
Thursday, October 30 2008
DrRich thinks conservatives shouldn’t sweat Senator Obama’s belief that health care is a right, because it will force us to ask: “exactly how much healthcare are you entitled to if you have a right to healthcare?” Fair enough – except that he argues this will result in an “extremely painful” debate that will “traumatize our social structure”. The reader is forgiven for any suspicion that DrRich is arguing against Senator Obama by reductio ad absurdum.
The crux of the problem, per Dr. Rich, is that:
In America we believe that it is wrong to limit healthcare in any way, that everyone is entitled to the very best healthcare, that any bit of healthcare that offers even a small potential of benefit should be provided [....]
I’m sure that’s what it looks like from the good doctor’s (imaginary) throne, but not from down here in the weeds. What I see is patients railing against the arbitrary cruelty of a system bereft of any coherent criteria by which to impose those limits. This means I happen to agree to some extent with Dr. Rich’s point about covert rationing:
…our entire healthcare system, from all three branches of the government, to health insurance companies, to hospitals, to doctors, to individual Americans (at least when they themselves are not actively patients), are fully and extravagantly and enthusiastically engaged in covert rationing.
A lot of what he calls covert rationing is in fact very overt denial of care, and the reason it happens isn’t some underlying fantasy of unlimited health. Instead, it’s because our system is entirely irrational; the similarity between “irrational” and “ration” is no coincidence. The system is designed in such a way as to resist any rational guidance or intervention, especially explicit rationing. This isn’t the product of selfish patients, but instead the interests of the people who actually profit from near-limitless health care spending. Those same people are behind the overt denial of care that Dr. Rich mistakes for covert rationing.
When a patient is told that something isn’t available – a procedure, a drug, whatever – there’s often no rational explanation behind that. “It isn’t covered” isn’t a statement of principle, it’s a statement of the plainly obvious. The fact that patients rebel against this kind of decision isn’t evidence that they want unlimited health; it’s evidence that they want a fair and reasonable rationale behind that decision.
Dr. Rich doesn’t get this because he doesn’t get his patients. He assumes they must be too stupid to appreciate their circumstances. Look at how he frames the question: “how much healthcare are you entitled to…?” Once again we have a “Dr” talking down to his patients, entirely convinced that they lack any capacity for reason. He’s failed at the basic empathy necessary for successful discourse (and, I would argue, medicine).
I suspect that most people – especially the chronically ill – accept the premise that there has to be some kind of limit on health care. But we want limits that are clearly and reasonably justified, and subject to public debate. Dr. Rich welcomes that debate the way John Hagee supports Israel – that is, disingenuously – because he grossly misunderstands the people he serves. I welcome it, because I honestly think we’ll be glad to have that conversation at last.
Yes, there will be energetic debate over what a right to health care means in light of the need to impose limits. Americans will argue over what rationale should inform that care, but the fact is that any rationale is better than our current system of no rationale whatsoever. So as trying as that debate might be, whatever result comes will be better than what we have now. And instead of traumatic, that debate will likely be cathartic – what a relief it will be to finally have a system that makes sense to someone.
Update: Maggie Mahar buys into Dr. Rich’s argument. Sure, some Americans may well think they can live forever, but we all know they’re idiots. On the other hand, people with chronic illnesses – those who account for 75% of health care spending – tend to have a hard-won appreciation for their own mortality. “Fear death”? Not even a little, and more than once I’ve prayed for it. The median life expectancy for someone diagnosed with Crohn’s at 17 is around 58 years, so I still have a while. But until that glorious day, I want exactly what Maggie says I should want: “higher quality of life”. That doesn’t mean unlimited care – just care that makes sense and doesn’t keep me from living a meaningful life. We’re nowhere near that at present.
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