Tuesday, August 18, 2009

Health Care: Who Decides What Is "Fair"?

It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. —President Barack Obama in a New York Times interview on how costly medical decisions should be made.

The people behind the long table do not know what they've become. The drug of power has been sugared over in their mouths with a flavoring of righteousness. Someone has to make these decisions, they tell their friends at dinner parties. It's all very difficult for us. But you can see it in their eyes: It isn't really difficult at all. It feels good to them to be the ones who decide.

"Well, we have your doctor's recommendation," says the chairwoman in a friendly tone. She peers over the top of her glasses as she pages through your file.

You have to clear your throat before you can answer. "He says the operation is my only chance."

"But not really very much of a chance, is it?" she says sympathetically. Over time, she's become expert at sounding sympathetic.

"Seventy percent!" you object.

"Seventy percent chance of survival for five years—five years at the outside—and even that only amounts to about 18 months in QALYs: quality-adjusted life years."

"But without this procedure, I'll be dead before Christmas."

Andrew Klavin: What death by bureaucratic fiat might look like.

When resources are limited, choices must be made. The debate over health care reform centers over who should make those choices.

The difference between cancer survival rates in the US and Canada aren't the result of poorly trained doctors in Canada. No one would suggest that Canadian doctors are less professional or less caring. In Canada, limited medical dollars must be allocated where they can do the greatest good. In the US, those decisions are made by individuals and families involved.

Klavin points out that for those in favor of a government takeover of health care the mantra is "fairness." Like it or not, we are not a country built on "fairness." We are risk takers and individualists. We still be believe that each of us controls our own destiny. Government control form stifles individual initiative.

In a system built on individuality there will be winners and losers. Under a government system there are winners and losers as well. Who would you rather trust with your fate, yourself or a bureaucrat?

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