Tuesday, November 24, 2009
Doctors would jab sharp instruments into King Henry VIII's arm and drain blood out of his body. The best medical minds of the 16th century prescribed bloodletting as a means to "rebalance the body's humors," the spring equinox being the ideal time. Henry didn't argue with his physicians. After all, Tudor England had the best health care system in the world.
Later doctors told later kings that bleeding was of no medical benefit. The kings did not thunder: "Off with your head. My health care will not be rationed." They said: "Great. I hated that."
But they were not stuck in America's health care debate, where foes of reform greet any effort to curb unnecessary treatments with hysterical rants about "rationing." Any real conservative would regard the enormous wasteful spending in American medicine as a wonderful opportunity to save money without undermining quality of care.
Every society must engage in difficult discussions on what insurers, be they private or government, should pay for. Arguments over very expensive drugs that extend lives only a few weeks or organ transplants with little chance of success are tough, but they are valid. Americans, however, can't even get a sane conversation going about procedures that do nothing or even cause more harm than good.
The underlying issue isn't what treatments one may have. You can buy as much health care as you want with your own money. The issue is what the taxpayers will cover.
"60 Minutes" had an eye-popping segment on what Medicare spends on patients in their final two months -- $50 billion last year -- and where the money goes. Up to 20 percent of these patients ended their lives hooked up to machines in noisy intensive care units. One woman complained that her dying mother was visited by 25 specialists who gave her dozens of tests, including a pap smear for cervical cancer, a slow-growing disease.
Like that daughter, many of us wouldn't want this invasive medical care for someone we love, even it were free. But it's not free. The taxpayers are bearing these costs, which left unchecked, will bankrupt America.
Remember the moronic "death panel" circus? Phony conservatives so vilified the sensible idea of having Medicare cover advance-care planning consultations between doctors and patients that it had to be ripped out of the legislation. Their twisted logic amounted to this: Taxpayers should be forced to pay for medical tortures that dying people never wanted.
Even healthy 25-year-olds should do advance-care planning in the event that disease or an accident leaves them unable to make medical decisions. That means having a "living will" and naming someone to make medical calls on their behalf.
A government task force recently released a study indicating that the number of mammograms now being prescribed hurts more than helps most women. Cost was not a consideration. But the demagogues re-emerged, accusing government of denying women potentially lifesaving tests to cut costs and of telling physicians what to do.
All the task force did was supply data that might lead some doctors to order fewer mammograms for the benefit of those patients at low risk of breast cancer. Medicare continues to pay for annual mammograms, and any woman who wants more breast x-rays than an insurer will cover can open her own wallet.
The bottom line for reform's enemies is not patients' health and certainly not the taxpayers. For them, the only bottom line that counts clearly belongs to the economic interests feasting on the status quo.
Had Henry VIII learned that he had been bled only because the court physician wanted more business, a lot more blood would have flowed than his.
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