Health Care and Genetics: Multiplying Paradigms
White, Stephen W., National Forum
In his 1985 book MegaTraumas, Richard D. Lamm, former governor of Colorado, imagines the following scenario:
It is the year 2000 and the new president of the United States is about to write her State of the Union message for delivery before Congress. On her desk are the frank and outspoken reports she has requested from her cabinet officers and agency heads; along with them are other memos, speeches, and excerpts. This is the raw material for her speech--and it makes up a fascinating and fearful account of how the United States got so badly off strategic course in the final two decades of the twentieth century.
The most disturbing document on the president's desk is entitled "A Speech by the Secretary of Health and Human Services to the Association for a Better New York, 15 February 2000," about the necessity for rationing health care--a proposal that has provoked a "firestorm of criticism."
The proposal to ration is driven by numerous forces. Hospitals have overbuilt; malpractice litigation is out of control (e.g., 100 percent of the obstetricians in Washington, D.C., in a given year were sued by patients); the practice of defensive medicine is spreading among doctors to avoid lawsuits; hospitals are purchasing high-tech equipment at alarming rates; facilities are duplicated many times over in the same town; more and more of the 37 million uninsured are using hospital emergency rooms, the most expensive way to deliver treatment for primary care; too many doctors are being trained; research is spawning new medical devices faster than the economy can financially assimilate them; greater access to health care for many had become a reality; and, to top it off, we have very few preventive health-care measures in place.
The statistics are dramatic and alarming. Health-care expenditures are rising three times as fast as the general inflation rate. Looking back from the year 2000, the secretary notes that in 1983, the United States was spending on health care "$355 billion dollars a year, approximately $1 billion a day, $40 million dollars an hour, $12,000 per second," so that health care was becoming the "Pac Man" of every household, business, state, and federal budget. The figures increased annually each and every year after 1983, trebling every ten years.
The secretary proceeded to get harsh: "The United States could not afford to entitle everyone to all the medical care that technology invented without" significantly traumatizing "other aspects of the economy." Specifically, in 1984 Chrysler Motors had to produce "70,000 cars just to pay its health-care costs." Then in a direct assault on specific aspects of an ailing health-care paradigm, one driven by consumer service demand rather than by health promotion, the secretary asks, "How many hearts should we give to the smoker? How many liver transplants can we afford to give to an alcoholic?" The secretary might also have asked, "How many drunk drivers will we allow to continue to maim, disable, or kill our fellow citizens who then require health care?" And the list of such questions could be multiplied ad infinitum.
Perceiving health care to be a potentially "public policy bottomless pit," the secretary proposes, as part of rationing, that we "not fund transplants, artificial organs, or extraordinary procedures for those over sixty-five." In 1993 our hope is that with the determination and sharp accounting scissors, policymakers will "fix" some of the problems that ail the current health-care system while expanding access. And the next issue of National Forum will be devoted to "Health Care and National Policy." We need to reduce the net amount of litigation, refrain from purchasing duplicative technology, and limit hospital stays. We may also want to institute price controls, establish stronger precertification requirements for in-hospital procedures, move more people to home health-care rolls, and limit access to procedures beyond a certain point. …