RURAL ROUTES/Margot Ford McMillen

Who Chooses Who Gets Cured?

Pop quiz: You pull a muscle while working in the garden. In great pain, you call the following person: A) Your doctor; B) Your masseuse; C) Your chiropractor; D) Your faith healer.

While my doctor won’t agree, all four of those choices are perfectly legitimate to some perfectly nice and intelligent people. And if we think it’s hard to figure how to pay for the health care system, we ain’t seen nothing yet. When it comes to health care, personal choice must trump all the other issues.

But new treatments are increasingly expensive. Even something as simple as a healthy woman having a baby now calls for ultrasound tests every month followed by doctor appointments and vitamin pills. Those precautions are reasons that health care has gotten so expensive.

And what about mental health treatments? This is an area where medications are working miracles, but the medications are expensive and need continuous monitoring because of the devastating side effects. How do we decide who gets what, or if anyone gets anything?

And, there are standard procedures that perfectly nice and intelligent folks question. Vaccinations, x-rays, blood transfusions. Many new moms want to have their babies at home rather than in a hospital. Many people would rather use acupuncture, herbal treatments or massage for sore muscles rather than seeing a doctor that might prescribe unnecessary medications.

Last week, I had a life lesson I’ve been lucky enough to, mostly, avoid. Within a few days, three dear friends came down with life-changing health conditions. One had an accident that cut him to the bone, and the sight of that white bone surrounded by bloody muscle is one I’ll never forget. Another dear friend, with a 12% chance that a cancer might re-occur, chose to risk side effects ranging from temporary hair loss to permanent forgetfulness by taking months of chemo. And an elderly friend inexplicably stopped eating.

And what I learned is that, when loved ones are ill, we onlookers will wish for anything. If a flight on the space shuttle would have fixed my friend, I’d have wanted it available.

And then, when my friends and their caregivers decided how to handle their conditions, their decisions were nothing like mine would have been, but financial considerations were part of the picture in each case.

Health-care costs have been blamed for forcing employers to outsource jobs and to lose better employees. It has forced other employers to get by with contract workers. The news pages are full of stories about companies that can’t afford insurance because they hire older workers or paying huge premiums because workers have pre-existing conditions. Employers are going from one insurance company to another, finding out that coverage is, say, $12,000 per month for five people.

Today’s proposals for health care reform only focus on how to standardize finances. Instead of thinking about how treatments are covered, they focus on how employers are covered. For example, one proposal excludes small businesses from being required to provide insurance. Another allows small businesses to join co-operatives for their insurance. But none of the proposals tackle the larger issue of how we choose treatments and whether that choice will be up to us or up to insurers.

For many years, the TV news has shown several minutes of medical news every night. These “medical minutes” were filmed at unnamed hospitals in undisclosed locations, but often the local station would edit in the voice and even the image of the local news anchor. For the news room, this was a fairly easy filler, pre-filmed and interesting. For the viewer, it seemed like the medical miracles were unfolding at a nearby location.

Fancy prosthetics, cures for cancer, diabetes and depression, treatments for ailments of the eyes, ears, noses and throats all seemed within easy reach. The medical minutes touted organ transplants, one-on-one therapy with caring physicians, and new diagnostics with nary a mention of cost. It seemed, watching these, that we could be vaccinated to prevent anything, and if we got it we could be cured.

Our expectations are unrealistic, and, indeed, society cannot pay for all of us to be cured of everything.

All three of my friends are, in fact, getting better, and I would have to say that their recoveries are partly due to the faith they have in their providers. One worry is that, under universal health care, treatments will be standardized and they won’t be able to choose between A, B, C, and D. It is likely that standardization will be set by committees listening to lobbyists for various medical treatments.

We need to begin the debate immediately and on a national level. As much as we need to figure out coverage, we need to talk about what’s reasonable and what’s possible and what is the difference between the two. The how-to-pay questions are hard, but the nation needs to talk about what treatments the insurance will pay for. Will we teach people with diabetes to take insulin or to change their diet? Will we pay for organ transplants for old folks and babies alike? Will we keep people alive on respirators for years on end?

These are hard questions to answer and the answers won’t be acceptable to all of us, but we will have to make decisions based on age and general health. We can’t do it all. Let the debate begin.

Margot Ford McMillen farms and teaches English at a college in Fulton, Mo. Email:

From The Progressive Populist, August 15, 2009

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