Health Care For All?
Another thoughtful editorial in this week's New England Journal of Medicine.
Clearly this is becoming a hotter topic in the medical journals.
I do not have comments at this time, but would be interested in comments from lay readers.
Check it out here.
7 comments:
My personal opinion is that the health of the citizens should be a public matter, not a business left to private companies. In the US is it possible to have patient who needs a transplant but doesn't have the money to pay it?
Rewards for people who keep in shape would be a real revolution in primary prevention of diseases.
For all practical purposes, it is next to impossible for uninsured or under-insured patients to have stem cell transplants, though we have done it on occasion.
The costs of stem cell collection, processing, and support through the post-transplant period are hard for hospitals and other providers to absorb.
I see the cost problem but I think that the state should pay for every treatment that is evidence based proved to be effective (in this case life saving).
In other words people in your country just die because they don't have the money! It's not their fault if they happened to get a lymphoma/leukemia, maybe even an aggressive histotype. This is really tragic and astonishing. Do you think after these elections policies will change?
Implied in your response is the recognition that some sort of rationing is necessary.
One way to ration care is through cost, and that's the way it is over here right now. Rationing along the lines you suggest -- allowing only evidence-based treatments -- may be preferable, though still problematic.
People will still die, but it will be because treatment is denied due to lack of scientific proof, not lack of money. But what about all those nebulous and uncertain factors that don't fit the clinical trials? It's a problem, too.
I don't see an easy fix. I expect the US will develop a national health care system. The elections probably won't change that fact. They may only decide how fast it happens.
Choosing from all the evidence-based therapies, maybe a start could be that the state could/should make an effort to pay at least for the life saving ones, such as bone marrow transplant.
Well, if the state starts paying for transplants, the next issue will be, "Do they pay enough?"
As I have written about here before, government payments are often below acquisition and overhead costs.
So it would be interesting to see whether transplants would actually increase or decrease in frequency.
I think the NEJM article makes some interesting points. But I think a bigger factor than the loss of the "shared sacrifice/shared care" mentality of World War II is simply that government is strapped for cash. That, and the individualism of Americans who want choices such as they are used to, will lead to the creation of a hybrid public/private system. I do think the author may be accurate in his conclusion, that government is not "a guarantor of easy living irrespective of striving but an insurer of basic decency when self-reliance fails."
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