Friday, August 14, 2009

Child is Father of the Man

The August 14, 2009 Wall Street Journal editorial “Obama’s Senior Moment” suggests older sick people may be denied care based on their life expectancy. The author appropriately cautions against European style QALYs (Quality Adjusted Life Year) as our yardstick to measure who should live and who should die. The vocal seniors at the town meetings may have it right.

The life expectancy of most premature infants born with hyaline membrane disease (premature infant respiratory distress syndrome) in the early 1960s was less than a week. During this short time, many unfortunate prematurely born newborns were placed in a covered crib (Isolette) and treated with a mixture of oxygen and moisture until they completed their course of illness. Statistically most died and a few survived. Applying QALYs to these children would have prevented the successful evolution of clinical treatment for this condition because the clinical experience was essential to evolve modern day care for this now treatable condition. It is true that if QALYs were used as a tool for managing costs many millions of dollars, over many years would have not been spent. However, not only would we most likely have wound up in the same quagmire we find ourselves today, we would be worse off as a society. We would have lost contributions from newborns whose lives would never have existed and we would have not benefited from technologies that were developed in learning about infant care that subsequently applied to a wide range of infant and adult health care.

Now faced with the same end of life dilemma in adults with many medical conditions, we are led to believe that in order to “survive” financially we must sacrifice our culture of learning and continued enhancement of life’s quality. Quality now will be defined by fiat from the State budgeting process and as the authors point out can ruthlessly prevent advancement of knowledge and compassion for families. As a result compassionate decisions about health are now going to be removed from the hands of doctors and patients and placed in the Dispassionate hands of government. This is not health reform, it is budgeting.

Now here is the irony. There is most likely enough money in the current medical system not only to cover end of life care but also all catastrophic care. As a society we choose to spend our resources frivolously when our bodies feel well by not identifying medical conditions early and by not complying to known high quality health standards for chronic medical conditions. People and their physicians together abdicate their health responsibilities every day and perpetuate growth of our national financial shortfall for health care. Creating demand for treatment of avoidable disease threatens to deprive all of us of continued access to care.

Until our national dialogue on budget shifts to a dialogue about health quality with good data to focus the discussion, we all remain at risk for ill fated legislation that will guarantee ill fated health care. When it comes to immortality, Wordsworth had it right!

The Health Gadfly

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