Arguing against the old

Polemical, to be sure, but an interesting set of questions in Richard Dooling's NYT op-ed:

With so much evidence of wasteful and even harmful treatment, shouldn’t we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers? Sadly, we are very far from this goal. A cynic would argue that this can’t happen because children can’t vote (even if their parents can), whereas members of AARP and the American Medical Association not only vote but can also hire lobbyists to keep the money flowing.

One thing’s for sure: Our health care system has failed. Generational spending wars loom on the horizon. Rationing of health care is imminent. But given the political inertia, we could soon find ourselves in a triage situation in which there is no time or money to create medical-review boards to ponder cost-containment issues or rationing schemes. We’ll be forced to implement quick-and-dirty rules based on something simple, sensible and easily verifiable. Like age. As in: No federal funds to be spent on intensive-care medicine for anyone over 85.

I am not, of course, talking about euthanasia. I’m just wondering why the nation continues incurring enormous debt to pay for bypass surgery and titanium-knee replacements for octogenarians and nonagenarians, when for just a small fraction of those costs we could provide children with preventive health care and nutrition. Eight million children have no health insurance, but their parents pay 3 percent of their salaries to Medicare to make sure that seniors get the very best money can buy in prescription drugs for everything from restless leg syndrome to erectile dysfunction, scooters and end-of-life intensive care. (emphasis added)
What does it say about a society in which medical care for the elderly is prioritized over basic care for children? I am, of course, being wildly reductive. The problem with even using a phrase like "medical care" is that it's sufficiently broad to be absolutely useless. It sounds good (and polemical!) but it elides the distinction between life-saving care and quality-of-life care (though some might argue that there's no firm distinction there either). But just speculating briefly: One of the many things floating around in my head right now is wondering at what people mean when they say that health care is a right.

At first blush, I'm inclined to agree. I think that arguing for or against health coverage on the basis of a cost/benefit analysis traps you into an econometric way of thinking that's ultimately reductive of human experience. At the same time, if we're going to talk about "health care" as a "human right", then we need to figure out what precisely "health care" refers to. Is LASIK health care? Is dialysis? Is a knee operation? Is bypass surgery? Is birth control? What does it mean to be healthy?

At its root, that question might come down to a question of how we frame what is (or is not) considered "human". If the "human" is some "natural" thing, then plastic surgery might not be an example of care that makes you healthy. But if the "human" is some potentially perfectable idea, then something like LASIK might well be a fundamental part of something that we think of as "health care".


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