Commentary: Health care, finite resources and endless problems

The Myrtle Beach SunApril 1, 2012 

The biggest story in the health care debate this week had nothing to do with three days of historic debate at the Supreme Court and everything to do with the failing heart of a 71-year-old man whose fans believe is an American hero and detractors think is Darth Vader, sans the personality.

Former vice president Dick Cheney received a new heart this past weekend in a Northern Virginia hospital.

He had survived five heart attacks and had been living with a left ventricular assist device while waiting on the transplant list for the past 20 months.

Because of Cheney’s age and well-documented heart problems, questions have been raised about who should be given priority for organ donations.

“I wish him well,” cardiologist Eric Topol told USA Today. Topol was a Cheney health consultant. “We have a profound shortage of hearts for transplantation. … It’s not that he shouldn’t get a transplant; it’s a question of ‘Who didn’t get one?’”

That question goes to the heart of the debate over health care reform – even though the experts questioned said the vice president received no special treatment, his wait was a bit longer than usual and the International Society for Heart and Lung Transplantation has said it is OK for selected patients over the age of 70 to receive transplants as long as they meet a variety of criteria.

But the health care questions remain. Who should get what, how much and who should pay the bill?

Should a CEO receive priority over a janitor? An unhealthy 35-year-old over a healthy 75-year-old? A non-smoker over a red meat eater?

Health care isn’t always a zero-sum game, though.

More of us can receive top quality care if we more deliberately determine how we divvy up our resources, which is what the Affordable Care Act is designed to do. Yet, despite the vast riches of the United States, health resources in this country are finite, including hearts and other organs for transplants, and there’s only so much money and so many primary care physicians and specialists and hospital beds.

Because of that reality, hard choices have to be made, but they can become more bearable if we first made smarter ones.

We’ve made making smarter choices harder because we so frequently refuse to acknowledge that reality that no matter the reform we choose – or none at all – somebody, somewhere has to decide which surgeries make the most sense to finance, which procedures should not be green-lighted even if they might save 1 person out of 1,000, and when we need to switch to making a person as comfortable as possible instead of trying to go all out to keep the heart beating long after it is clear the person will not recover except for a miracle.

But talk about this subject in mixed political company and the image of death panels are quickly tossed about.

And that’s why we’ve spent so much time and energy debating the individual mandate and just how much government should be involved, because those are easier topics. We can stake out a theoretical position and hammer it home until the cows come home.

But it’s not as easy when trying to weigh real-world medical conditions and considering this other fact: The bulk of Medicare costs are incurred during the final year of recipients’ lives, a lot of it has been found to have been ineffective – and those rising costs represent the top threat to the country’s long-term fiscal health.

We are caught in a web of trying to decide how best to dole out finite resources to handle an endless array of medical conditions, overlaid by overpowering faith beliefs that suggest doing anything less than everything – in hopes of manufacturing that elusive miracle – is a profound disrespect for life itself.

No matter what the Supreme Court decides about the Affordable Care Act, we have to have more mature discussions about that conundrum.

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