This Week's Clue: Health or Medicine?

Following is the essay you can designate as Volume 10, Number 37  of This Week's Clue, based on the e-mail newsletter I have produced since March, 1997. It would be the issue of September 17.

Enjoy.

---

Recently I began blogging a new healthcare beat over at ZDNet.

I'm certain their idea was to bring in some advertisers who work in medical IT. I also assumed I would be writing most of my stories about technology -- about topics like electronic medical records and medical gadgets.

Instead I'm often blogging basic questions of human liberty.

For most people it's up to us how long we live, and in what condition. If you don't smoke, cut your drinking, exercise, live out in the country away from pollution, and avoid stress then chances are you'll blow by 80 without needing much attention. If you don't you won't.

This is not true for all people. My friend Martin Bayne is blameless for his Parkinson's Disease, from which he has now suffered for 11 years, the last few in nursing care.  Kids with bad hearts, or cancer, are blameless in their diseases.

And it turns out this is why kids and blameless celebrities are rushed to the front by the medical community. They're propaganda. And they're being used in the same way General Petraeus is being used by George W. Bush -- to keep support high and the money flowing.

Does that sound cynical? For those who work in medicine and deal with the bills, it's  a common attitude.

From both left and right, we hear this regularly. If we separate health from medicine, we can cut what we spend in half, without changing the outcome.  Michael Moore says it using the example of Cuba, which puts its money into prevention and has its people living as long as Americans. But Robin Hansen of George Mason University says the same thing, using studies in from the RAND Corp.

Both men are pushing completely different agendas. Moore wants guaranteed check-ups, and early treatment which can save lives. Hansen wants to eliminate Medicare and private health insurance, forcing people to bear the burdens themselves.

But as you see from the picture to the left, Moore's own appearance can undermine his argument. When he gets the stroke which is the price of his obesity, should the public pay for his care? Or watch him die?

Sometimes this is even noted in medical shows, like in a recent re-run of Scrubs I saw. One of lead actor Zack Braff's omniscient narrations casually noted that most people who come into Sacred Heart Hospital die. This was said in the context of the toll it takes on doctors. Don't get too emotionally close to the patients.

It's true. Most of your lifetime medical costs will be spent in your last year or two of life, probably to give you a rather horrible quality of life. I have a relative right now who is facing this. He's depressed. Some say suicidal. But is he irrational?

Choice. Freedom. Ethics. These are the real questions which drive our nation's health care budget. But they are not the questions which drive the debate.

How much should we restrict human freedom, and economic subsidy, in the name of cost?

• Can you be forced by law to get a checkup?
• Should smoking be made illegal? How about obesity?
• Should we let fat smokers die when they get sick?
• When should my relative's call to end his costly care be heard, and followed?
• Should Mickey Mantle have gotten that second liver?
• How much extraordinary medical care should the poor get?
• If Dick Cheney wants a new heart and lungs, as I write in The Duke of Oil, should he get them?

Anyone who seeks to deal seriously with these questions sets themselves up for ridicule, as John Edwards did when he proposed mandatory check-ups. His proposal represents a slippery slope conservatives don't want to consider walking down. Once you mandate the check-up, do the doctor's recommendations take on the force of law? Should they determine whether public money is spent on extraordinary care?

Tough questions. Made tougher by his wife's own medical condition. If Elizabeth Edwards were poor, when would our public medical system tell her to die?

This is among the questions posed by people like Mr. Hansen which quickly become just as tough as those he ridicules from Moore and Edwards. Should wealth determine your lifespan? Should doctors toss their Hippocratic Oath and simply refuse care to those who can't afford it? Should the free market be extended so that the rich can buy the poor for their organs?

These are all real-world questions. The horrors of the rich sucking-up the living tissue of poor people to extend their own lives, so beloved of 19th century horror writers, is reality in the private hospitals of Asia. You don't think that Mr. Cheney could get a new heart and lungs if he lived in Dubai? You think anyone would seriously ask how the donor died?

Basic questions. Life or death questions. Which become funding questions, and technology questions. These questions are not really being approached in the present health care debate, and likely won't be, because they make voters squeamish. Yet they're faced every day by people on the front lines, by doctors and nurses and hospital administrators.

Do we concentrate on health or medicine? Where are the limits? Someday these questions will matter to you. They will be matters of life and death.

Will we have answers then? Or will you, as Americans do so often, simply live to the end of your fortune?