U S Health Care Debate 2010

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No one in this world, so far as I know…has ever lost money by underestimating the intelligence of the great masses of the plain people[1].” — H. L. Mencken

The Hippocratic Oath commands that the physician consider his teacher’s family as his own; do no harm in treating patients; defer to specialists where surgery is concerned; abstain from sexual seduction of/by patients; and never divulge the secrets of the medical profession to the public.

Moses ben Maimon (The Rambam, 1137-1204) is credited with this oath:

“God above, before I begin my holy work, healing Your [human]  creation I lay my plea before You, that You will grant me the strength of spirit and the vast energy to do my work with faith, and that the aspiration to accumulate wealth will not blind my eyes from seeing… suffering (of) a human being, rich or poor, friend or foe, a good or evil … in his My love for the learning of medicine should only strengthen my spirit, only the truth shall be the light before my feet, for any weakness in my work might bring about death and illness to Your creation. I beg you, please, compassionate and gracious God, strengthen and focus my body and my soul and plant within me a spirit that is whole.”

Since 1948 physician oaths have been repeatedly revised adding more modern commandments, including:

  • Service to Humanity;
  • Respect for ”secrets” confided by patients;
  • Non-discrimination by age, disease, disability, creed, ethnicity, gender, nationality, political affiliation, race, sexual orientation, or social standing;
  • A carefully but vaguely defined ”respect” for human life; and
  • Not using medical knowledge to violate human rights or civil liberties, (whatever those terms may mean.)

In the U.S., new ethical maxims are often declared sacrosanct, such as:

Medical care is a human right, properly guaranteed by the state.

Any human life is priceless; so cost is irrelevant.

The problem created is then obvious; because if medical care is a right, it should be guaranteed by the state; yet no state can provide unlimited medical care (or anything else!)  to everyone. Therefore the inevitable necessity to limit medical care affects our national debate today.

Despite much noxious misinformation from conflicting powerful self-interested parties, the U.S. medical discourse will, I feel, ultimately be constructive, positive, and in a word, healthy. We are undergoing a transformative process forced upon us by technology. While technology offers limitless possibility[2], human limitations are inadequate to fulfill all our needs or expectations. Yet when has it been otherwise? That is the nature of life.

Our national conversation on health is made more honest, open, and productive the uncontrolled exchange of ideas and information on the internet. Bypassing the unavoidable bias the media, over time the public will, I believe, sort truth from half truth or lies, emotion from reason, and collectively reach the best common conclusion. This is why the free exchange of ideas is feared by power, and by government everywhere, even here. That is why so many governments attempt to restrict, or control the internet as do China, Russia, Iran, Venezuela, and Cuba; to varying degrees, so do more democratic governments  not excepting the U.S.

Nonetheless, we are, I believe, in an incomparably privileged position to transform our national medical care, even though there is no way to provide everything for everyone. Unfortunately we cannot successfully adopt or adapt a ready made import for health care.

Why? The U.S. is not comparable to any other country; that is why the many comparisons often made are simply vacuous. They are all true lies. For example, it is iterated ad nauseum that we pay more per capita for health care than any other nation but lag behind most industrialized nations on any accepted standard of health care. The UN, to the contrary, rates the U.S. as first among 190 nations in responsiveness to the needs and choices of individual patients; is it any wonder we are undecided about change?

The U.S. has some clear advantages. No nation with so many resources, and so large and diverse a people as ours could address the complex issue of 21st century medical care in such a productive, universal, and public manner. We are still a relatively wealthy, open, civil society. While many of us are not great readers, nor great intellects, we are not all stupid. Given open access to information of all sorts, and free debate, any people’s collective decisions outperform those of the educated, the wise, the powerful, privileged, and the best informed.  No Aristotelians needed; go back home.

Provided we can protect our democracy, despite its defects, and if the public debate over medical care is allowed to continue to a reasoned step by step conclusion, our resulting decisions will effectively provide the best health care possible, considering our strengths, and limitations. I think we should be thankful that the debate has been resuscitated by our current legislators. But we must not allow ourselves to be stampeded for the benefit of someone’s name, fame, or legacy.3

Let’s continue the discussion, speak up, and listen, and together decide on the future of medicine in this fortunate land.  All our separate but equal colleagues and citizens want to participate. Even if we ain’t on Da’ Big Beltway Stage we are able to contribute; and we will, be advised. When we are heard we will more willing to accept Change.

So Hammurabi, Hippocrates, Maimonides, and DC elite, roll over.Again. Get used to it.

  1. See James Surowiecki, The Wisdom of Crowds, 0-385-72170-6
  2. See the Unabomber. His manifesto is on line: voluminous, ranting, but interesting. He feared Big Tech would ruin our world, our lives, shut us off from our real selves. To the contrary it has amplified our lives, our potential, and our world; but we ourselves are hard put to use it wisely or even understand its potential.
  3. For a taste of the eloquence and the urgency of the argument, google Ezekiel Emmanuel. For over 10 years he is has been a powerful writer, although a man in a hurry. But hey, Zeke. Easy
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