Herd Medicine?

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The nation has opted to create some form of universal health care. That is clear.

“…physicians, as an ethical duty owed to society, must practice efficient, parsimonious, and cost-effective health care.” from The American College of Physicians Sixth Edition of its Physicians Ethics Manual

While this statement is reasonable and reasoned with regard to national health care, it is in clear contrast to the time-honored ethical position that ‘Every life is beyond price”.

Though an ambitious endeavor like the creation of national health care is a process, to be revised and restructured as required, strident debates continue.  Consider these quotes:

“Traditional medical ethics, based on the doctor-patient dyad, must be reformulated to fit the new mold of the delivery of health care. . . The primary function of regulation in health care. . .is to constrain decentralized individualized decision making.”  From ‘New Rules” by Troyen A. Brennan  and  Donald M. Berwick MD MPP

“…the GOD panels (Government Operatives Deliberating) – … which will determine the most cost-effective way to practice medicine, and… distribute rules down to American physicians for deciding who gets what, when and how – tell us that what’s good for the herd is certainly what’s good for the individual.”  From the DrRich blogsite January 3rd, 2012 “…

“M.D.s do not think of … patients as  (a) herd (but) future health care decision-makers will.”   From ‘Obama’s Herd Health Program’ by Heather McCauley DVM

herd  (hûrd)

1.  a) A group of cattle or other domestic animals of a single kind kept together for a specific purpose.

b) A number of wild animals of one species that remain together as a group: 

2. a) A large number of people; a crowd: 

     b) The multitude of common people regarded as a mass:

IMG_4818

 

I am not a veterinarian. Yet it is reasonable to observe that in general  veterinary medical practice is found in two forms:

Herd Medicine -focused on the greatest benefit to the greatest number of animals, and the economics of health care;  and  ‘Companion Animal Medicine’- fee for service care focused on individuals.

The term herd, when applied to human health care is disturbing to some, who see in it Huxley’s Brave New World;  on the other hand, some see in our current medical ‘system’ much of  Dickens’ 17th century industrial Britain. I contend that both views are flawed, and that the voting public in general, should realize that these two aspects of health care are not mutually exclusive; they are necessary in a national health program.

The table below provides side-by-side comparisons between herd and companion animal medicine. They are not altogether translatable to human health care, yet they are helpful in considering the implications of the national health care like that of the Affordable Care Act.

________________________________________________________________________________________

Herd-Vet Medicine                                           Pet-Vet (Companion Animal) Medicine

Focus on large populations                                         Focus on individuals

Collective outcome central                                                           Individual  outcome  central

Greatest  benefit to greatest number                                          Greatest benefit to the individual pet

Cost /benefit a major factor                                         Cost limiting, but not central

Economic viability/profit  critical to all                                  Profit a consideration for ‘providers’.

Herd owner  pays                                                                               Pet owner pays

Decisions based on outcomes , economics                                 Decisions based on emotions and owner resources

 Ethical Considerations:                                              Ethical Considerations:

Euthanasia, cloning, etc.  justified by economics.        End of life and advanced tech decisions by law.

Animal Rights not a prime consideration                       Animal (‘patient’) Rights of prime   importance

Special considerations & legislation                            Special considerations & legislation

Valuable animals treated as individuals                                       People can be  jailed longer for abusing a

Animal rights laws may affect outcomes                                        pet than a person.

                                                                                                                                                                                                             

In a sense, ‘Pet-vets’  infringed the patent on physician fee for service medical care. (So did hospitals, phone companies, government agencies, and other entities that bill for ‘services’ through a lengthy and unintelligible list of charges; but that’s different essay!)

Society  needs now to infringe the  patent on veterinary herd medicine, in a dual system to make national health care  effective, practical and viable. In fact, dual- herd/individual care-  systems have always existed in medicine,  like the county hospital/private hospital dichotomy that survived until half a century ago,which was imperfect but functional. In fact, every nation that has a sustainable national health program allows or employs both types of health care:  one focused on large numbers, outcomes, and economics, and the other focused on the rights of individuals. Both rest on ethical and practical considerations, which address different aspects of national health care. The ACA is such a duality, theoretically and functionally imperfect but  subject to revision and improvement.

Every nation able to offer ongoing universal national health care to all its citizens has found it necessary to develop some sort of  ‘two tier system’. Can we do so now in our democracy?  We’ll see. I believe we can, and will.  Any objective look at the life of people on this earth makes clear that over the centuries, people have lived progressively longer, healthier, more comfortable lives. I predict we will develop a functional, ethical, and affordable national health care consistent with our own culture and history. It will reflect  one key word in the Affordable Care Act that implicates features of herd medicine; that word  is: Affordable.

 

 

 

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