David's Feed
Aug 21, 2009
via The Great Debate

Refuting healthcare myths


— David Magnus, Phd, is the director of the Stanford Center for Biomedical Ethics. The views expressed are his own. —The public discussion of healthcare reform has been full of so many lies and myths that it is less a policy debate than bad theater.Critics of reform (conservatives hoping to score political points and oppose Obama on anything; free market ideologues; those with threatened financial interests) have stooped to absurdity in their public pronouncements. One publication declared that severely disabled physicist Stephen Hawking would never get life saving medicine in a national health system, ignoring that Hawking is British—virtually all of his life saving treatments were done through their National Health Service.As debate over reforming health care continues, these are some of the key myths that get in the way of truly meaningful discussion.Myth #1—We have the best health care in the worldThis is probably true for some Americans. But on the whole our system is among the poorest of all developed nations. We spend far more per capita than any of our peers on healthcare, yet health outcomes measures are no better in aggregate. The World Health Organization ranking of health systems rated 36 other countries as having better health systems despite spending far less. The U.S. was right behind Costa Rica (and only two spots ahead of Cuba).But the reality of the failure of our health system is best seen by the thousands of people being turned away in Los Angeles last week at the massive free clinic set up by the Remote Area Medical Foundation (see Reuters story). When the country spending the most money can not meet the basic medical needs of so many of its citizens, it does not have a good (or just) health system, much less the best system.Myth #2—Health reform will lead to less personal freedomThere is nothing in any of the proposals that requires anyone to give up her existing health plan. In fact, Medicare proves that public-private partnerships can result in individuals choosing their own plans and their own physicians. Opponents of reform have argued that any government involvement means loss of freedom. This ignores the reality that insurance companies, employers, and financial limitations are already curtailing freedom for many individuals. When co-payments are too high, or someone has no insurance and health care means going bankrupt, those are real losses of freedom. It is ironic that unwavering faith in the free-market (and contempt for any government role) is being expressed at the same time the country is recovering from an economic meltdown caused by too much greed and too little government oversight.None of the proposed plans involve socializing medicine, creating a single payer system, or government run or owned hospitals. They merely acknowledge the reality that a morally defensible health care system will only come about with some government involvement.Myth #3—Health reform will control costs by depriving patients of needed medical treatmentsThere is absolutely nothing in any of the reform measures that suggests or requires that needed medical treatments will not be available. In contrast, within our existing system, those without insurance or “under-insured” patients who can not afford rising out of pocket payments are denied needed medical treatments on a routine basis. Reform makes it more likely that patients will receive needed medical treatments (not less likely).Myth #4—Health Reform will deny older Americans medical treatments at the end of lifeThe lies about “death panels” that Palin, Gingrich, and others have been spewing have led the Senate to withdraw one element of the House legislation that would have both reduced costs and increased patient freedom. This is the proposal that would have allowed payment to primary care physicians who spend time with their patients talking about the patient’s wishes with regard to end-of-life decision-making. Right now, 25 percent of Medicare is spent on the last two months of life. Families in these contexts often face difficult decisions with no idea of what a patient’s wishes are. In those settings, we typically default to providing more aggressive measures, even if it increases suffering and may be at odds with a patient’s wishes. Encouraging patients to make choices ahead of time–whether for more aggressive measures or for a greater focus on comfort at the end of life– promotes freedom and has the potential to reduce costs (since 80 percent of people prefer less aggressive care).This is the precisely the role that government should be playing—creating incentives for good medicine that promotes patient autonomy—and to counter existing incentives which all too often lead to less choice, more suffering, and increased costs. When Palin, Gingrich and others portray talking about our wishes with our doctors as “death panels”, when they attack scholars’ work out of context, when they misrepresent what is in proposed legislation, they undermine any hope of rational dialogue about the ethical challenges presented by health care and the very important and very real challenges and trade-offs that should be the subject of debate.