More and Less
Let me let you in on one of the basic facts of life, and no, you don’t have to be a doctor to know this one. Everybody wants more!
Who knows? More money for some, more fulfillment for others, or perhaps just more love, a lot of times it varies. It may be one thing one day and another thing the next. What we want more of is variable. The feeling that we need more of something is universal. For me what I need more of depends on the season and what mood I’m in. In the fall I need more jackets. In the spring I feel like I have a shortage of golf clubs. Never mind that I have closets overflowing with both and I have more of either than I can ever reasonably use. I don’t have the one I need now.
And I’m not unique to this affliction. Need proof? Just look in the self-improvement section at your local bookstore, or turn on a little daytime television. Flip through the channels any day of the week and two thirds of what you’re going to see pouring out at you is how to get more ________. The blank may change from one channel to the other, but the quest, the need to get more, remains universal.
Why do we need more? Well, we need more money so we can get more stuff. For two decades the U.S. economy has been based on a simple principle…consume, consume, consume. When our economy hit a bump and consumer spending dropped the first domino fell, setting off a chain reaction that reverberated around the world.
I hate to admit it, but I’m no different from anybody else. I fall hook, line, and sinker for the lure of the consumer advertisement. I know that they’re just shallow manipulations of my individual gullibility. And while I know this intellectually, at some deep basic level, for some reason, I believe what the commercials are telling me. I need a new Lexus. That three-year-old bomb I’m driving isn’t cool anymore. I need the new one. And yes…yes…yes Lord knows I need that new I-pad. I can download three million songs and a thousand movies and…and…and, who knows what else? All I’m sure of is, I'm sure I need one.
Unfortunately, as much as I delude myself into believing it is, my need isn’t real. I don’t have time to download a hundred movies, much less a thousand. I have three movies on my current tablet, and yet I’m coerced into believing I need a newer, more technically sophisticated model. With the rapidity of technological evolution in the modern world, this cycle of need and fulfillment is never ending. As soon as I buy the new Lexus or I-pad they’ll start advertising a newer model. One that fuses both of them and comes with a thought activated cell phone in it. And as soon as I get that, there’ll be an even newer model with both the cell phone and a miniature teleportation device, so I can teleport myself, my Lexus, and my I-pad to Tahiti to drive around for only a nominal fee. And so it goes ad infinitum.
In a lot of ways medicine is the same way, but instead of ego and vanity being the primary driving forces, it is our very lives that are at stake. We want more and we want better, the heck with better, we want the best. Who doesn’t feel like they deserve the best health care? America is nothing, if not an egalitarian society, in this regard. Everybody deserves the best health care, right?
Well, I don’t know. Let me pose a hypothetical scenario. What if there was a drug that was ninety-nine percent effective in preventing osteoporosis in post-menopausal women? And, what if it had no identifiable side effects? Shouldn’t we give it to everyone that could benefit from it?
That seems like a “no brainer”. And it would be, until you find out that it costs twenty thousand dollars a dose? Ok, well, that does seem a bit steep. But it really would make so many lives better. I guess we still should.
The problem is, at that cost, for that many women, most of which will be sixty-five years old or older, the cost of the drug will bankrupt Medicare in a single year.
Now, should we make this wonder drug available to our Medicare beneficiaries? By the way, I hate the term beneficiaries, almost as much as I hate the term, health care provider. These are patients; sweet little grandmothers and mamas, wonderful women, and you’re their doctor and you have this wonder drug that will make their lives so much better. No longer will they have to face the chronic back pain and the debility of nerve root compressions that are associated with the pathologic fractures of osteoporosis. Should you give it to them? And, if you do who should pay for it?
This isn’t a medical decision. Medically, the answer is obvious. From a risk-benefit standpoint the drug is amazingly effective, so it’s all benefit with no risk. The only risk is to the solvency of the largest health care provider in the United States, Medicare, and by extension the viability of our government as a source for health care coverage for those that have no other way to afford it.
So, this decision becomes not a medical decision but a social decision, a governmental decision, a legal decision, even a moral decision. It is a decision that will reverberate through the years.
If the recent financial downturn has shown us anything, it’s that consumption has it’s limits, and those limits are imposed by the availability of funds. Deficit spending and debt are only sustainable so long as there is someone willing to lend us the money that we don’t have. We are currently in a position that requires that we make a decision on how we will impose spending limits because we’re running out of credit.
Because our economy is, to say the least, less robust than it was a few years ago and the increasing number of folks becoming Medicare eligible due to the baby-boomers pouring into the over-65 population like water from a busted dam, things can’t work like they used to.
We need a better system. Not one dominated by partisan politics, and we need to do it soon. The system we have now is failing and its loss will effect, not just ourselves, but what kind of future we leave for our children.