Have you ever owned a dog? If so, did you ever take him to the vet? I’m sure that even if you don’t own a pet, you understand the gist of the question, but now I’d like to ask it again in a different way. Before taking your animal to the doggie doctor, do you ask the little guy which vet he wants to see, or what treatment he wants to have? Of course not, that’s ridiculous. The animal doesn’t understand anything about their illness or injury, and besides, who is paying for their care? They should just be grateful that their magnanimous owner provides for their needs.
I’m saddened to say that in today’s healthcare environment many, if not most patients are being treated as if they are owned by their insurance company, or in the case of older patients, the disabled and the poor, it’s the government that functions as the de facto pet owner. This comparison also extends to most of America’s physicians who, like their veterinarian counterparts, work for and take their marching orders from “the owners.”
There are two basic problems with comparing “people care” to veterinary medicine. First, people are not domesticated animals, George Orwell’s satire not withstanding. For the most part humans have the ability to reason for themselves, make their own choices, complain when they are not treated fairly, and even possess the right to pursue litigation as circumstances demand. Despite these clear advantages, most people have passively allowed a set of faceless third party payers to dictate the who, what, when, where and how surrounding their healthcare, then blame the lack of personal service on the provider. Second, unlike government or corporate entities, the average pet owner actually loves the pet, and it is that affection that leads them to make compassionate decisions on behalf of their charge. It goes without saying, neither insurance companies nor the government love you.
Perhaps many find this comparison objectionable, and I can certainly appreciate that opinion, however, a closer inspection shows the American healthcare system is inching closer to veterinary clinic status every day. Payers contract with the providers for discounted payments without the knowledge of those who are most impacted. Eventually, when payments are slashed to the point of economic insolvency, the service is simply no longer available. This is precisely why many seniors are having trouble finding a doctor that will accept new Medicare patients and why a growing number of physicians are breaking the bondage of insurance contracts.
Much of what is being discussed in the media about death panels and rationed care is the direct result of the government’s attempts to control costs. In a veterinary clinic the overall cost of any animal’s care is determined not by what can be done as much as it is by what the pet owner is willing to pay for. Needless to say, there are not a lot of animals who receive hip replacements, heart transplants, chronic dialysis or chemotherapy. What makes us think that our healthcare owners will be any less willing to employ this same philosophy when it comes to decisions about your care, or mine.
We are already seeing the effects of the hundreds of thousands of pages of federal regulations on individual choices and fundamental freedoms. This is in spite of the fact the majority of Obamacare hasn’t even been implemented as yet. Starting with the mandate that all people buy health insurance and now mandating that insurance pay for specific reproductive related services is social engineering on its most basic level. What’s next, mandating that every American over the age of 50 get a colonoscopy based on the presumption that it is good for us, and therefore we should just take it?
The constitutionality of the new law was argued before the Supreme Court of the United States, and a decision is anticipated sometime this summer. Perhaps the whole thing will be thrown out based on the individual mandate and the lack of a “severability clause,” but the outcome is anything but assured. Even if the court finds it unconstitutional, there will be an immediate cry from those who have become dependent on government support, both patients and physicians, to replace it with another version. Eventually, we could still end up with a system much like they have in Great Britain, where healthcare is “free,” taxes are high and rationing is an obvious reality for all those who can’t afford private care.
Perhaps the most troubling and dehumanizing aspect of a government take over of “people care” is the loss of the individual’s legal rights. Unlike private insurance companies, the federal government has “sovereign immunity” from litigation in all cases of tort law, unless they specifically wave that right. Quite simply this means that if you are denied care based on a decision by a government board or bureaucrat, you will have no legal recourse.
The framework for the feds to take action that will ration certain types of care was included in the economic stimulus bill of 2009. Tucked inside that bill is a provision to spend $1.1 Billion on research to determine “Comparative Effectiveness” of various treatments. According to Robert Pear who authored an article in the New York Times, February 15, 2009, “The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.” What they fail to say is that this same method has been in use for some time in Great Britain, specifically to assess the relative effectiveness of costly treatments when weighed against the anticipated life expectancy of the individual. At some point you are simply too old to “benefit” from a hip replacement or coronary bypass.
One of the most difficult things that every pet owner eventually faces is the decision about how to deal with those final days. Rover’s cataracts have rendered him blind and he’s no longer able to make it outside to do his business. He’s not been eating, has lost several pounds and seems to have trouble even getting out of his bed. You take him to the vet and then comes the ultimate discussion. He’s had a long and healthy life, and its so sad to see him suffering like this. It really is the humane thing to do, isn’t it? Long pregnant silence … Okay, I guess it’s really for the best …
When you go home you find Rover’s empty feeding bowl and that old bed he slept on for all those years, and you feel bad about your heart wrenching decision for weeks, right? This is only natural, but under “universal people care” don’t expect the government to feel bad. Remember, they don’t love you, they just own you.
Robert Sewell is a surgeon who blogs at The Spirit of Healthcare.
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