What about the violent sexual predator or murderer who becomes ill while incarcerated? He not only gets gold-plated medical care at no cost (to him) but requires two guards as escort throughout the process. Why do we do this? The cynical answer is that if we didn’t the cost of the lawsuits would be more than the medical care. I suppose a more nuanced analysis is that failure to do so would mark us as a less compassionate and moral society. To me, this is false compassion, a form of hypocrisy. In a medical environment with limited and fixed resources, expending them in this way makes them unavailable to others who are contributing meaningfully to society, such as the working indigent. It strikes me as not moral, but immoral behavior.

Now, when there’s great demand, supply rises to meet it. Bad doctors and medical vendors will exploit this, especially when patients are insulated from the costs by the insurers. Even good doctors, as previously discussed, can and do experience practice drift, where a move to more and more expensive care becomes the community norm, then becomes incorporated into patient expectations. And unmet expectations are fertile soil for lawsuits. This contributes to spiraling costs; insurance premiums go through the roof and more people become uninsured or their benefits decline. The government finds itself looking down the maw of untenable shortfalls in the Ponzi scheme known as Medicare. It desperately starts slashing payments on the most commonly ordered tests, whether appropriately ordered or not, and screams “emergency,” although they knew the train was barreling down the track out of control a hundred miles earlier. And the president calls for instant action on a massive problem so complex that no two people agree on the solution.

Now, I’ve never been one to base medical decisions solely on age. There are many elderly patients that have less overwhelming disease and a longer life expectancy and anticipated quality of life than the examples I’ve given. But if we have so much trouble electing conservative care for the sickest and oldest, imagine how much more difficult it will become to make decisions in circumstances that are, in my opinion, even murkier, as funding continues to dwindle.

 The train is still speeding down the track; and it’s not slowing down.


NEXT: The Solutions


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