Where's The Morphine?

The NY Times puts forward the following sob story:

FLINT, Mich. — Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.

That's very bad, by the way.

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.

She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

For what purpose was she being put through Chemo and Radiation "therapy"?

Look, I don't mean to sound callous, but there are times we must be objective.  This is one of them.

Let's talk about the monetary issue here before we get back to the patient issue.  Specifically:

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

Do you understand what this means?

Let me explain it to you:

If you are not on Medicaid you are paying part of the Medicaid patient's health care bill every time you walk in that doctor's door. 

You are literally being held up at gunpoint, without even being told, to pay someone else's bill.  This happens because you had the temerity to get sick.

This is at the core of what is wrong with so-called "health care" in America.  Your price is not my price, for the same procedure performed on the same day in the same clinic or hospital.

If you pay cash, you probably pay the most.  If you have a "health insurance plan", it pays something less.  And if you are on Medicare or Medicaid, it pays less still. 

Now here's the part you're really going to like: If you're an illegal invader or flat broke, you will pay nothing at all.

In each case those who pay less force those above them to pay more.  This happens because doctors and hospitals are immune from anti-trust laws, which generally bar this behavior.  They lobbied hard for this "right" to screw you blind - literally - rather than acting as every other business in every other profession does.

Oh, and as they did, prior to these changes in the law.

Your "local physician" and "local hospital" is not a "victim" of this.  He, she, or it is a willing, intentional malignancy in fomenting this distortion and, unless you're one of the "privileged" (that is, on Medicare, Medicaid, an illegal or broke), is screwing you blind.

This is why your health insurance premiums are going up 20% or more a year.  It, along with what comes next, is the precise reason that costs are out of control.

Now let's get to the other part of it.

I feel for Ms. Vliet.  But this view of entitlement to medical care and (extremely expensive) treatment, when there is no ability to pay or any reasonable medical chance of a cure (metastatic cancer that has spread to multiple locations is nearly always fatal - we're arguing over time here, not outcome), while the patient does not have the means to provide for that care, is a problem.

This is the discussion - the debate over what you're entitled to as a matter of social responsibility and law - that nobody wants to have.

But we have to have it.

See, there is only $X to spend on health care.  We cannot spend the last dollar to wring the last minute of life from every person.  Our nation, and indeed no nation, has the wealth to do so.  This isn't about compassion, it is about reality.

This does not mean we shouldn't provide comfort.  We deign not to do that either, and that's flatly wrong.  We're so "scared" of someone getting addicted to heavy painkillers that doctors are afraid to prescribe them to people with illnesses like this lest the DEA come knocking and threaten them with either arrest, the loss of their medical license, or both!

But this much I can tell you - we can't afford to provide "every last option" for those who have no resources to spend of their own, yet have contracted an illness that we cannot, within reasonable medical certainty, offer a cure for.

Indeed, the line is probably further back from there - although we don't want to admit it. 

Nonetheless, it is.

This is a fundamental debate around our medical policy we simply must have.  We as a nation believe we're supermen and superwomen, and we're distinctly uncomfortable with our own mortality.  This must change.

We can either change it by choice, or fiscal realities will change it by force.  The latter will be far more traumatic, and less-pleasant, than if we do it voluntarily.