Life and Death in America
This column by Bob Herbert of the New York Times struck me in a way that he did not anticipate. It was meant to dramatize the tragedy of leaving people to fend for themselves without universal health care. But, it actually illustrated one of the unexamined reasons why such an entitlement will be impossible to achieve in today's America.
Herbert's column, which he entitled "The Long, Dark Night" begins by introducing Dan and Sharon Brodrick, who have just found out that at 56 years of age, Sharon.....
has cancer of the duodenum and it had already spread to her liver and pancreas. Not only is the prognosis grim, but the medical expenses will soon leave the couple destitute. Mrs. Brodrick has no health insurance.
These are decent hard working people, who by circumstances beyond their control are faced with this overwhelming tragedy. And the condition was dire:
“They opened her up, and then they closed her right up again,” said Mr. Brodrick.
Not only had the cancer metastasized, it was moving very aggressively. Various estimates were given, each one shorter than the last, about how long Mrs. Brodrick might live.
While his wife was being prepped for chemo, Mr. Brodrick sat in the corner of another room and spoke about what it was like to have one’s life all but literally blown apart.
“It tears you down,” he said. “You’d like to fight this with your bare hands, but you can’t. We’ve been married 37 years September 2nd, and when I think about it, it was the quickest 37 years I’ve ever seen go by in my life. It went by in a flash. And we have leaned on each other that whole time.”
Herbert's message is clear; these decent Americans should not be made destitute just because they want the best medical care.
There is just one problem with this story. Based on the description given in the column, chemotherapy was not indicated in this case, since there was "5% or less chance of "success." No one said that a cure was possible; but perhaps, just perhaps, there was less than a 1 in 20 chance of a bit longer life.
Herbert is not interested in something as cold hearted as cost benefit analysis. He wrote a story of a stricken woman who wanted to live, as do we all. Yet the availability of chemotherapy that he implicitly defined as the desired outcome of universal medical care is in actuality a twenty thousand dollar placebo, that the oncologist would be perfectly willing to administer.
Right now he will not do so because these people do not have the money, or if they do, it will cause them to sell their house. But if this were paid for by "universal health care", "the government," and yes, the taxpayer, then there would be no hindrance to having the last days of Ms. Brodrick's life one of false hope and increased suffering. Palliative care just doesn't pay the mortgage- on the Hospital building or a suitable doctor's home.
The nature of democratic politics in this country, if not universally, is to satisfy the needs of the voters, however unrealistic they may be. Perhaps there was a time when elected leaders transcended this, when there was respect for their "wisdom and integrity". Now, with politicians one of the least respected professions, it is either they deliver the goods, or they are out.
So, the pressure would be inexorable to provide every service proffered by the medical profession, the pharmaceutical industry, and anyone else who can convince the public of the value of their offerings. And woe to the office holder who resists comes election time.
All the American voter wants is eternal health and a quick peaceful death after living life to the fullest. And, they can be convinced that the only thing that stands between this goal is the insensitivity of people, like me, who want to shine the cold harsh light of reality on this hope. Who have the effrontery to equate dollars with life.
I do not want to pay for Mrs. Brodricks chemotherapy through my taxes, anymore than I would pay for my own chemo if I had her illness. It is disturbing that Mr. Herbert did not anticipate a reaction such as mine, as if it could only come from someone devoid of human empathy, rather than his readers.
There are many arguments for universal health care, ideally single payer, in this country. But it will never happen; or if it does, it will be a fiscal and social disaster, unless we face the limitations of our political system.
With mandated universal coverage, our political system, our elected representatives, must make the hard decisions that we now hate HMOs for making. Our vulnerable elected representatives must burst the dreams of patients such as Mrs. Brodrick and thwart the avarice of those who feast on their desperation.
I have no reason to believe that our political system is up to this task.