For a reminder of the big picture issue in health care, former Colorado Gov. Dick Lamm’s Sunday opinion piece in the Denver Post is well worth a look. Lamm has been writing about this issue since the mid-1990s, and federal deficit and spiraling costs have moved events increasingly into his philosophical sights.
The piece argues that we already ration health care (“Your health insurance contract is a rationing document setting terms of coverage”), and that, given the conflicting directions of cost curves and budgetary reality, we have no choice but to face some very difficult decisions. Lamm reminds us that federal health care costs now exceed Social Security costs, and that Medicare and Medicaid tabs amount to more than triple the federal defense budget, with no signs of slowing.
For all the talk of resurgent family medicine, the creation of medical homes, and the use of electronic medical records to avoid redundancy/foolishness in care, the monumental cost of end-of-life care is an issue we can no longer skirt. Health care is ultimately a zero-sum game, with a finite basket of resources already inadequate to cover 51 million insured in this country. Whether by “death panel” or a simple refusal by insurers, public or private, to pour tens of thousands of dollars into services that extend a patient’s life for a month or two, change has to happen, and we should support it.
