Should a Gardener Get the Same Care as a Vice President?

Medicare should find a way to pay for lifesaving heart devices such as one implanted in Dick Cheney.

The other day I was treating a patient, a gardener, whose three grandchildren rely on him. He needs an implantable cardioverter defibrillator, or an ICD. This is the heart-shocking device made famous by Vice President Dick Cheney, who has one protecting his life.

The press has called his ICD "an emergency room in the chest." The description is apt and a measure of the technological marvel that these pager-sized devices are.

Editor
Los Angeles Times

Sir:

It appears that Dr. Leslie Anne Saxon is an exemplary doctor. But I suspect she skipped Economics 101 while cramming for Anatomy. I'd like to offer the beginnings of a remedial course.

Dear Dr. Saxon: The law of supply and demand dictates that for any commodity--such as medical care--which is characterized by an infinite demand and a finite supply, there must be rationing. It is not a matter of choice. It is a law of nature, kinda like gravity.

Now. Since there WILL be rationing, the question is: what is the fairest way to do the rationing? Or--put another way--who is to play God? Should it be politicians like the robust and healthy Ted Kennedy and Jerome Nadler? Should it be insurance company drones? Should it be HMOs? Should it be doctors (they are used to playing the part, at any rate!)? Or perhaps the free market?

Only one thing is certain: it will be somebody.

We have before us copious evidence that government and HMOs and insurance companies have less-than-stellar track records in the rationing game. And advanced reading beyond the scope of this letter would inform the good doctor that it is the Free Market which is the most fair system for rationing scarce goods in the presence of unlimited demand.

Although the good doctor is careful not to use words like "illegal" or "undocumented", forgive me for suspecting her gardener is not a U.S. Citizen. The answer to her question is then transparent: he should get all the quality medical care he can obtain--in Mexico.

--Boris

I won't register to read the rest of the article.

However, Medicare certainly pays to have such devices installed. I suppose Medicaid does as well.

If the gardner is poor and a legal citizen of the US the government will already pay for that operation and device.

I suspect the real problem is that 20% of the doctors fee's are not covered. Many poor people are unable to pay that 20% but the doc's will perform the service anyway. They still make money on the procedure and they get to declare the lost 20% as a write off on income taxes.

This doc wants more money, which is fine but I resent her demands that she be paid by stealing money from us at gunpoint.

The law of supply and demand dictates that for any commodity--such as medical care--which is characterized by an infinite demand and a finite supply, there must be rationing. It is not a matter of choice. It is a law of nature, kinda like gravity.

I know that in theory, "there WILL be rationing", but I wonder if this has to be true. Rationing says there isn't enough to go around. Why isn't it possible to have enough doctors, hospitals etc. to take care of our medical needs as a nation? To say something is the "law of nature" presupposes the conditions are driven by natural forces. When we are talking about medicine, we are not talking about something that has natural limits like "gravity" but limits imposed by our knowledge at the time or choice.

"I know that in theory, "there WILL be rationing", but I wonder if this has to be true. Rationing says there isn't enough to go around. Why isn't it possible to have enough doctors, hospitals etc. to take care of our medical needs as a nation? To say something is the "law of nature" presupposes the conditions are driven by natural forces. When we are talking about medicine, we are not talking about something that has natural limits like "gravity" but limits imposed by our knowledge at the time or choice."

A couple of responses, dancing around your central question:

(1) I once had a debate with a doctor on-line. He said there should be "free" medical care for everyone. "Gee, that's swell of you, doc, volunteering to work for nothing," I said. No, no--that's not what he meant--"free" means someone else pays for his salary--someone other than the patient. That's "free".

(2) "Our medical needs as a nation" tends to be a moving target, does it not? Do our medical needs as a nation include, say, Botox injections? Facelifts? Hair transplants? Unlimited heroic measures to keep AIDS patients alive while YOU pay the price? Life support for anencephalic babies? Experimental cancer treatments for all? In vitro fertilization for infertile couples?...As new medical discoveries are made, do they become part of the 'medical needs'? Gigantic magnetic imaging machines in every rural clinic?

If they find the Fountain of Youth but it costs a million bucks a day for a year, is that included also?

Oh. You mean basic medical needs, like booster shots, bone setting, etc....Except that one man's "basic" is another man's extravagance...

--Boris

(1) I once had a debate with a doctor on-line. He said there should be "free" medical care for everyone. "Gee, that's swell of you, doc, volunteering to work for nothing," I said. No, no--that's not what he meant--"free" means someone else pays for his salary--someone other than the patient. That's "free".

(2) "Our medical needs as a nation" tends to be a moving target, does it not? Do our medical needs as a nation include, say, Botox injections? Facelifts? Hair transplants? Unlimited heroic measures to keep AIDS patients alive while YOU pay the price? Life support for anencephalic babies? Experimental cancer treatments for all? In vitro fertilization for infertile couples?...As new medical discoveries are made, do they become part of the 'medical needs'? Gigantic magnetic imaging machines in every rural clinic?

How many pay the actual cost of medical care now? Isn't that what the insurance industry is about, some pay more in than they take out, while others take out more than they pay in. So for the latter group, someone other than the patient is paying the doctors salary. When I purchase insurance, I am making a bet that I will be transferring my future medical costs to someone else.

If they find the Fountain of Youth but it costs a million bucks a day for a year, is that included also?

Oh. You mean basic medical needs, like booster shots, bone setting, etc....Except that one man's "basic" is another man's extravagance...

Do you really think it would be so difficult to agree upon medical treatments that are necessary and those that are frivolous? Isn't cosmetic surgery and treatments pretty much excluded from insurance coverage now?

Just out of curiosity how do you feel about abortion? If the baby in distress you describe in your post is known before birth to have a defect making necessary expensive medical treatment, and the parents are unable to pay the medical costs, should that baby be aborted, or do we demand the baby be carried to term and then withhold treatment due to lack of money and allow it to die?

”How many pay the actual cost of medical care now? Isn't that what the insurance industry is about, some pay more in than they take out, while others take out more than they pay in. So for the latter group, someone other than the patient is paying the doctors salary. When I purchase insurance, I am making a bet that I will be transferring my future medical costs to someone else.”

The difference is that purchasing health insurance is voluntary. Paying taxes is not. It is coercive. “I demand that you pay his medical expenses!” at the point of a figurative gun…even if the patient is an illegal alien.

”Do you really think it would be so difficult to agree upon medical treatments that are necessary and those that are frivolous? Isn't cosmetic surgery and treatments pretty much excluded from insurance coverage now?”

I do think so. Read the papers. People are always protesting, suing, and ranting over just this issue.

I am against abortion. Anencephalic babies are born with no brain. They usually die within days of birth. There is a huge controversy about “harvesting” their organs because basically they are lumps of flesh with no feeling or emotions. I’m conflicted about this issue; I can see merit on both sides of the anencephalic flap.

I suppose we could keep them alive to add to the number of registered Democrats in their locale…

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