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Posts Tagged ‘Donald Berwick’

My article in today’s HeadlineBistro.

The recess appointment of Dr. Donald Berwick as head of the Centers for Medicare and Medicaid Services (CMS) has triggered alarm among various quarters for his self-professed admiration of health care rationing as seen in other countries such as Britain’s National Health Service. The issue here moves well past the politics and begs the question: How have we as a society become so deadened to the value of human life, that in our abundance of wealth and blessing from God we could seriously entertain the word “rationing” as applied to health care for our elders, for the poorest among us?

This move is a game-changer on so very many levels. Juxtaposed with the almost weekly reports of breakthroughs in cancer therapy, treatment of chronic conditions and adult stem cell therapies, this is not only an odd moment for considering rationing health care, but a dire threat to the advancement of science. A society that commits itself to death as a solution to its self-inflicted financial wounds cannot long endure as a pioneer of extending and improving the quality of life through research in the biomedical sciences; not when the government that funds such research is busy eliminating the need for it.

So how did we get here?

Twenty years ago when I was studying and working as a psychiatric research assistant at Columbia University, I was invited by one of the faculty to attend a talk being given by a medical economist. The topic was the new system of managed care and HMOs. In this talk, the economist made a very prescient observation that I took as a harbinger. He said that increased access to high quality health care does not make for a healthier population. It creates a larger, more chronically ill population of people who will exceed the lifespan dictated by their illness by twenty to thirty years.

Consider those who undergo coronary bypass surgery, who have pacemakers, treatments for cardiac dysrhythmias, diabetes, HIV, hypertension, vascular disease, COPD, cancer, etc. Advances in medical treatments and access to those treatments produces a population who live decades longer, mostly by taking medications daily. The longer we live, the greater the likelihood of new conditions arising needing surgical and medical interventions. All of this costs money.

The economist went further. Are we prepared to extend social security benefits to an ever-burgeoning population of retirees? Can the civil servant pension systems cope with people who retire after twenty years in their early forties and collect pensions well into their eighties and nineties? What do we expect from managed care?

Two decades later we are now being forced to address these questions. It seems that death is being proffered as the solution. Ridding ourselves of the elderly not only saves Medicare dollars, but also saves social security dollars as well as civil servant pension payouts. Cutting Medicaid services also saves on welfare and related money. Such solutions to vexing financial difficulties requires little intellect and even less heart and soul.

Death is cheap and easy.

The coarsening that has led us down this path began with the sexual revolution and legalization of abortion. Mother Teresa of Calcutta cut straight to the heart of the issue when she stated that it is a poverty that a child must die so that we may live as we wish. That has been the great selling point of abortion, that babies are an economic encumbrance that will hold us back from being and doing all that we wish to be and do.

The coarsening continued to unfold with the “Death with Dignity” movement, which really appeals to the same obsessive need for radical control and moral autonomy that has gripped us ever tighter during the past five decades of the sexual revolution. Now we have a political appointee whose duties could foreseeably include saving the nation money by institutionalizing a system of treatment refusals that make the worst of the HMOs pale in comparison.

In Immunology, the process of opsonization – the marking of a pathogen for destruction – has its etymology in the Greek word meaning “to mark for death.”

We opsonize the unborn, the poor, the elderly. With the steady rise in autism diagnoses, which are breaking the backs of school districts across the country (one out of every 110 children), will we return to eugenic sterilization that is still Constitutional Law, enshrined in the 1927 Buck v. Bell decision?

We cannot absolve ourselves of culpability in this trajectory toward the Culture of Death. Pope Paul VI warned us of this in Humanae Vitae back in 1968. Pope John Paul II warned us repeatedly for over twenty-five years in all of his writings, in which he gave us the roadmap, philosophically and theologically, back to a Culture of Life.

We should not deceive ourselves: The raised issue of health care rationing represents significant momentum for the Culture of Death that will require a muscular response to slow, halt and reverse. We need to become very vocal in our affirmation of life in all of its stages. We are in dire straits, but we have all the answers before us, and all of the graces of Heaven for the asking.

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