Musing: Ethics and Economics

Dark was the operative word this morning. I dressed in it, so as to preserve my night vision, thinking all the while of how much harder it is to do these days, now that labels are printed on clothes instead of sewn in, then Koko and I walked in it, beneath dense clouds that obliterated both sky and mountains.

The only light came from the reflections cast by street lamps and headlights on the rivulets and pools of dark water deposited by rain that fell all night and paused just moments before we went outside. Felicia was kind enough to provide us with a good soaking, rather than a drenching, and a friend on the North Shore said he hoped it would be enough to send the 'o'opu down in earnest. He’d already begun hooking a few.

One of the big hooks in the Obama campaign was the promise of health care, and not just for those with good jobs and lots of money, or no jobs and no money, but even for the tens of millions who fall somewhere in between.

Instead, what we’re likely to get is something far less. As Hendrick Hertzberg so eloquently observed in The New Yorker:

Pretty much everybody who believes that health care should be a human right, not a commercial commodity, and who makes a serious study of the abstract substance of the matter, concludes that the best solution would be (to borrow Obama’s words at the press conference) “what’s called a single-payer system, in which everybody is automatically covered.” But, by the same token, pretty much everybody who believes the same thing, and who makes a serious study of the concrete politics of the matter, concludes that a change so sudden and so wrenching—and so threatening to so many powerful interests—is beyond the capacities of our ramshackle political mechanisms.

The cry most often heard is that we simply can’t afford it. But even as we’re claiming we can’t provide basic care to all, we’re providing extraordinary care to some. Among them are the tiny premature babies, many of whom, according to a nurse friend, will require extensive medical assistance for the rest of their lives, and the elderly, who are often subjected to expensive, invasive and ultimately futile procedures at what would, without these interventions, be the natural end of their lives.

And then there are the transplant patients. In a riveting New Yorker article entitled ”The Kindest Cut,” Larissa MacFarquhar discusses the emotional, ethical and practical complexities of organ transplants, focusing on kidneys. She writes about the advent of dialysis:

….a federal entitlement through Medicare was passed that secured access to dialysis for nearly everyone. The result of this has been that thousands of kidney patients who forty years ago would have died quickly now die slowly while waiting on the [transplant] list.

The article was fascinating because it showed how we've got the technology to perform these organ transplants, but in so many of the cases involving live donors, there are all sorts of psychological jam-ups on both ends that have not been resolved or even dealt with in a comprehensive way. And even with organs taken from cadavers, there's a big dispute over how to dispense them fairly.

Similarly, people struggle with guilt and other intense emotions when faced with having to decide if they really want their loved ones to receive all the care that hospitals are willing, even bound, to provide.

As a result, we're providing some people with an extended life that is often poor quality, while withholding care that could actually improve the quality of life for others.

Once again, technology seems to have outpaced humanity.

We all know that if we weren't spending so much on the military, we'd have more to spend on health care. But those misguided priorities don't seem likely to change any time soon. And currently, we don't have either the facilities or trained professionals to provide the ultimate level of care to everyone.

So some choices need to be made.

I’m not saying that any of the groups used as examples in this post should be denied care. But I would really like to see us, as a society, having discussions on how health care resources should be allocated, and not just from the standpoint of economics, but ethics. Right now, millions are being excluded, and millions are being included, without any social debate as to who should get what, and why.

As our technology advances, these questions will become ever more compelling, and our need to address them ever more urgent. But if we continue to focus only on the money side of health care, which is, at its core, a human and social issue, our efforts to reform the current unweildy system are bound to fall terribly short.

Perhaps where we really need to start is by examining our seeming reluctance as a society to face up to the one truth of our existence: none of us will escape alive.