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Rocking the Boat On Health Care

What is the value of a human life?

Oh, I know that there was a time when we believed every life was valuable and worth defending.

“We hold these truths to be self evident, that all men are created equal and are endowed by their Creator with certain inalienable rights, among them life, liberty and the pursuit of happiness.”

But that was so 1776.

For the last thirty years or so, we have been taught that some lives are, well, more equal than others.

We learned it in Social Studies and Humanities classes.

In fact, they even came up with charming games to allow us to get a little hands on experience in the fine art of choosing whose lives are really worth preserving when the going gets tough.

Avante garde Christian musician Steve Taylor captured the essence of these exercises in human triage in his song “Life Boat”.

Teacher: Good morning, class!

Class: Good morning, Mrs. Aryan.

Teacher: Today we’re going to play a game!

Class: Yeah!

Teacher: This game is called Lifeboat. All together…

Class: Lifeboat!

Teacher: Good! Lifeboat is a lesson in values clarification. Can you say values clarification?

Class: No.

Teacher: Values clarification is where your little minds decide which lives are worth living and which lives are worth…ahem…not living. Now here’s how we play. A big ship just sank. There are five people on the lifeboat. But the lifeboat is only made for two. I’ll list the five people on the chalkboard, and you, class, will decide which three will be thrown overboard. Are we ready?

Class: Yes, Mrs. Aryan.

Teacher: Good! First, there’s an old, old crippled grandfather. Second, there’s a mentally handicapped person in a wheelchair.

Alison: What’s mentally handicapped?

Teacher: It means they can never be a productive members of society. Third, there’s an overweight woman on welfare, with a sniffling, whimpering baby.

Max: Is the baby on welfare, too?

Teacher: Let’s not push Mrs. Aryan…

Sydney: Who else is in the boat?

Teacher: A young, white doctor with blue eyes and perfect teeth, and Joan Collins. Now, class, take five minutes to make your decision. … Times up! Well class?

Class: (singing)
Throw over grandpa ’cause he’s getting pretty old
Throw out the baby or we’ll all be catching it’s cold
Throw over fatty and we’ll see if she can float
Throw out the retard, and they won’t be rockin’ the boat

Teacher: Very good! That was fun, wasn’t it?

Class: Yes, Mrs. Aryan.

Aside from the catchy song, most of us have been exposed to this very same kind of  “Values Clarification” curriculum.

But here’s a news flash – the very same kind of decision making concerning who is worth saving and who is not may become far more relevant to all of us than a game in a class room.

In fact, it may be at the very heart of the current debate about national health care.

Now there is no doubt that a whole lot more heat than light is being generated on this issue.

Claims and counter claims, usually expressed at high decibel levels are the order of the day.

But certain facts are undeniably true.

First of all, quality health care ain’t cheap.

Second, technology and breakthroughs in therapies have markedly increased the level of life expectancy in our society.

Third, we do not have a limitless supply of funding to pay for these therapies and treatments.

So in order to provide a basic level of care for everyone, someone will have to decide how to divide up the pie.

Who will make these decisions?

We have already seen proposals floated for the formation of the Independent Medicare Advisory Group.

This proposed five person panel would be appointed by the president and would make recommendations specifically concerning services for the elderly.

Concerns have been raised that this may be the first step toward a much more powerful board like Britain’s ironically named NICE.

The Wall Street Journal offers this heads up.

The United Kingdom, which is often praised for spending as little as half as much per capita on health care as the U.S. Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE. Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you.

The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used “best practices” in medicine. As the Guardian reported in 1998: “Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere.”

What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS.

No matter what politicians tell us, sooner or later health care will be rationed.

Which raises an even more important question – On what basis will care be given or denied?

In Britain it comes down to a mathematical formula.

NICE is the target of frequent protests and lawsuits, and at times under political pressure has reversed or watered-down its rulings. But it has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.

The NICE board even has a mathematical formula for doing so, based on a “quality adjusted life year.” While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn’t adjust for either overall or medical inflation.

Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).

The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price — the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000?

It may get worse.

Who is to say that as the Baby Boom generation enters into the especially expensive last years of life phase, our rationing board may start making decisions on care based on the same ethics we learned in “Lifeboat”?

The handicapped.

Those who need long term therapies (like dialysis).

Even children with life threatening diseases like cancer may be pushed to the end of a waiting list for funding because “they weren’t really leading a quality life anyway.”

Let me be absolutely candid with you.  I wouldn’t want to try to straighten out our health care system for all the tea in China.

It is a daunting, even overwhelming task.

But unless we approach this problem with the absolute, non negotiable value that every human life is entitled to dignity, protection and the best care we can provide, we may end up in the sensible shoes of Steve Taylor’s  “Mrs. Aryan”.

How did her game of “Lifeboat” end?

Teacher: For our next lesson, we’re going to do an experiment!

Class: Yeah!

Teacher: We’re going to test the law of gravity, just like Galileo, by
dropping two objects out the window–one heavy and one light–
to see which one hits the sidewalk first. Now what shall we
use for the lighter object? I’m thinking of something small
and square…

Class: An eraser?

Teacher: Good! And what shall we use for the heavy object? I’m
thinking of something round and bouncy… Tommy, I haven’t
given you permission to leave your sea…class, the bell has
not rung. What are you… oohh! Class…put me down!
Put me down this instant! Ooohhh! Ooohhh!

Class: Throw over teacher and we’ll see if she can bounce
we’ve learned our lesson–teacher says perfection’s what counts
she’s getting old and gray and wears an ugly coat
throw over teacher and we’ll play another game of lifeboat
throw over grandpa ’cause he’s getting pretty old
throw out the baby, or we’ll all be catching it’s cold
throw over fatty and we’ll see if she can float
throw out the retard, and they won’t be rockin’ the boat

To a  society that seems to be heading for the “Lifeboat”, God has a challenge:

Defend the poor and fatherless;
Do justice to the afflicted and needy.
Deliver the poor and needy;
Free them from the hand of the wicked. (Psalm 82:3-4)

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