Health Care Debate in Eugene: Two Physicians Face Off

Two local physicians have had a debate on the opinion page of the Eugene Register Guard. I reproduce it here for your
interest, because it seems to me to capture two possible pure positions

Doctors take an oath to serve, not a vow of poverty

By I. Howard Fine. M.D.
For The Register-Guard
Appeared in print: Sunday, Jul 26, 2009
http://www.registerguard.com/csp/cms/sites/web/opinion/17388970-47/story.csp

Health care reform is a hot topic today. To most people, reform means reducing the cost of health care. There is much in our current health care delivery system that could be improved, but ultimately with only a relatively marginal reduction in costs.

The only way to dramatically reduce health care costs is to dramatically reduce health care — and that means allowing people to suffer and die early from treatable diseases. Unacceptable, you say. And I agree.

This forces us to recognize how much we value good health, without which much of the joy is taken from our lives. What else that we look upon as valuable do we believe to be our right at a very low cost? Food? Shelter? Clothing? Cosmetics? (Americans spend more on cosmetics each year than on medications).

We all look forward to the availability of a cure for cancer and heart disease, our biggest killers, but that can come only at a huge cost — a cost in which, one way or the other, we must all participate. If we remove or significantly reduce profits from manufacturers of medical devices and pharmaceuticals, their research budgets will disappear. How much medical innovation is created in Great Britain or Canada?

Physicians take an oath to serve, but they do not take a vow of poverty. Like almost everyone else, they wish to achieve financial security for themselves and their families. If we devalue the worth of their long training, hard work, expertise and responsibility, their numbers and their productivity will decline.

In spite of the very high taxes that the Swedish people pay for universal health care, there was recently a five-year wait after diagnosis for cataract surgery in the first eye and an additional seven-year wait for surgery in the second eye. That is a 12-year wait for bilateral visual rehabilitation. Those who could left the country for their cataract surgery. A law was passed in Sweden allowing privately paid cataract surgery in ambulatory surgery centers, and within a very short time the 12 year wait was reduced to about six months. That happened without an increase in the number of surgeons. It’s not surprising.

An emphasis on preventive care is a cornerstone of our impending health care reform: Smoking, obesity, substance abuse, auto accidents and emotionally undisciplined living extract a huge amount of precious health care resources and are totally unrelated to the availability of health care professionals or facilities. This is not new, and it is totally preventable. It depends on voluntary behavior modification by our citizens, which thus far has not been forthcoming.

When we cure cancer and heart disease, people will live longer and be more free of symptoms.

But more people will need more medical care for a longer time to address the chronic infirmities of increasing age — increasing the overall cost of health care. Like global warming, this is an inconvenient truth.

We all want the best of health care. When President Obama and the U.S. Congress say we can save billions of health care dollars each year over the next decade, we should also all want to know how.

Health care is already rationed

By Todd Huffman. M.D.
For The Register-Guard
Appeared in print: Saturday, Aug. 1, 2009
http://www.registerguard.com/csp/cms/sites/web/opinion/17196580-47/story.csp

How tiresome it is that the backers of for-profit health care continue to use FUD (fear, uncertainty, and doubt) to maintain the unjust and unjustifiable status quo.
Even esteemed colleagues are not above attempting to frighten the public with anecdotes of rationing of care and long waits. Of course, what is neglected to be mentioned is that this is exactly the situation we have now under our current “system.” Right now, right here in the United States, health care is indeed being rationed, by CEOs behind the closed doors of corporate board rooms.

Wouldn’t it be wiser, fairer and more justly American to take the tough decisions about health care out of the boardrooms and shareholder meetings and put them in the hands of professionals, patients and the public?

The truth is that the U.S. rations care more harshly than any other country. We ration care by wealth, by employment, and by age. Conservative estimates are that nearly 20,000 Americans die every year due to lack of insurance, while millions more go without needed care every day because of cost. Now that’s rationing!

Health care should be guided not by unregulated profit motives but rather by science, compassion and rational policy. It should be rationed, yes, by outcome and not by income. We must ignore when profiteers and fear mongers raise the specter of rationing when their pocketbooks feel threatened.

And as for vows, mine were “to come for the benefit of the sick, remaining free of all intentional injustice.”