Wednesday, August 19, 2009

My God! I'm Going to Die.

The Flaming Lips' song 'Do You Realize' has a quote that while at worst falls prey to emo-culture is at best the foundational statement of existentialism: "Do you realize that everyone you know someday will die."

I think about this amid the rancor and vitriol which is currently masquerading as a public discourse about health care reform in this country. This goes for both sides; conservatives and liberals.

Apparently, Rush Limbaugh is saying that White House health care reform will 'kill grandma.' And, I really have little interest in that fight. What I find more interesting is that no one seems to realize that grandma, along with everyone else you know will someday die, including me.

Such a blunt proleptic prognosis is sobering. It also elucidates a grim reality about the ultimate efficiency of modern medicine, it always loses. The house, just like death, always wins. Christians may have a rejoinder, but that's another topic. No surgery, vaccine, or rehabilitation program will ever stave off the sting of death forever.

Heath care, no matter the delivery system, is a scarce good confronting an ever increasing need and never satiated demand. Health care 'rationing' seems an uncaring or even crass description of squaring the supply of it with the demand for it. But, it is the reality, and it must be faced.

Peter Singer wrote an editorial for the New York Times a few weeks ago that framed the issue of rationing quite well.

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

Yet, Christians, rightly, may not find rationing a theologically, if not pastorally, acceptable. Stewardship, however, I think, offers a refreshing paradigm in understanding healthcare. Stewardship implies limitedness. It helps suggest that while healthcare is a good and is Good, that it cannot overcome death and must be understood in light of this fundamental limitation. After realizing that everyone we know will someday die, we then turn to the task of health care policy. This does not make the task easier, it will probably make it ever the more gripping and painful, but it may also offer a platform for real public discourse.

What do you think? I'm interested to know.

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