Health care systems kill people. So what?
posted by Nate Oman
As the debate over health care reform slogs on, a particular kind of argument has become quite familiar. It goes something like this:
Health care system X is a bad system because it kills people.
In support of this assertion, we are then treated to a set of anecdotes about how this or that person died as a result of this or that health care system break down. Hence, we see critics of Obama’s proposals trotting out horror stories about how NHS bureaucracy resulted in the death of this or that Briton’s loved ones. Likewise, we see supporters of health care reform unearthing heartbreaking stories of how the American patchwork of private insurance and Medicare or Medicaid killed off dad or mom. My question is, “So what?”
My point in this post is not to argue the merits of this or that proposal. I’ve got opinions on those things, but I’ll save them for another time. Nor do I want to create some kind of equivalence between all health care systems. America’s strikes me as exceptionally expensive and inefficient. Rather, I want to make a much simpler point:
All health care systems kill people. All of them.
They do this for three reasons. First, death is not ultimately preventable. We all die, although in the United States in particular we seem loath to acknowledge this fact let alone let it influence how we think about health care spending. Second, and perhaps more importantly for our purposes, things always breakdown. Even a system designed by smart people of good will will, for time to time, go horribly wrong and do something stupid. Unfortunately, this holds true in health care, where the stakes are high, and the forces of entropy and stupidity can kill. Finally, nobody has ever been willing to spend infinite resources to eliminate every preventable death. Every day we all engage in behavior that creates some non-trivial likelihood of death because the costs of doing otherwise are prohibitively high. Using automobiles is an obvious example, but a moments reflection will multiply them. The unvarnished truth is that we necessarily are willing to let people die preventable deaths.
As a result, I find myself unmoved by the stories of grandma killed off by the NHS or dad left to die by an insurance company. Health care systems kill people. So what? Can we start having a real discussion?
September 15, 2009 at 7:48 am
Posted in: Bioethics, Health Law, Tort Law
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Responses (3)
Daniel S. Goldberg - September 15, 2009 at 8:28 am
Nate,
While I generally agree with the tenor of your post, the fact that iatrogenesis inheres in all health care systems does not licence the conclusion that there are no substantive and ethically important distinctions to be drawn between the prevalence and nature of iatrogenic harm in different health care systems.
Thus, the well-established fact that a preposterously high percentage of the interventions used and care deployed in the U.S. seems to be of little benefit (if you go by the Dartmouth Atlas evidence, as high as 30-40% in some regions) may be relevant to an ethical analysis of comparative health care systems.
However, the most important point, once that is currently virtually undiscussed in the reprehensible “discourse” on health care, is the absence of any significant link between the distribution of acute care services and population health. That is, we are obsessed with health care, when what we ought to be talking about is health. We generally assume a tight connection between the two, when robust evidence suggests the connection is extremely weak on the population level.
Still, if we are determined to discuss health care rather than health, iatrogenesis is certainly relevant, even if horror stories about a particular system killing persons are not substantively as significant as they are often trumpeted to be. Nevertheless, if there is one thing we can definitively say about health care discourse in this country, it is, historically, that narratives are what move people, including horror tales.
SusanS - September 15, 2009 at 7:20 pm
I don’t think nothing makes a difference follows from this post.
mila - September 24, 2009 at 1:58 am
Hi all,
I just like to remind you about HISTORY.
My teacher says: after discovering America in 14s
Europe wanted it to serve as “rubish bin” for less “Noble\”.
So many of those unfortunate transported people died after they were used for sciantific experimental purposes as part of population control.
The same happend later to Australia and New Zealand.
For last 200 years our Health Systems are STRONGLY linked to Law and Bank system and controled by Wall street.
Your displayed scull is very good example why our dentists are dangerous.
With dental lobotomis that are in practice
for more than 100 years we have dentists serving as real “Scull and Bones” members .
Without dentists acting as disgised canibals it would not be any”R&D”.
Please tell, me would any of you be prepered to pay for “Preventative Dental Treatment” that would turn out to be one of Mengele’s experiments?
Stay in good health!
Mila
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