Remember Wilde: Every life ends in a tragic death

The healthcare debate in this country seems obsessed with who should pay for healthcare, and the fear of rationed healthcare, as though it isn't already rationed.

There are the right wingers largely trying to impede any progress by scaring the chickens with the threat of 'death committees', a version of the UK's NICE committee that decides when a drug is too expensive to approve. They have established a value of life cash amount of around $30K/yr, and if a drug costs more than that and doesn't significantly improve the patient's life, it is not approved and is available only to those who don't need insurance. Our 'death committees' would presumably follow suit, putting dollar amounts to quality of life and letting Granny die because Coumadin costs too much.

Then there are the left wingers, and this is often younger folks, who don't want to pay into a health insurance program knowing they are subsidizing the cardiac care of old people who eat the classic 'western diet' (i.e. fatty foods). Interestingly, I've read that insurance companies seem comfy insuring these elderly cardiac cases (they usually avoid those with 'preexisting conditions') so long as the youngsters are required to sign up - so the left wingers have a salient if selfish point. Needing very little care, they will be paying the same as the elderly cardiac patients...

So, healthcare rationing and who pays for this rationed healthcare? It seems clear that nobody under thirty wants to pay for anyone but themselves, and most everyone wants to believe we don't ration it. John Mackey of Whole Foods recently wrote an op-ed (and is being cross-nailed for it) proposing eight steps to better healthcare. I mistrust the advice of any millionaire on this issue, but Step 6 I like: make costs transparent so consumers understand what treatments cost. My current carrier, BCBS, does send FYI notes to us, detailing our claims and what was paid. It is enlightening - one sees the dynamic tension between what a physician wants to make and what the policy pays and there's usually a gap. I don't know how common this practice is, but if we all knew exactly what payments are made on our behalf, maybe that would smarten the debate, one way or the other.

As for rationing healthcare: a simple search of your favorite engine (yeah, probably Google) using terms like 'insurance denies claims' will net you much reading material, largely protests from angry Americans with denied claims for expensive medical treatment. It's easy to find human interest reporting on fund-raisers to pay for the treamtent or medical device an under or un-insured soul otherwise can't get? Our insurance carriers already have their version of the NICE committee/Death Committees. Wouldn't you like to make that process more transparent?