Blind Faith and Choice
George Orwell's book 1984. published in 1949 proved to be an accurate harbinger of the dependency so prevalent in our world today. I was struck by the juxtaposition of a recent article in Health Affairs and an article in the Wall Street Journal which illustrate how far we have come down this road. In the first link, Dr. Rhiannon Tudor Edwards ( a name with great historic interest to thoracic surgeons) founding director of the Center fro the Ecomomics of Health at the University of Wales, Bangor in the UK described her experiences in the US during a fellowship year at a health studies center in Seattle . She is blind, and traveled with her seeing eye dog. The dog came up with a lump on her side which necessitated a visit to a veterinarian.Upon arrival at the vet's office, she was seen immediately in a pleasant environment and offered a choice of three veterinarians to help her dog. She was charged $120 for the service, and went on to explain that in the UK all seeing eye dog veterinary costs are covered thoughout the life of the dog. She then developed a sinusitis herself.and went through a bewildering process of finding a provider (ie doctor) who was acceptable to her insurance carrier. "The irony was that in the U.S. there was more choice of providers unable to offer me an immediate appointment ( 24-72 hours delay) while in the U.K. it is routine to wait a day or two for a primary care appointment at your nearest general practitioner clinic. It is possible to choose with which clinic to register, however in practice we simply registered with our nearet provider." She then comments on the overwhelming array of ice cream flavors at Baskin-Robbins ice cream shop. Her final comment on all this "as consumers, we are expected to pay for the privilege of choice, and if we cannot pay, we do not get to choose and ,more than likely, do not get at all". This last statement is always frustrating for me because it shows how even health care economists from Europe do not understand that no one in the US goes without medical treatment. Everyone gets treated, but it may not be as convenient as private health care, quite similar to the difference in convenience to getting your health care in the UK in the Public Health Service Hospital as opposed to Harley Street. I used to have a list of politicians in the UK who had various medical procedures, and not one had their surgery in a Public Health Service Hospital, but that is another story. Now the other article has to do with the value versus cost argument. A drug for Alzheimer'sdisease, Aricept, has appeared in studies to help in some patients, at least for a while. The National Center for Health and Clinical Excellence in the UK developed a mathematical and economic model to test the value-cost parameters for Aricept and decided to remove it from the formulary, although only for new Alzheimer's patients. The coat is $1500 per year, and it is not clear if a patient or his family could buy the drug privately if they so desired. Which gets me to my point. By turning over decisions on our health to a mathematical-economic model, as well intentioned as it might be, is to put more trust in the wisdom of the process than I am will to concede is justified. In Orwell's book Big Brother, through his agents, says," one of the aims of the Party is to extinguish once for all the possibility of independent thought--the Party sought power because men in the mass were frail cowardly creatures who could not endure liberty or face the truth, and must be ruled over and systematically deceived by others who were strongr than themselves." When we cannot think for ourselves, when we cannot make a choice, particularly at a time when more and more information is at our finger tips, I believe the future is bleak. And so it goes.