Perfectibility

Prohibition was about human perfectibility, that humans can be perfected. You could have the perfect marriage if you could eliminate alcohol. from Ken Burns’ Prohibition

I watched Ken Burns’ Prohibition on PBS last night. A group of people decided what would be best for everyone else. Armed with moralistic fervor inspired in equal parts by their G-d and their fear of others (immigrants and non-whites), they campaigned to eliminate someone else’s vice. And they succeeded in part until they failed entirely.

There is a shocking parallel between the Prohibition movement of one hundred years ago and today’s health care debate.

Part of what drives the current discussion is this concept of perfectibility. If only the profit motive was removed from the delivery of health care, if access was unlimited, then no one would die before his/her time.

• Can you really remove profit from health care?
• How unlimited is unlimited?
• When is it our time?

The simple answers are – NO!, Who knows?, and Gosh, what a silly question.

Doctors need to be paid.  Medical equipment suppliers need profits to build their businesses.  Pharmaceutical companies risk millions to develop new compounds that may cure illnesses and alleviate pain and suffering. The insurers play a role in all of this, too.  Eliminate them, the market organizers, and their function will have to be performed by the government. You may debate whether that would be more efficient that the businesses, but to deny that money is a key element in the delivery of health care is to deny reality.

Heart transplants? Liver transplants?  Any age?  Any health status?  Should a 75 year old overweight diabetic with bad lungs from years of smoking stand in the front of the line waiting for a new heart?  There have always been, and always will be, some limits to access.  What we have not had, as a country, is an open, honest discussion about limits. We are not talking about death panels.  We are talking about realistic expectations.  What is society’s responsibility to the sick and injured?

The last part of this is the most difficult.  Who amongst us wants to address our own mortality?  No amount of health care would keep us alive forever.  We are not machines.  Yet there are people who claim that changing our health care delivery system will magically enhance our life expectancy.

Which returns us to this concept of human perfectibility. Can we improve the payment and delivery of health care in the United States? Absolutely! The first steps will be transparency and an honest discussion about achievable goals.

Now would be a good time to start.