I back Jack.
No, not Jack O’Malley, the Cook County state’s attorney.
I back Jack Kevorkian, the Michigan doctor who helps pain-wracked, terminally ill people commit suicide.
He has my support for two reasons.
First, I think people with intense pain and no hope of recovery have a right to check out. Suicide allows them to end their suffering and spare their survivors from financial ruin. Dr. Kevorkian helps people do this in a quiet and dignified way, at home and in the company of loved ones. I say, more power to him.
Second, and in a more abstract sense, Kevorkian does a service by forcing us to confront difficult issues that we can no longer put off. Think of him as a latter-day John Brown, the militant abolitionist who used extralegal means to force the issue of slavery on a country not quite ready to decide the matter.
The issue we’d sooner avoid is this: Who’s going to make life-and-death decisions about access to expensive medical care?
I’m talking about rationing. Intentional rationing, that is, not the neglectful kind we now inflict on those who can’t afford health insurance or basic care.
The politicians and special-interest groups are in no hurry to deal with this. We are told only that Hillary Rodham Clinton has convened a task force of experts who will recommend, by May 1, how America is to provide care for all its citizens and at the same time curb costs.
There’s virtual consensus that something must be done. If not, the expense of health care, rising at quadruple the rate of inflation, will claim more than one-fifth of our national output by the end of the decade. That wipes out any chance of reducing the deficit or making our businesses competitive in world markets.
Hillary & Co. reportedly are crafting a system of “managed competition.” Employee groups and individuals would belong to huge purchasing cooperatives that would shop for care in a marketplace of competing super-HMOs. These would be like insurance companies, but with their own in-house doctors, pharmacies and even hospitals.
Within a few years this kind of arrangement could produce considerable savings. But those savings will be more than offset by the cost of bringing into the fold the 37 million people who now go uncovered. That alone is projected to cost an extra $33 billion the first year.
The only way to achieve real savings, assuming Mrs. Clinton rules out Canadian-style nationalized health care, is by rationing. It won’t be called rationing, of course, but “global budgeting.” An overall dollar limit will be set, and the powers that be will proceed to decide who will get how much care within that limit.
“Cost controls are likely to be more painful than many envision,” a top federal budget official hinted last week, “requiring consumers to accept some real limits on the quality or quantity of medical care.”
Sounds ominous. And it should.
Someone, probably a national health standards board, will have to draw up an elaborate list of medical procedures and the circumstances under which they will be provided. There will be lots of no-brainers. At long last every mother and child will be assured a minimum level of prenatal and pediatric care, including immunizations. And chances are that sick kids, with years of life ahead of them, will be denied little in the way of sophisticated medical procedures, however costly.
But what about the elderly? At what age will it be judged no longer cost-effective to provide bypass surgery or kidney dialysis? How about organ transplants? Or bone-marrow replacement?
Such are the tough calls that lay just around the corner. And maybe that’s why so much derision is being heaped on Jack Kevorkian. The militant right-to-lifers dog his every move; one Michigan prosecutor calls him “Jeffrey Dahmer in a lab coat.” The questions he raises nobody wants to hear, much less answer.
Doctors, hospital administrators and insurance companies can hardly be expected to take the lead-at least within the existing system, one that encourages patients and their families to hire lawyers and sue over services not provided.
Last week a mistrial was declared after a jury couldn’t decide whether obstetricians committed fraud by not mechanically resuscitating an extremely premature baby. Doctors said the fetus had a low chance of survival and a high chance of severe brain damage. Lawyers for the parents, who had sought $4 million, say they’ll sue again.
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That’s how policy is shaped now. Not with an eye toward long-range costs, quality of life or who must be denied care because others use up available resources. It’s every man for himself, first-come-first-served, give me my heart transplant or I’ll sue.
Are things about to change? We’ll see May 1-if we can bear to look.