A Meditation on Health Care

As I sit in the Monday predawn light at Muang Khoua, a small town in northeastern Laos, the House has probably already voted on health care reform in the United States, a bit over 8000 miles away, where it is early Sunday evening.   There is no internet here – so I won’t find out the results  until we reach the larger town of Udom Xai.

 

I just finished reading “True Compass,” Ted Kennedy’s final memoir.  Toward the end of the book, he recounts his joy (and pain) upon discovering that methotrexate was indeed beneficial to adolescents with osteosarcoma, like his son Teddy Junior.

 

Teddy’s treatment, like that of the other children suffering from cancer, was free in the first six or seven months, because it was part of an NIH experimental grant….[when] the experiment ended, the patients’ families were billed for the remaining treatment.

I will never forget sitting down and listening to those parents.  Suddenly, they were faced with finding a way to scrape up three thousand dollars for each treatment. The treatments were necessary every three weeks for two years. These families were terrified.  They could not begin to afford it.   They would tell me of being reduced to grim, almost macabre calculus: How much of a chance…did their children have if they purchased the resources for only a year? Or eight months?  Or six months? …Many had already borrowed to the limit.  Others had sold or remortgaged their homes.

 

I’m hopeful that the House will have passed this legislation – however imperfect.   By regulating certain insurance practices and providing subsidies for those of modest income to obtain health insurance, we will increase “medical security.”  By mandating that all obtain insurance, we will diminish the problem of adverse selection.  In the end, we need to genuinely lower the rate of inflation of health care costs. This bill decreases the rate of future Medicare increases – so puts pressure on the provider community to find ways to continue to advance practice while restraining cost increases.   There is certainly no guarantee that this pressure alone will be enough to manage health care costs. Without this pressure, costs will continue their inexorable rise.

 

I’ll be back to travelogue tomorrow.