Whoops, Sorry!

The human mind is a wonderful entity with an incredible ability to make things clear that are vague, make sense out of nonsense, and create order out of chaos. Unfortunately, it can also be totally unpredictable and come up with some really far out stuff.
Keeping this in mind, I think this preoccupation with making our health care system cost effective and sustainable has brought about such an event. I had the unfortunate experience in my years of practice to have a patient who was denied a liver transplant and died. He was denied the transplant because he didn’t meet the Alberta “criteria”. It took them three weeks to make that decision in Edmonton in spite of my many phone calls and although he was approved by the U. S. “criteria” he died within three days of his arrival in San Diego, not enough time to find a match. The Calgary newspapers had a huge spread on this individual after his death, enumerating all the good things he had done for the community, the organizations he sponsored, and the charities he supported. Being quite miffed at how long the Edmonton transplant team had taken, and the fact that they had rejected my patient for transplant, I sent the newspapers clippings to the head of the transplant team in Edmonton. (Criteria for transplant in Canada are often different than in the U.S. because our transplant teams have an annual budget that needs to be met, and therefore there are only so many transplants they can do in a year. In the U.S. the main determinants are availability of donor organs and the feasibility of good outcomes, and the patient’s ability to pay). The transplant team was polite enough to reply to my newspaper mailings and basically told me they did not make judgments on the “value” of a human life.
It was with this scenario in my mind, and the ever pervasive knowledge of the need for a cost sustainable public health care system that I had what my children would have called “a brain fart”. Maybe if we need to make our public health care system cost effective and sustainable, we do have to put a value on a human life. Since the public system is sustained by tax dollars and the very vocal groups like “Friends of Medicare” are adamant that this be preserved, we should look at every opportunity to increase our tax base for funding Medicare. Making the spending part of the equation cost effective is now past the fat, muscle and into the bone, but no-one has looked at what the public health care system can do to sustain its self in addressing the funding side of the equation.
Are you ready for this? The answer is simple, keep the people alive that generate and pay more taxes! Let’s face it, a fellow who employs 100 people, all of them paying taxes, and he himself paying a million dollars in taxes will contribute to the tax base and sustainability of the health care system more than an unemployed worker. Give the available organ to the biggest tax payer. Have your doctor just send your last tax-return along with your medical referral so that the team can make a “cost effective judgment” on who should be saved. What’s that you say, everyone in the system is to get the same care, and we should not discriminate on the value of a human life? But that’s not cost effective. Oh well, maybe my kids are right, I just had a “brain fart”. Sorry. Just trying to help.