Reducing suffering vs. reducing costs

Bill Gardner offers his customary wisdom:

80% of Medicare dollars are spent on persons with five or more chronic conditions. In essence, there is a great concentration of illness and expense in a relatively small group of people. […] So let’s save costs by making them healthy, or at least getting them cared for more efficiently.

I’m all for it.

But I am skeptical whether this will save a lot of money in any short run. It is true that caring for these souls often costs more than it should, because they have avaoidable hospitalizations and emergency department visits. But the better alternatives — schemes for intensive outpatient care — cost money too. Moreover, if you decide to focus your attention on someone whom your records suggests has four chronic conditions — say, diabetes, hypertension, arthritis, and glaucoma — you will often find additional undiagnosed problems — say, depression, or periodontal disease. When these problems come to light they will generate health care costs. I’m not arguing that caring for these patients is futile. You can relieve suffering, and save some money. But most of these patients will remain ill, and expensive.

So why is this the best way to cut health care costs? Let’s get our priorities straight. The reason that this is the most important way to cut health care costs is that this is where the suffering is! If we can relieve some of the suffering, and break even on cost, then this is the most important thing we can do. [Bold mine.]

In all the debate over health reform and health costs, how many of those make this point loudly and unambiguously? If we spent a little more time exploring the physical and mental anguish that some of those with multiple chronic conditions deal with — those for whom we are spending the vast majority of our health care dollars — we might retain a better grip on what this is really all about. It’s a bit like spending a fortune on repairing and renovating one’s home and never stopping to notice one’s family members who receive shelter from it.

I’m as guilty of this as the rest of the media and policy wonks, maybe more so. I might as well be throwing money at people, sick people, with disgust. It’s not really how I feel. But I don’t acknowledge them enough. If I’m going to spend the money (or, rather, if the tax revenue I contribute is going to be spent) on them anyway, I might as well deliver more dignity and recognition with the cash.

It only takes a moment to honor someone’s humanity. Let this be such a moment. And let there be more of them.

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