Map of life expectancy at birth from Global Education Project.

Thursday, May 17, 2007

A useful summary of the changing zeitgeist

It's subscription only, but that's probably just as well because you don't necessarily need to actually read it, but anyway Ezekiel Emanuel uses a rather strained analogy to George Carlin's famous "Seven Words You Can't Say on TV" to review changes in broad perceptions about health care over recent decades.

If you've been reading this blog, you won't find anything new here, but I agree with Emanuel that what was once considered offensive or ridiculous is now generally accepted. The three big changes are:

The U.S. has the best health care system in the world: I used to give a talk every summer out on Cape Cod. I remember denying this in my talk back in, oh, '95 or so and having some people in the audience get on me like Abu Ghraib dogs (if I may project a current metaphor into the dark backward of time). Specifically the offended ones were medical students, as I recall.

Well nowadays just about everybody who isn't faith-based, including I'd venture to say your typical medical student, knows that the United States does not have have Th' best darn health care system on the planet. Nope. We pay twice to three times as much as everybody else, we don't cover everybody, and we get worse results. It is now okay to say this on TV, and on Cape Cod.

You can't put a price on health care: Ezekiel's formulation is "Health Care is Special," but what he means by this is that it's offensive to "ration" health care and to consider cost as a factor in whether we give somebody a brain transplant in a desperate attempt to extend their life by seven minutes. Well, health care is costing so damn much nowadays that it seems the biggest worry people have about it is how to spend less, and there has been a basic cultural revolt against squandering treasure on the hopelessly terminally ill and the vegetative.

Of course religious fanatics continue to be an exception, but as the bizarre Terry Schiavo case showed, they are in a distinct minority. It is now okay to say that sometimes, it just isn't worth it, although I believe you could always say that in Wellfleet.

New is Better: As Americans, we have a profound affinity for the innovative. All an advertiser has to do to sell sugar water or a toilet cleaner is to put up


above a picture of the product. But lately, we've learned the hard way that in health care, new isn't necessarily better -- whether it be Vioxx, or drug eluting stents, or hormone replacement therapy. In fact, it is the height of wisdom to suspect that the new is worse, and even quite likely dangerous, until sufficient time has passed for it to be proven otherwise, at which point it is no longer new.

I'm not sure you can quite say that on TV yet, the idea is still too new. But soon . . .

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