May 13, 2009 09:08 PM UTC

On End-of-Life Care

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• by: Patrick Sean Byrne

I don’t believe in political third rails. If we go through life treating bad public policy like it’s taboo, eventually those bad policies will become so expensive that they’ll bring the whole system crashing down.

I am half English and half American. So was Winston Churchill, who was simultaneously the most prolific historian and the greatest Prime Minister in the history of Britain. Almost everything he said was quotable, perhaps none more than:

“Americans always do the right thing, once they have exhausted the alternatives”

In Britain, continental Europe, and Canada, people spend about 10% of their income on healthcare, as compared to 20% here in America. You might think their health outcomes would be a lot worse than in America, but actually the opposite is true.

One of the reasons they do healthcare so much better than we do is because they actually control their costs and don’t spend money on treatment for certain people if it could be better spent treating other people.

An example:

Besides London (and maybe Coventry), Liverpool was the most bombed city in Britain during the Second World War. This was because Liverpool was a strategic port, and because Hitler knew that the Allied North Atlantic Command was somewhere in Liverpool; he just wasn’t sure where. The Command was below 40 feet of concrete underneath a nondescript office building near the docks. It’s a really cool tourist attraction now; you should check it out.

My grandparents survived the relentless attack of the Luftwaffe by serving in the (very busy) firefighting service during the day and sleeping with their infant son (my uncle Tony) in the underground train stations at night.

The Nazis weren’t the only grave threat to my grandparents’ health. They somehow lived into their eighties in a city so polluted by coal furnaces that every building was black with soot.

However, eventually my grandmother Lucy was diagnosed with breast cancer. She had lived a long life, and the prognosis wasn’t good, so the National Health Service (NHS) made a simple (and ultimately compassionate) decision. They could treat her and maybe give her a year or two of diminished life, or they could spend the money treating a six-year old girl with leukemia.

Since the NHS only has finite resources, it used them to the most sensible effect, sending my grandmother to hospice, making her comfortable, and letting her live her remaining days with some semblance of dignity.

A few years after she died, my grandfather William came down with lung cancer, and the NHS made the same simple, compassionate calculation.

Of course I would rather have preferred that my grandparents live as long as possible, and I still miss them 20 years on, but it made no sense to treat them at the implicit expense of someone who would be able to live a much longer and pleasant life for the same cost of treatment.

I know that most Americans aren’t yet ready to think in these terms, but we will need to have a rational conversation about end-of-life care in this country eventually.

Right now, we spend billions of dollars a year artificially prolonging the miserable lives of terminally ill people, but we also have 40 million uninsured Americans. We are making a moral decision when we spend our public resources this way, and it’s the wrong one.

Dick Lamm was ridiculed and criticized for highlighting this 25 years ago, but he was exactly right. We have an epidemic of bad healthcare policy in Colorado and the rest of America, and it’s not going to get any better if our heads are firmly stuck in the sand.

Because I’m not a conventional politician, I am not afraid to talk about these sorts of issues. We can address them now, or we can prove Lord Churchill right yet again. Let’s do the smart thing and start the conversation.

Patrick

http://Byrne31.blogspot.com