As a medical resident in a busy hospital, I learned the terrible nature of a drug called dobutamine. Injected during a cardiac "code" into someone who was dying, the drug would restore a pulse and blood pressure to all but the most lethally compromised. We'd intubate, do CPR, and send the poor wretch we were working on to the ICU - often with several broken ribs from chest compressions -- where the poor bastard would usually die a week or two later.
What I'd like to put out there for consideration -- as our present medical insurance system wobbles toward collapse, along with the rest of the economy -- is how much this stunt costs.
Medicare, as we know it, is in near-collapse. Unlike social security, the medicare trust fund is near bankruptcy.
The cost of health care overall has grown from about 4% of the gross domestic product in the 1970's to 16% now - with costs sure to rise further.
Powerful physician (I'm a MD myself) pharma, and other health-care industry lobbies block meaningful changes as the cost of the program spirals out of control. Meanwhile, more and more citizens lose access to the most basic (and socially cost-effective) care.
There are plenty of simple ways to save money: restricting use of expensive "copycat" drugs, for example; or limiting compensation to the vast body of for-profit players raking in huge profit under the present system. But the problem of cost growth is deeper than that.
One problem is that people near death are typically kept alive - at enormous expense and often physical agony and spiritual degradation - before we let them die.
Presently about 50% of medicare spending is devoted to people in their last 6 months of life -- extremely expensive ICU and aggressive care of people who are extremely unlikely to survive more than a few years at best.
As technology improves, our ability to keep people alive a bit longer expands - at tremendous cost. Meanwhile we don't pay to care for a 45 year old's diabetes and high blood pressure.
But the other option - limiting end-of-life care which can be live-saving in a minority of cases, is politically and morally very difficult. I wouldn't feel good about an insurance company hack telling me it was time for my dad to die -- would you?
I'm not saying I have the answer. I care passionately about providing medical care to my patients, and I believe that everyone should have access to excellent medical care.
But as a progressive society, we need to have a straight dialogue about some of these tough questions; not just feel-good promises of "Universal" health care.