Lets dance in style, lets dance for a while

from Alphaville…

Lets dance in style, lets dance for awhile,
Heaven can wait we’re only watching the skies
Hoping for the best but expecting the worst
Are you going to drop the bomb or not?
Let us die young or let us live forever

Forever young, i want to be forever young
Do you really want to live forever

Dance in style? or dance for awhile? or whoever can make it to the floor, dance

And that should be the center of the debate in healthcare delivery and finance (unless you have the resources to pay for it yourself). In the midst of a global financial readjustment, an oncoming explosion in government fiscal obligations, and a fortunate relentless onslaught of better and more effective, but unfortunately more expensive diagnostic and treatment options, the discussion shifts from humanity’s fundamental right to equal access to healthcare to how do we pay for all this stuff that everyone in an ideal world should have access to without overburdening economic growth in general and without stifling innovation. (see Dr John C. Lechleiter, chairman and CEO of Eli Lilly and Company comments in Biospectrum Asia) .

In the real world, the inevitable course will be the rationing of healthcare. Whether we ration on the basis of personal wealth and who can afford to pay, or on the basis of other indirect means (treatment protocols, waiting lists, insurance criteria) , not everyone will have equal and ready access to the best in diagnostics and treatments.

If we accept this inevitable notion of rationing, then I believe the choice should be dancing in style. Society must factor in the price paid for the incremental improvements in quality of life as opposed to a focus on longevity. Length of life should be really one of many considerations and an incidental factor in determining how we dance.

Is it really necessary for a newly diagnosed 45 year old mother of 3 young children with metastatic brain tumour to undergo surgery followed by chemotherapy or radiation treatment? Possibly. Everyone would like her to live as long as possible and to watch her children grow. What if we can only add 18 months of life in exchange for invasive surgery potentially resulting in adverse neurological impairment, chemo and radiation potentially resulting in severe adverse effects, but mother and family willing to tolerate… at a cost of $250 000 USD. Who will play the role of God and decide? What if that $250 000USD had an opportunity cost of helping 1000 undernourished infants obtain appropriate nutrition and vaccines? Who will do the capital allocation in our future resource constrained world? The trade offs are huge but someone will have to play this role….OR we have to stop pretending that all men will have equal access and allow free markets and competition (note: I DID NOT say the U.S. type of “free market”) to attempt to allocate capital and resources in the most efficient ways. But no matter which path we tread, there will be haves and have nots.

Tej Deol, M.D.