Limits of health care, limits of technology - History Lessons and Health Care Arguments

In his new book, The Thirteen American Arguments: Enduring Debates That Define and Inspire Our Country, Newsweek columnist Howard Fineman says the American penchant for arguments is all for the best.

"We are an Arguing Country," he writes, "born in, and born to, debate. The habit of doing so--the urgent, almost neurotic need to do so--makes us unique and gives us our freedom, creativity, and strength." Rather than arguing too much, which is "the conventional wisdom's critique," he notes, "we in fact do not argue enough about the fundamentals." Our never-ending, evolving disputes shape the very essence of America, he maintains, serving as a blessing rather than a burden.

In health care, current arguments boil down to Big Government vs. Individual Choice, and Health 2.0 vs. Human 2.0.

• Government and Choice - Proponents of government care argue only government has the wherewithal and wisdom to cover all the people for the common good. We’re doing it in Social Security, Medicare, and National Defense, why not for Health Security for all? But, ah, say historians, America is built on the Constitutional foundation of checks and balances – on a bottom-up system of governance giving individuals the right to check the power of government to intervene in individual lives.

So who will win this argument? When will reform occur? Not this year or next, maybe not even in the next decade. After all, Americans have been arguing about national health insurance since 1912. Health reform in America is an evolutionary and incremental phenomenon. What will it take? Probably a charismatic, bullet-proof President with a veto-proof, lobby-proof Congress, a promise of no tax raises, no goring of special interest oxen, and cooperation of physicians to deliver the goods.

• Health 2.0 vs. Human 2.0 - Health 2.0 is the next generation Internet with increasing simple applications and simultaneously more sophisticated software allowing ever widening access and uses of information at the site of care by end-users, namely patients and doctors. Proponents of Health 2.0 argue that the health care world already runs on Internet time, that friendly end-user search and social networking programs empower and enlighten everyone; that we can now aggregate data, spend money rationally, predict outcomes, and intervene wisely; and that we can make real-time, informed decisions everywhere, anytime, every time.

Wait a minute, argue skeptics. Health 2.0 creates electronic straitjackets constraining individual choice, imposes artificial, often irrelevant decisions on doctors and patients that don’t fit real-world conditions; invades and threatens privacy and security of patients and doctors; gives payers unwarranted power to monitor and police those seeking and giving care; and, in many ways, overcomplicates, in many cases, simple clinical situations. Besides, say opponents, a computer in the same room situated between a doctor and a patient changes the human chemistry between the two. Some things are best expressed through the head of a pen rather than the click of mouse. Computers are not magical machines. Computers are human tools.
And so the arguments continue.