Wednesday, January 18, 2012

The Limits of Health Reform Intervention

All I want is a warm bed, a kind word, and an unlimited life and power.


January 18, 2012 - Capsizing of the giant Italian cruise liner brings to mind the gigantic revising and upsizing of the U.S. health system and limits of health reform. Expert guidance systems may not keep you off the rocks when human beings are involved.

The unfinished business of health reform is a story about limits of government intervention and federal power. Everything in human affairs has limits. The health system is no exception. In health care and medical care, which are not the same thing, as in everything else, the sky is not the limit, measures of outcomes is not the limit, estimates of costs is not the limit, wisdom of the elite is not the limit, wonders of medical technology is not the limit, power of federal intervention is not the limit, human folly, abuse, and overuse is not the limit. The human condition and human nature are the limit.

The limits are human desire to live another day in the best health and the best functional condition one can, the desire to have access to the best medicine has to offer, the dream of participating in a free and open society that doesn’t limit one’s actions or behaviors, and above all, something that few ever mention – acknowledging the limits of human biology. These are the limits.

• Human longevity has limits, somewhere around 110 years in the best of times, provided one’s mind remains intact. To pretend or predict otherwise is foolish, even if one blindly believes in gnomes and genomics.

• Human reproduction has limits, somewhere around 45 for women, unless, of course, one wants to prolong the reproductive cycle with artificial intervention, which, after all, is artificial even superficial for most of humankind.

• The human brain has its limits, somewhere around 5 minutes without oxygen, somewhere around an IQ of 200, and everywhere when it comes to foresight, judgment, and reasonableness.

• The human vascular system, which supplies oxygen, the stuff of life, to our vital organs, has limits - every pathologist knows the years deposit lipids on arterial walls, stiffens the vessels, and mankind is as old as his arteries.

• Human behavior – its wants, flaunts, haunts, and taunts – has limits. Humans will always do what they do to pursue happiness, pleasure, and power.

• Human cultures have limits and are set in stone by the time one reaches adulthood and beliefhood. Witness the world’s great religions, belief systems, hatred, bigotry, and conflicts and conflagrations that ensue.

• Human disease has limits. Most human diseases have mysterious origins and limited fixes, although it is incumbent for medicine to probe the mysteries and to create the cures when nature allows.

• Human benevolence has its limits. There is never enough money or resources to do what needs to be done, and there is always malevolence lurking around every corner, across every border, and in minds of adversaries.

• Human technology has limits. Technology can create artificial intelligence, but it always just that –“artificial”; it can amass data to guide us to more rational solutions; it can connect individuals to one another; it can disconnect them from corporate and political masters; but it cannot basically alter human conditions and limitations, nor can it intervene to reform everything human.

Tweet: As in everything human, health reform has limits of intervention.

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