Friday, October 24, 2014

Benefits and Limits of Health Care Intervention

No participant in controversial , unfinished enterprises can pretend to unblemished objectivity. No claim is made that the discussion here is confined to the facts or the facts as presented are argued with scientific detachment.

Townsend Hoopes, Undersecretary of the Air Force, in Limits of Intervention, David McKay and Company, 1969

As ObamaCare, as we know it and President Obama meant it, draws to an end, the words of Townsend Hoopes resonate. Hoopes was describing the approaching end of the Vietnam War, and how military intervention was being de-escalated. Similarly some ObamaCare aggressive health reform policies will be modified or reversed.

It strikes me we are in a period of reversing many, but by no means all, of the policies embodied in the Patient Protection and Affordable Care Act. Some of these policies, such as expanding the pool of the insured and recognizing the plight of minorities and the poor, are beneficial. Other policies, intervening in the private affairs and choices of citizens, are harmful and have reached their limits.

Limits of Government

Government , and its intervening bureaucracies, can do only such much to improve the health of the nation. Government can purify the water, eliminate environment hazards, introduce public health measures to prevent and contain infectious disease, outlaw or make prohibitively expensive drugs and cigarettes, monitor deleterious human behavior, and supplement and regulate the education of health professionals.

But government cannot eliminate poverty, guarantee family cohesion, enforce education, change the negative ways they choose to live, limit their freedoms and choices, or redistribute health and wealth benefits without disrupting society. Nor can government ignore the consent of governed, or the activities of political enemies, domestic and foreign, should either consistently oppose , flaunt, and undermine government programs.

Limits of Medicine

Modern medicine has its benefits. It has effectively eliminated infectious disease in developed countries, developed drugs and surgical interventions to cure disease and degenerative conditions, and, by one means or another, lengthened life spans from 47 at the turn of the century to the 80s and beyond today.

But medicine has its limits. It cannot expand life expectancy indefinitely. It cannot reverse the end of life or the conditions that produce that end. It cannot reverse the irreversible. It cannot alter one’s genetic predispositions. It cannot, in most cases, change the life style or embedded behaviors of patients, whom it sees only occasionally and then only for limited times. People lead their lives outside of bounds of medicine. It cannot change the career choices of its practitioners, who tend to choose lucrative specialties, who prefer to practice in attractive urban surroundings, who like to exercise their clinical judgment and practice autonomously rather than bow to government mandates.

Limits of Technology

We live in an age of technological marvels. These marvels include the Internet, artificial intelligence, social media connectivity, robotic substitutions, genetic engineering, space exploration, satellite monitoring of earth, air conditioning, hydraulic extraction (fracking), data measurements of health care population outcomes, and instructional and mandatory protocols. These activities have unquestionable benefits.

But they do not replace personal human interactions. They do not replace human narratives. They do not replace human creativity and collaboration. They are supplemental, not elemental in improving the human condition. One cannot change humankind through technology alone.

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