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Point of View: How Does Government Pay For Services People Want?

By Henry J. Stern
Former NYC Parks Commissioner
 
NEW YORK — One recurring problem in government is the shortage of funds needed to meet reasonable demands for services by the public.
 
This situation occurs for a number of reasons. One, when payment is made by a third party demand for services increases substantially; the more that is provided, the greater the level of expectation for additional services. 
 
These demands, although costly, are not inherently unreasonable. But the question is where to draw the line.
 
At what level does one provide or discontinue treatment for autism-spectrum disorders, dialysis or other serious medical conditions? To what level of existence is it ethical to condemn a patient because either he is uninsured or has exhausted his benefits?
 
It may also be asked, how can society support the steady increase in heath costs which is far above the GNP? Even if 90 percent of the waste or inefficiency were eliminated, wouldn’t society be engaged in a game of desperate catch-up with the rapid advances in medical science that greatly increase our lifespan without adequately addressing the complications that arise from advanced age? The conquest of certain disorders has led to an increase in death rates from other causes.
 
Ultimately, the bottom line is that sooner or later everyone dies. One might live for 10 years on a respirator, but that does not answer the questions: Who turns it on, who turns it off, whose consent is required and what is the quality of life? That is why many people, although blessed with good intentions and capability, often move away from the field of medicine to pursue other endeavors after early participation.
 
When I visit pediatric wards, I am struck by the relative cheer of the patients and staff, even though some children are suffering from terrible diseases. The situation New York City faces is similar to the problems of many other cities. Unless health care becomes a recognized reimbursable right, the situation becomes more serious over the years to come. 
This is not a question of wrongdoing by one group of individuals, although there are professional parasites who prey on people’s fears for their own private profit. If you care for an elderly or disabled person, you know the steady toll it takes on the rest of us (or, as the politically correct now refer to the majority somewhat dismissively, the temporarily able-bodied).
 
When Sarah Palin sounded what became a national alarm on “death panels,” which she falsely said would empower federal bureaucrats to determine the life or death of every American by their authority to prioritize medical care, she struck a sensitive chord that becomes more important to people as they grow older and begin to feel the ravages of physical and mental deterioration.
 
Behind Palin’s distortion, there may be a small truth. The fact that decisions on life or death may be made in part by unrelated professionals, rather than family members, alarmed not only the Tea Party crowd, but others who believed that they would have the last word as to whether they and their elderly parents continued to live in comfort and dignity. For how long should lives be extended by increasingly artificial means and substitute organs? How should we take into account the nature and the consequences of age-related illness, the possibility, if any, of recovery, and the depth of the pockets of the afflicted and their putative heirs?
Even though in fact, the survivors’ and dependents’ choices would be severely limited by the same market forces they extol in principle, it is part of American exceptionalism to believe that we can do whatever we really want to do.
 
Many people’s views on issues of health are heavily influenced by the amount of physical and emotional pain they are enduring. Also, since people’s pain thresholds are believed to differ widely, it is difficult to set standards for human suffering. The role of government in measuring or postponing the death of particular individuals is an area that requires both better monitoring and sound judgment. The religious or philosophical views of the person dying should also be given more credence and respect than they receive today.
 
Speaking only for myself, I want to determine when my life should end, rather than leaving the issue to strangers who may have economic interests which conflict with my wishes and those of my family. Someday American society will advance to a level where my wife and I will receive the same consideration that we gave our dog Boomer in 2004.
February 13, 2012 - 1:07pm


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