Liberty and Equality,……tenets of Western Civilization that actually compete? Does predominance of one ‘right’ necessarily diminish the other, i.e., a zero-sum game?
“Full liberty for wolves is death to lambs” he wrote. Positive liberty (freedom to do ‘X or Y’), or negative liberty (freedom from ‘X or Y’)…..? Enlightenment or Romanticism? Georg Hegel or Karl Popper? Immanuel Kant or Johann von Goethe?
Do humans possess ‘natural rights’? 21st Century healthcare ethics places an astonishingly high premium on autonomy,……is that the same as choice? Do we then conflate choice with dignity? Is it conceivable to agree upon basic, true value healthcare as a ‘right’, perhaps a feature of a civilized society that cherishes children, families, the misfortunate?
Our resource pie is unquestionably finite, to secure funding for whatever your healthcare ‘right’ happens to be will involve dispute. Our glaring healthcare failure is lack of honest clarity and reasoned discussion of true value health services,….which investments produce desired health at reasonable cost?
Baicker and Chandra (attached) effectively summarize Do We Spend Too Much on Healthcare? They emphasize the importance of limiting low-value care (which per event can be expensive or inexpensive,….the point being it’s low-value). Their graphic is powerful. Do note p. 608 middle column, their exquisitely understated mathematic filet of the ‘quality-adjusted extra year of life’ concept – 2.5 days/365 x $150,000 = ~10% of what we spend per person per year in the USA.
Healthcare Spending in Premies (attached) from Beam, Zupancic et al is a wonderful contribution to healthcare economics, Figures 1 and 2 are exquisite graphics.
Joe Kaempf, MD
District VIII Member Extraordinaire
Portland, OR
Volume 3, Number 35