One of the most fascinating quotes in this article was Dr. Kirschner's (the doctor who replaced Schaller as administrative head of the AHCCCS) view that "a public program with limited resources must establish clear priorities for treatment." For Kirschner, this meant dollars should be spent where they had the greatest effect, so he advocated spending more on prenatal health care for the poor. His reasoning was that prenatal care cost about $2,000 per case, had effects that could last an entire lifetime, and whose benefits would be felt be a wide swathe of society as a whole.
Although I will confess to not having yet formed a definite view of right and wrong in this case, Kirschner's philosophy makes a lot of sense to me. As long as the Arizona legislature was representing people who believed in small government, lower taxes and pick yourself up by the bootstraps philosophy, it had to pick and choose what it covered. And it seems completely reasonable that low-cost, widespread, high-benefit policies would be the priority. Rep. Resnick made a strong argument when she said, "If it was just pure concern about the [medical] needs out there, we'd have far more burn units than we have transplant units."
I'm not defending the mentality of minimalist, libertarian-esque voters, nor am I condemning them. I am simply trying to say that the legislature's task was mammoth, and in a case like this there could be no winners--either the state government's finances collapse (and who can say what far-reaching consequences that would have?), or a Dianna Brown case would occur. It is easy to simply say a person's life is worth more than a balanced budget, but the truth is no system would be perfect. Someone would get left out, or the public would get left out. That's all there is to it.
Resnick's philosophy may seem harsh, callous and utilitarian, but sometimes there is no better choice. If the American people are not willing to pay for universal health care, health care will not be universal. If this is the case, there will always be tragedies like Dianna Brown's. And one last thought. Kirschner said, "Every time we bring a new person into the world, we accept the fact that that person's going to die, and we're almost reaching the point in society where we want to repeal that biological fact." Again, it is harsh, but this simple truth must be addressed: everyone is going to die for some reason eventually. Death is always a tragedy. Does that mean someone must be to blame if the death could have possibly been prevented? Or should we resign ourselves to the fact that sometimes the costs of keeping someone alive are simply too high to pay?
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That final quotation of Kirschner's that you brought up is harsh, but yes, it's definitely true too. Upon reading it, I wished he had followed it up with something about how people have different times to die, and that nobody likes it. I also agree that what seems most feasible in this situation is the idea of spreading the money around so that it can do the most good for the most people, though I generally don't think of myself as utilitarian. I believe that your recognition of the type of legislature set-up in Arizona at the time and what it implied convinced me:
ReplyDelete"As long as the Arizona legislature was representing people who believed in small government, lower taxes and pick yourself up by the bootstraps philosophy, it had to pick and choose what it covered. And it seems completely reasonable that low-cost, widespread, high-benefit policies would be the priority."
It makes sense to me. If you choose to pursue very little health support for your constituents for whatever reasons, I think that helping out the most people with the least amount of money is the only option you've left yourself.