Night in the Emergency Room

Walking out to lunch yesterday in the 99% humidity I started to feel an odd heaviness and pressure on the left side of my chest. No pain, no shortness of breath or anything else out of the ordinary, so I thought, “’ll go away.”

Thanks, Boss, but isn’t there a better way?

I didn’t take in any shows while in Las Vegas, but I did see a presentation on healthcare trends by futurist Andrew Zolli that was almost as eye-popping. According to Zolli, the price of a typical new car in the U.S. includes about $1,000 in materials…and $1,200 in health insurance costs for the men and women who built it.

One of the most significant factors in the perpetually rising cost of healthcare is the distorting effects of employer- and government-paid health insurance that insulates the market from supply and demand. If you have health insurance today it is most likely an employee benefit from your job, thanks to an act of Congress more than 60 years ago. Today at least 25 congressmen would like to undo that. Before you reach for the tar and feathers, however, allow me excerpt a couple of articles that set the stage.

For a little history, here’s what Karl Zinsmeister wrote in the March issue of The American Enterprise magazine (boldface emphasis mine):

The root of this is very simple–and it is an accident of history. During World War II, while strict wage controls forbade companies from paying higher salaries, firms short on labor grew desperate for ways to attract and keep badly needed workers. They discovered the government would let them pay the health costs of employees as a kind of backdoor substitute for increasing their wages. And health benefits, unlike wages, weren’t taxed, a loophole that made them even more attractive to both workers and companies than cash wage increases. Employer-paid health benefits soon became universal and permanent.

The unforeseen side effect was that it became uneconomic for Americans to buy health care for themselves. Why pay your own doctor and insurance bills with after-tax income when your employer can do it with pre-tax dollars? Soon health care seemed like a “free” entitlement to average Americans. Given that something like 80 or 90 percent of our health care costs are now picked up by someone else, it’s no wonder that medical expenditures in the U.S. have soared to 15 percent of our national income (roughly twice the level of countries like Japan, the U.K., and Italy).

What if those World War II employers had offered instead to pay the grocery bills of their workers? Imagine if today hardly anyone handed his own cash to checkout ladies, but instead a food co-op or insurance company selected by your boss covered the costs of whatever food you consumed. You can be sure that 1) You’d be spending a lot less carefully (and a lot more) on groceries today. 2) You’d have much less individual control over your diet. 3) The grocery and food-provision business would be far less efficient and varied and competitive and cost-controlled–almost certainly it would be one of the more troubled sectors of the U.S. economy.

Hmmm, I wonder if opportunistic politicians might be organizing bus rides for seniors to Canada to buy back bacon? Similarly, do you think you’d be happy if the groceries by government plan required you to spend a large chunk of your “benefit” on groceries you didn’t like and didn’t need, even if you never consumed them?

Charlotte’s Web: When the State Decides if Your Baby Shall Live or Die

Don’t stop me if you think you’ve heard this before:

A British court decided last week that 18-month-old Charlotte Wyatt need not be resuscitated by her doctors if her breathing fails. The unusual twist to this story, at least to American ears, is that it is the doctors who sought and received this sanction over the steadfast objections of Charlotte’s parents, described as devout Christians, who believe she can still thrive.

My take on this may not be quite what you anticipate either, but stick with me for a couple of paragraphs.

Here are the details: Charlotte was born very prematurely at just 26 weeks of gestation, and has been hospitalized since that time. The doctors say she is in constant pain and cannot have a meaningful life. She was born in October of 2003 and the doctors originally said she would not survive the winter; they now say she will not survive infancy. Her parents say she has become more responsive and, though impaired, can see and hear to some extent. (For more details read this story from Friday’s StarTribune or visit this Q&A on the Charlotte Wyatt Case from the BBC.)

While I can’t possibly know what this girl’s condition and prognosis truly are and what is best for her, I’m strongly in favor of leaving these decisions to her parents. That said, there are things I do know about that give me pause about this case and the many others like it yet in store.

First, what caught my attention when I read Friday’s Strib article was that it is the doctors that want to deny resuscitation and it ended up in the High Court because the parents wouldn’t agree. In my day job I frequently work with a group of nurses who provide healthcare consulting nationwide for high-risk pregnancies and newborns. I asked and was told that Charlotte’s situation would be highly unlikely in the U.S. One nurse even told me that you might have a better chance of finding a case where doctors were advocating for more care or intervention than the parents were willing to try.

I’m generally suspicious of anything that purports to be a microcosm, but this case does illustrate for me the difference between not just Britain’s nationalized healthcare system and the U.S., but between socialism and capitalism as well. For all the hoary cliches proponents of each system throw at the other, this is a case that shows that under socialism the State definitely does believe that it ultimately owns your children, and will act accordingly when it has to.

As a parent, it is bad enough for me to imagine doctors coming to me and saying there’s nothing they can do. It would drive me right over the edge, though, if they were to come and say there’s nothing they will do – and to have that decision enforced by my government.

Earlier I mentioned that there will be many more of these types of cases to come. There’s some social commentary involved there to be sure, but this observation is mainly due to the improvements in medical technology now available to us. Another one of the things I’ve learned from our group of nurses is that it is now possible for babies to be born at 24 weeks (not 26, like Charlotte) and survive. A high percentage of these babies don’t survive, and there are definitely developmental issues for those that do, but these “miracle” babies are becoming more common. Indeed, I’m told the biggest reason behind the U.S. infant mortality rate going up for the first time in more than 40 years is because it used to be that babies born this prematurely could not live and were counted as “fetal deaths” instead of live births. Since infant mortality rates are based on infants that die sometime after a live birth, an increase in 24-26 week live births with some subsequent deaths ends up – strangely enough – increasing the mortality rate even though more babies are actually surviving.

Is it expensive? You better believe it. A case like this could cost more than a million dollars. In Britain, where the State pays, the State is willing to put a value on an individual life. They will rationalize it as allocating resources for the greater good, or try to frame it in terms of it really being in the best interest of the sufferer.

I believe that in the U.S. there’s still a greater desire to value life rather than put a value on it. That may be changing, however, and one of the ways people will use to find a way out of the dilemma is to talk about “meaningful” life or quality of life, as if life that doesn’t line up with some ideal is somehow not as precious.

I can firmly say that that is an ignorant attitude not worthy of the exalted intellect this philosophy supposedly honors. I can say that because there’s something – or rather, someone – else I also know.

Hardly a week before the StarTribune ran Charlotte’s story, they ran this article about Marja Laina Cassidy. I know Marja’s mother Maija and was working with her when Marja was born prematurely three years ago at just 23 weeks gestation. Marja weighed barely over a pound and a half then and was so small that Maija’s wedding ring slid easily over her baby’s upper arm. Follow the link above and you can see the pictures and read the story about how – and what – Marja is doing now. And if that gives you a lift, I’d also recommend reading this story from Stones Cry Out.

Yes, the cost of Marja’s life – and the lives of the growing number like her – is frightening. It is not nearly as frightening, however, as what I fear it will cost us as a society if we say that they are not worth it.


I spoke with another nurse today who has had years of experience in hospital Labor & Delivery rooms and in neonatal care. She confirms that a “Do Not Resuscitate” order could not be issued in the U.S. without the parents’ consent. Furthermore, if such an order were given, it would have to be renewed every 24 hours.