Musings of an Old World doctor about the New World healthcare marketplace.

When Is Enough, Enough?

Thoughts on access to healthcare.

“Godliness, with contentment, is a means of great gain. ”  Paul, a Jewish rabbi and early Christian apologist.

The past six weeks have been very hectic for me, involving stops in 5 nations, and putting on about 50,000 air miles.  What was I thinking when I planned all of this!  But the time in some of the world’s poorest nations, along with plenty of time to reflect (I was too uncomfortable to sleep) while sitting in cramped seats on airlines has again challenged me to think through the concept of “enough.”
What is enough?  There is an ad for one of the major insurer companies that often show on the television where it prints a dollar figure on the head of the person being highlighted, with a question mark to indicate what may be enough for this person to retire.  Is the figure two million, or one point five million, or will $850,000 be enough?  The concepts are similar in healthcare!
I remember doing house calls (yes, doctors really did used to do house calls) back in the ‘70’s while working in England that really challenged my assumptions of what is “enough” medical care.  In those days in the UK, it was the patient, not the doctor, who made the decision of whether or not a house call was necessary.  There was the family with a young teenager who was bleeding per vagina.  In vain I tried to reassure them that this was most likely a normal period, based on their description, and they insisted that I come to check, rather than them bring their daughter to my medical office.  It was just a normal period!  But on another occasion, a family called me to visit their mother who was bleeding p.r. (per rectum).  Again I suggested that they bring her to the office, but they didn’t have a car, and wondered if I would mind trying to save this old lady a rather uncomfortable bus ride.  I agreed, and found on examination an advanced carcinoma of the rectum.  On immediate admission to hospital, it was already too late to provide anything except palliative care. 

So how many house calls would be “enough?”

When in Myanmar (the old Burma for those who don’t keep up with the ever changing names of countries) two weeks ago, I had the privilege of meeting with many brave people who live with joy in the middle of much poverty.  What is “enough” medical care for them.  It reminded me of a fantastic book that I have recently read called “The Bone Cutter,” by a professor at Stamford University Medical School.  Part of the story chronicles the medical care that was available to the rebels in Ethiopia when they were fighting against the government of Halie Selassie.   So what is “enough” in that situation?

You may be asking what any of this has to do with medical care in the United States.  I think that it has everything to do with this subject, because the key issue in tackling health care costs in the United States is finding who has the courage – and maybe the wisdom also – to be able to define what is enough.  We already spend more per capita on health care than any other nation on earth.  And there does not seem to be any limit to what the average citizen is willing to spend as long as they are spending other people’s money.  The trouble is that government has tended to have much the same attitude.  But the role of government, whatever party is in power, is to work for the common good.  You cannot solve the issues of a never ending demand for more health care, along with ever increasing medical sophistication associated with higher costs, without addressing the issue of what is “enough.” 

This reminds me of what King Solomon, supposedly the wisest man who ever lived, had to say about this subject.  “There are three things, no four that never say enough.  The grave, the barren womb, land, which is never satisfied with water, and fire, which never says, 'Enough!'  

I think that we need to add to this list the human desire for access to health care!  As has been widely quoted before, “When your outgoings exceed your incomings, then your upkeep will be your downfall.”

This is where serious discussion of the health care issues facing this country needs to start.

About The Author

The Karis Group is best known for the Patient Advocacy services that it provides to many DMPO and Limited Medical Benefit Plan (LMBP) members around the country.  Tony is a passionate defender of all people’s right to access medical care, and their subsequent responsibility to see that the medical provider is adequately compensated for the valuable services rendered.  Recognizing that there will often be a tension between the value of the services received, and the ability of any specific patient to cover those costs, patient advocacy from The Karis Group provides a professional and dignified way for members of DMPO and LMBP to receive the help that they need when out of pocket expenses are mounting and benefits are running out!

Patient Advocacy from The Karis Group is also an invaluable part of various EAP programs.  Even when the employee may have adequate health insurance, there are often family members who are not fully covered.  Patient Advocacy provides quality help for employees and their families when medical bills are proving a serious distraction.

As well as his entrepreneurial activities with The Karis Group, Tony is also very involved in missions and church work around the world.  For more information on The Karis Group see www.thekarisgroup.com.