It is common to read an obituary that describes its subject as having fought a courageous battle against a medical condition, often some form of cancer. Last fall, I had a skirmish with prostate cancer, but I’m not sure how much courage was involved. My only bravery was jumping into my car for the 20-minute drive to the Payson Center after pounding down two or three pints of water to prepare my bladder for the glamour shot my prostate got right before every dose of radiation.
Be that as it may, the idea of battling with cancer has raised questions in my mind — some philosophical, some practical.
On the philosophical side, without meaning to sound morbid, I wonder whether, for a 68-year-old guy like me, declaring war against prostate cancer was better for the individual than it was for the herd. And beyond that, how much does the herd, or the individual, really benefit when, for many people, half the money spent on a lifetime of health care is spent during the last six months of life?
I am almost 70 years old. I have helped launch my daughter into the world. She is an adult and doing fine. I may still have a few words of wisdom to impart, but it is not exactly crazy to think that most of my heavy lifting — most of my service to the herd — is behind me.
These days, I am more a consumer than a producer, so I don’t think it is unreasonable to wonder just how much the herd needs me. That philosophical question leads to another: Is every serious medical condition a call to arms, or are there times when it is better to waive the white flag? Will there come a day when I should just let the herd get thinner, even if I’m the one being thinned out? Will my next cancer diagnosis signal the arrival of a new foe or an old friend coming to escort me off the stage before my act gets stale? After all, my predisposition for prostate cancer is just a genetically rooted as my blue eyes. It is me.
Turning from the philosophical to the practical, employing military metaphors to describe our response to illness reminds me that every battle requires ammunition. The ammunition for medical battles is health care, and I have grave concerns about the supply lines that put those munitions on the medical battlefield.
I approach this issue with a concept in mind: the tragedy of the commons, a term used to describe situations in which the consumption of a finite resource is governed by individual rather than collective decision making.
Whether we like it or not, health care is a finite resource. There are only so many pills, hospital beds and doctors. Last fall, well over $200,000 worth of radiation went into my 68-year-old prostate. On the surface, all the decisions about my care were made by me and my doctors. I was an individual making decisions about drawing on a finite community resource. That’s how our system works.
Except it doesn’t always work. As I said, the sticker price for my cancer treatment was north of $200,000. But due to good insurance, my only out-of-pocket expense was the gas money I spent driving to my treatments. I am very fortunate, and I know it.
On the other hand, there are thousands of cancerous prostates in this country, many of them younger than mine, that are trapped inside bodies of men who don’t have insurance as good as mine. What happens to them?
Many, I suspect, go undiagnosed or untreated. Then, burrowing around in my mind, a post pops up in my Facebook feed every couple of weeks listing several dozen industrialized nations along with the number of people in those countries who go bankrupt every year as a result of medical debt. The chart shows a long list of zeros, one for every country but the United States, where medical bills drive hundreds of thousands of people into bankruptcy every year.
That statistic always makes me think about the benefits of a single-payer system under which health care is treated as a basic human right and provided to all.
There is, of course, a fairly common objection to the idea of a single-payer system, some version of “I don’t want decisions about my health care to be made by some government bureaucrat.” That objection, however, is based on a belief that under our current system, health care decisions are made by patients and their doctors alone. But there is quite often a third voice in the conversation: the insurer paying for the care.
Who do you want to have a say in your health care? A government bureaucrat applying principles designed to balance the interests of the individual and the interests of the herd, or a private-sector bureaucrat applying principles designed to balance things out in favor of shareholders?