In 1972, George Carlin, the irreverent comedian who believed that boundaries are meant to be crossed, listed the 7 dirty words that could never be aired. These were considered to be a broadcaster’s ‘never event’. While society’s prohibition against offensive language and images have relaxed exponentially, there are still words and expressions that are radioactive.
I am quite certain that health care reformers have conducted focus groups to determine which verbiage offends and which phrase soothes the skeptical public. Words matter. I used to think that studying linguistics was merely an academic pursuit for grad students. Not so. These wordsmiths can now find honest work on Capital Hill. They can educate politicians on the nuances of language and expression so that our elected officials can speak out of a third side of their mouths.
We all remember from the prior presidential campaign how a wayward sentence can be exploited by adversaries who are poised to pounce. Recall this remark that Barack Obama made on the campaign trail in San Francisco in 2008.
So it’s not surprising then that they [midwestern communities]get bitter, they cling to guns or religion or antipathy to people who aren’t like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations.
If only there had been a linguist on the speechwriting staff. Obama and his handlers wish there had been a 7 second delay so that his misunderstood remark could have been bleeped, like a Carlin epithet. I don’t fault the president for his oratorical misstep. Considering the unrelenting campaign schedule, it’s expected and forgivable that candidates are not on their game 24/7.
Health care reform (HCR) advocates know that words and phrases may matter more than substance. Seasoned D.C. pols make only occasional rhetorical gaffes. Freshmen congressmen, however, rely on linguistically-correct HCR cue cards so that their words will be on message. Obviously, there are pro and con versions for each side of the aisle.
HCR Opponents Say…............... HCR Supporters Say
Tax and Spend.....................................Invest in the Future
‘Death Panel’........................................Comfort Care
Government Run Health Care..............Public Option
Free Market..........................................Price Gouging
‘Jackpot Justice’...................................Patients’ Rights
Medical Rationing ................................Evidence-Based Medicine
Clearly, I am no politician because I support medical rationing, and I’m not afraid to use the smokin' hot term. Indeed, we ration resources in our own home. Our income is finite. Our family cannot run a deficit year after year, leaving our kids or their kids to pay the bill. We have our priorities and fund those activities that we feel are critical. Like most families, we run out of money before we run out of worthy pursuits. Since our kids and us can’t have it all, this means that we are rationers. I hope that no outraged reader will report us to child protective services for negligent parenting.
Sure, the stakes in health care are higher, but the principle remains. Resources are finite and medical care is infinite. Consider this shocking development recently reported in The New York Times. A new drug, Folotyn, was approved by the Food and Drug Administration (FDA) this past September against lymphoma, a blood cancer. The tab? A mere $30,000 per month. This makes other chemotherapeutics that cost only 10 grand per month seem like bargain medicines. What does Folotyn deliver for a monthly cost that exceeds many Americans’ yearly earnings? Not much. It shrinks tumors in a minority of patients, a common claim of benefit by cancer drug advocates. However, just shrinking a tumor doesn’t make a person feel better or live longer. Indeed, no mortality advantage of Folotyn users was demonstrated.
Can we afford to spend fortunes of money on treatments, even if approved by the FDA, that have no meaningful proven value to patients? Let me respond boldly to my own inquiry. We can’t and we shouldn’t.
Other medbloggers have voiced concerns about the struggle to achieve cost control.
Medrants, an academic physician, writes that...we cannot control costs if we indiscriminately order every possible test, every new expensive drug, and provide futile care.
Dr. Val points out that other countries are more aggressive about prioritizing health benefits than we are. She writes that in Canada, expensive chemotherapies are not commonly covered by the national health plan, and in Britain, age is a determinant for transplant eligibility.
Medinnovations, a thoughtful blog by Richard Reece, M.D. states the obvious that the supply of health care is a limited resource, and the demand in an aging population is unlimited.
If the nation isn’t ready to ration hard, let’s at least ration easy and push back against expensive medical care of questionable or no value. This is the low hanging fruit. Harder choices will follow, and we will have to face them. Rationing can’t remain on the ‘dirty word’ list any more. We need to scream it out because it needs to be heard. Like Carlin, we need to break through some boundaries.