Former Colorado Governor Richard Lamm tells a wonderful story in his book “The Brave New World of Healthcare.” As Governor, he had proposed to expand the immunization program for Medicaid children at a cost of $500,000. In the 1985 where there was not as much support for universal immunization this was a radical idea. He was opposed in this not by fiscal watchdogs or legislators with pet projects but by a physician.
The physician wanted to open a rural dialysis clinic so that people in sparsely populated Colorado did not have to travel so far. This too was a radical idea,
Lamm argued strongly from a statistical point of view why immunization was important for all Coloradoans. He had studies that showed it was worth the money and would improve the health of children. He argued that the dialysis project would only help 45 people but the immunizations would help thousands.
The only thing the physician did to rebut this facts was have a press conference with 2 or 3 dialysis patients who told their stories of having to travel so far. He never tried to prove there was a need for the clinic. He put a tragic face on his problem however.
The physician won. There was a dialysis clinic and no money for immunizations.
Now you may think that the real question here is why can’t there be enough money for both? Why can’t we pay for immunizations and dialysis centers? However I think this is a false question. Over the last 25 years we, as a country, have fed more and more money into healthcare. We have put enough money toward health care so that there should be enough money for immunizations and necessary dialysis.
The question is really simpler. Do we need more dialysis clinics? This question is objective. However, it is difficult to think of the answer to this question and not think of the tragic face at the press conference. In the face of suffering we lose objectivity.
I think we saw this play out in the current debates on health care. When we as a country try and discuss the effectiveness of a treatment, powerful interest quickly turn the discussion into story of tragedy. Objective facts are countered with sentiment.
I am not one to say that the patient experience is not valuable, far from it. But the ability to have reasoned discussions about treatments is oftentimes lost in the sob stories of one person.