HEALTH SPENDING: Former Colorado Gov. Notes Limited Resources

      Writing in today's Journal of the American Medical Association, former Colorado Gov. Richard Lamm (D) asserts that the way medicine is practiced by doctors is at odds with the realities of constrained budgets, particularly in a health care system like ours where the government plays a significant financing role. This "dilemma," he writes, poses a threat to the government's long-term ability to provide for the public, or societal good. Medical ethics are largely to blame, Lamm writes, putting the priorities of the individual patient over those of society as a whole. "This is an unsustainable standard," he argues, "because it does not recognize the law of diminishing returns." Repeatedly in the essay, Lamm argues that satisfying the health care needs of every individual patient cannot be reconciled with providing for the general good: "Government cannot fund any public service to the satisfaction of the public constituency for that service; it must maximize good within limited resources. ... It is, thus, unreasonable and impossible to assume that what was ethical for a government policy wold be the sum total of the needs of all individual patients. Government cannot and should not automatically pay for everything physicians and patients think they need. The government cannot subcontract or delegate its obligations to weigh and balance all social needs."

What's Missing From The Debate
      Lamm argues that spending on health care must be weighed with spending on other social goods, "such as education, job training, and maintaining infrastructure." To illustrate his point, Lamm writes: "Half-empty hospitals sit in Colorado (and nationwide) blocks away from a myriad of people who are without health insurance. ... We have trained far more nurses and pharmacists than we need, and, yet, many public schools are using outdated textbooks. We blindly subsidize the well-to-do elderly and leave women without prenatal care and 40 million Americans uncovered by health insurance. We unnecessarily deny more people health care than any other industrialized country." He goes on to charge that the U.S. is "spending too much money (much of it in the wrong place), receiving insufficient returns on our dollars spent, and not even laying on the public policy scale alternate uses of those dollars." Lamm concludes by urging readers to place health care spending within a broader context: "The best medicine for an individual is not always the best health policy for society. Government's goal is health and the physician's definition of health care is not always the best or most efficient way to deliver health. By not crawling out of the trenches of our professions and looking at the total battlefield, we fail to maximize our contribution to the larger battle for a decent and productive society" (9/9 issue).