In Barack Obama's June 24th town hall meeting on ABC he was asked by one Jane Sturm, whose 99 year old mother had received a pacemaker and is now thriving at age 105, if consideration ought to be given to a patient's "spirit" for life when making those hard cost effectiveness medical decisions. Here's what he said:
"I don't think that we can make judgments based on people's spirit," Obama said. "That would be a pretty subjective decision to be making. I think we have to have rules that we are going to provide good, quality care for all people."
Um, excuse me Mr. President but that's what doctors do. We make clinical decisions based on a multitude of factors: best evidence, cost, and suitability of the particular patient in question for the treatment strategy. Arguably the most important factor is that human being sitting across from us in the exam room. You cannot divorce the individual patient from the decision-making process. I'll choose to operate on the hale and hearty 85 year old WWII veteran who walks his dog three miles a day over the obese, diabetic 52 year old with a history of angina every single time. Subjectivity is of paramount importance when trying to determine the best course of action. We act on subjective hunches all the time (Mr. X looks "sick", Mrs. Y just "doesn't look right", etc). That subjective clinical judgment develops with experience and time. And those who ultimately acquire it are the ones who make the best doctors; or at least the sort of doctor I want taking care of my family.
Once again, we see the Obama administration trying to railroad through an overintellectuallized, hyperrational alternative to healthcare reform as policy. It's like Obama/Orszag are an elite consulting firm doling out advice on how to streamline operations of an inefficient business enterprise. This isn't a fortune 500 company though. These are real people we treat, gentlemen. Save your models and bureaucratically designed algorithms for the banks and auto industry...