Are there any healthy conclusions


Here is an unfortunate scenario, one that is highly unlikely in the real world yet might serve to illustrate the some of the complexities surrounding the health care debate and American values.

There was a bad car wreck in a rural area. Each car contained one middle-aged driver and no passengers. There were no witnesses, and apparently no one was at fault as this was a head on collision: both cars had crossed the median during a sudden, freak snowstorm that ushered in white out conditions late on a Sunday night.

The first driver — we’ll call him Al — was in a new Lexus sedan. The second, Bill, drove a 10-year old Nissan Altima. Both cars were totaled. The two men were in critical condition and were transported by ambulance to the nearest urgent care facility in small town we’ll call Freedomport. On this night, there was one physician on duty, along with a receptionist and nurse.

So you can see where I’m going with this: a decision had to be made as to which patient would be tended to first. Given all things equally dire, and knowing that the second patient would likely suffer more damage or die, how would a doctor make such a determination?

If the doc possessed a kind prescience and could instantly gauge the probabilities, then he or she would know what to do. But, alas, she/he has no such talent, and must make the decision rapidly, without the benefit of any information about the victims other than what was found in their wallets and glove compartments by the EMC folk, which was turned over to the receptionist whose job it was to register the insurance information.

Al had excellent insurance. But other than that, we know little about him other than that he probably had money given that he owned the title to the Lexus. If the doctor knew that Al had a family, let’s say three children, a wife, a dog … would that have mattered? Should it have? Perhaps Al was a brilliant inventor of some sort, or a doctor or entrepreneur or philanthropist. Or, perhaps he inherited his money, or got lucky on the Stock market, or was the kind of greedy businessman who profits on the misfortunes of others.

Bill’s insurance had expired earlier that month. Based on the condition of his car and the overdue bills in his glove compartment, we might guess that he was pretty broke. He might have been a lazy bum who didn’t like to work, or a gambler or addict of some sort. Or he might have had a rough childhood or been the victim of some crime or debilitating event. And did he have a family — a wife and kids?

Would it have made a difference to the doctor if he had known the true stories of Al and Bill? If the receptionist had told the doctor about the insurance for each man, and given that the urgent care center was underfunded and at risk of being shut down in the future … would it matter to the man who had taken the Hippocratic oath and, as a scientist, wants no part in playing God?

If it were your decision to make and you had to make one, what would it be? If you opt for the poor man, you expose yourself as a biased liberal whose contempt for the rich corrupts his/her judgement. If you favor the Lexus owner, you have revealed your allegiance to the “haves” — to the privileged ones with Capitalist advantage, the ones who believe that he who has the most stuff should win.

Obviously there are too many variables to make a meaningful conclusion about which patient to treat first. However, the scenario brings into sharp focus the philosophical core of the health care debate. As Joe Biden framed it, some people regard universal health care as a human right. Other see it as a privilege.

Most readers can guess which way I lean on this. But I will shirk responsibility in this episode. I say to the doctor, flip a coin!

Pete Howard is a Dunkirk resident, writer, musician and teacher. FOCAL Point strives to make insightful social commentary through the integration of Facts, Observations, Compassion, Awareness, and Logic.