Thursday, March 26, 2009

The Lessons of Natasha

The tragic death of Natasha Richardson last week gave us all much to think about. In sitting down to write this installment of Prairie Pondering (again), I am (again) hit with a stream of consciousness of subject matter: the fragility of life, bad things happening to good people, privacy rights of celebrities, cherishing the time we have with friends and loved ones, sweating the small stuff, "if only ____", karma, taking advice, refusing advice, health care, the irrelevance of social status in matters of fate, etc., etc., etc.

No doubt I will revisit the event from time to time to make a point or two, but today I intend to focus on just a couple of the things I have been pondering.

My first reaction to hearing the news was that I would need no further urging from my bride to wear a helmet when bike riding. A few years ago, I spent one summer as an avid cyclist and, supported by a client in the business, loaded up with fancy riding equipment, including a tear-drop shaped helmet that I was instructed never to ride without. Once we moved to the country one farm over from a bike trail I used to drive a half hour to get to, I decided that it was more important to look "cool" than ride safe. I believed that since I was limiting my cycling to carefree jaunts down car-free gravel paths, I could leave the helmet behind and rely only on a baseball cap to shield my balding head from the sun. Deb protested; I chose vanity over safety.

That will not be the case in the future. The fluke of Ms. Richardson's death made me realize that it was stupid to unnecessarily risk my life on the hope that my baseball cap and enclosed head would not suddenly hit the gravel roadway (less forgiving than snow) as a result of a blown bike tire, unleashed dog, unnoticed rear-approaching cyclist or inability to timely remove my feet from toe clips.

Undoubtedly, many cyclists, skiers, snowboarders and other outdoor enthusiasts will similarly take the lesson of Ms. Richardson's death to heart and head. Her senseless sacrifice will save lives. That is not much of a silver lining, but it satisfies our collective desire to find something positive come from a shared horrific experience.

The second item I keep returning to is the lesson to be taken from Ms. Richardson's death with respect to the allocation of health care. Allow me the assumption that an identical fall and resulting injury sustained by any other visitor to that ski resort last week would not have made front page news all over the world.

After the event, I suggested to my wife, an R.N. with 30+ years of experience, that the public's awareness of the dangers of subdural hematomas publicized by Ms. Richardson's death would result in more accident victims obtaining treatment, as Ms. Richardson had been encouraged to to, and, correspondingly, many lives being saved.

Deb's response illustrated the stark realities of health care today. She explained, accurately, that medical facilities lack the hardware and staff resources, and insurance companies lack the funds, to allow everyone who takes a tumble on a ski hill to obtain an M.R.I. or a CAT Scan. For the most part, the wounded will be advised to watch for symptoms of head trauma and seek medical attention only in the event symptoms develop.*

I can imagine some contentious debates over course of treatment while the Richardson tragedy is fresh in our minds. The forthcoming demands for expensive procedures to rule out undetected, potentially fatal trauma, are consistent with the level of care we have come to expect and which have resulted in health care costs that have created the current health care crisis. In reality, entitlement to basic health care, including access to preventive medicine, must be distinguished from universal entitlement to the best possible health care that science can deliver.

This reality constitutes the flash point in any discussion about what kind of universal health care system we can and should adopt. Accepting it means that we acknowledge that some people will suffer health consequences medically avoidable. On the other hand, accepting it means we also acknowledge that the greater good, i.e., the ability to deliver affordable basic health care services to the largest number of recipients, trumps the alternative of spending the same finite amount of funds on premium levels of care for far fewer recipients.

Whoever is funding universal health care, be it insurance companies or the government, absent an increase in premiums or taxes, there will always be a limited amount of money to spend on all the medical services that will be delivered to all the beneficiaries of the funding entity. Therefore, as a matter of fundamental fairness, the pool of shared available funds should not be depleted by the purchase of extraordinary services by the most demanding. Rather, it must be left to individuals to purchase extraordinary services, like an immediate M.R.I. in response to a seemingly innocuous bump on the head, either directly, or with supplemental insurance coverage priced accordingly.

Again, this approach means that patients with better financial resources will receive "better" health care. There is no viable alternative. The hope, of course, is that by bringing costs down through the implementation of universal coverage, everyone's basic health needs will be met and higher levels of care will become more affordable and therefore available to more and more patients. In the mean time, we have to accept the fact that we are not, and will likely never be, a prosperous enough society to offer unlimited, on demand, state of the art, high technology medical services to everyone regardless of their ability to pay.

The Natasha Richardsons of the world will, of course, always have the offer of such services available to them. Hopefully, when needed, they will take advantage of the privileges they enjoy, continue to thrive and, use their privileged status to support philanthropic endeavors, as did Ms. Richardson, that care for the rest of us. I'll be thinking about that while riding down the neighborhood bike path wearing my geeky helmet.

*P.S. The morning after I posted this blog, there was a related story on ABC's Good Morning America. Here's a link to the news coverage of the story. May God bless you, Natasha.


Mary said...

Hey Sam,

Your comments on Natasha Richardson's death, and the fragility of many who are close to us, touched me. I was shaken by this accident, the idea that a luminous smile, brilliant talent, and apparently very kind person could go, really, in an instant. Some, as we both know, argue longer with leaving this world and fight against doing so--and my hope is that whatever health care we each end up receiving, it is compassionate and kind when we need it most. Perhaps if we can all slow down and focus on the "kindness" part of it, the idea of a peaceable kingdom will come to be... Thanks for your eloquence once again. Mary

danimal said...

Great writing Sam. Just what I needed to hear. I've been testing fate a little bit by riding around Boston w/out helmet. Justified by (when I was a kid, we never wore helmets). Dumb. Girlfriend asked me last night if I wore one and I just gave her a quick kiss and she knew what the answer was. Going forward, I'm covering the dome w more than just a hat. Thanks for sharing.