In "A Calculus of Suffering" Martin Pernick describes the introduction of general anesthesia
into surgery. There were dilemmas in trying to understand what gains and losses would
accrue. Anaesthesia certainly appeared dramatically effective in reducing indeed abolishing
the extreme distress patients experienced during surgery. But was it safe? How many
patients might die as a consequence of this novelty? How many deaths might be accepted in
the interests of massive relief for the many? Would even those who survived have worse
outcomes attributable to anaesthesia? It is fascinating study which might serve as a model
for a new, urgent analysis, in this case pitting the concerns over cost against the assorted
dimensions of benefit which stem from modern healthcare. If we are uncomfortable paying
as much as we do today, ( and perhaps we needn’t be*) where are the savings to be made?
Conventional writing on the topic tends to stick with looking at efficiency, "eliminating
waste" which is uncontroversial (though harder to assess and pursue) and thereafter
discreet mumbling about general affordability much of cloaked in the unstated view that
those who can pay will receive and the rest will ....... trailing off into unstated detail. This
will not do. We need an adult approach based on the foundation that effective healthcare
should be available to all however resourced.
To begin we need a clear eyed view of what issues are up for debate, what dimensions might
we trim in pursuit of savings.
Any respectable Healthcare system has to attend to the following:
Equity of access
Capability/ Efficacy
Safety
Comfort (being both comforting, and providing comfort)
Convenience
Confidentiality
- in an efficient economical manner.
You mean we might spend less on safety? Yes we might. But clearly there is a hierarchy of
potential here. Safety might not be first - but it might not be last!
* How much should or can we pay for healthcare? As much as we choose, recognising that
the more we spend here the less we have to spend on everything else which might
collectively be regarded as health promotion or protection activities devoted to preventing
illness rather the necessarily narrower focus of healthcare on correction of established
disorder.
