Well, to reduce costs effectively we're going to have to ration and/or determine where people can get care for what....
.... or trade-off some other expenses for these, all-the-while also facing the prospect of everything being more costly because of a declining global advantage.
First: A categorical rejection of change is a forceful endorsement of the unfairness and daily tragedy of our current system. Are you open to that?
Second: There are two sides to the equation: costs and revenues. I've already addressed, elsewhere in this thread, matters of fairness on the revenue-side (people who can afford care should pay for it, rather than have the public pay for it - and affordability should be determined
before factoring-in discretionary spending).
Third: Remember that we're already rationing care. At this point, the rationing is, at least to some extent, based on affluence. Changing things so that the rationing we're already doing is based a bit less on affluence and a bit more on a generally-accepted metric of likely impact on quality of life is an interesting idea, that I can't find fault with (but only phrased
that way, including the specific trade-off I mentioned, and with the clear qualifications that I included, especially that it is a "bit" of a change toward a better balance, not a quantum shift from one extreme to another).
Fourth: There are no simple answers. Anyone who thinks there is a simple answer to anything in this realm is foolish. The only simple aspect to this is that there is something, now, that isn't fair. However, it is craven to avoid working to address an issue because you fear that the answers aren't simple, that the path isn't clear, that the result isn't guaranteed to be positive.
Our system is far from perfect, but much of the issue is a culture in our country which will not accept rationing and stipulations on where, with whom, you receive care. Changing culture is a mammoth task that is particularly ineffective when you're talking about health habits. It's great to talk about wellness and prevention, but it's not in the nature of many Americans. We need a unique solution to our unique issues.
ITA.
Let's stop letting politicians deal with this and get a bunch of experts into the room who actually work the trenches.
And what happens when, as is inevitable, they disagree with each other? In a way, the "get a bunch of experts into the room" approach is too simple. It ignores the realities of the complexity of the issue, that you outlined so well in your previous paragraph.
If you haven't worked an ED on a Monday night, you have NO idea what it's like in the trenches.
And if you have, then you'll be far too biased in that direction. There's a reason why judges are chosen so as to be impartial. What's missing here isn't the ED's perspective. What's missing here is the leadership that would be able to pull-together the vast array of different perspectives into a cohesive, consistent and equitable path forward. However, again, there is no simple answer.
And one of the most troubling aspects of the fact that there are no simple answers is that there may not be
any answer. That's something that no one has broached yet in this thread, but it is a reality of life that we all have to come to understand and accept, even if it radically undercuts our hopes and dreams. It is very possible that this aspect of our society is going to suck badly (averaged over all people) no matter what we do, and that all we can hope to do is move the shells around a bit so that different people gain advantage at different times, or that perhaps advantage is spread more evenly (which is perhaps the most defensible approach).
And even if there is no answer, that doesn't mean we shouldn't stop seeking one.
