One of the critiques of ObamaCare has been its proposal to use review panels to allocate medical resources to areas where the payoff would be best.  On a micro scale this used to be called triage and it makes perfect sense.  In Viet Nam when incoming wounded were overwhelming the medical staff on duty at the hospital where I worked triage decisions were routinely made about where to allocate the very limited resources.  Both those who would likely live without help and those who would likely die with help were forced to wait while those who would likely only live with help were treated.

I spent some time in the Emergency Rooms at Huntington Hospital and two different Kaiser hospitals this week helping my Father-in-Law through his latest crisis so I had lots of time to think about review panels, triage and allocation of resources.  In fact I also had enough time to read The Hidden Symbol, Dan Brown’s (author of The DaVinci Code) latest thriller.  I agree with President Obama that it is a bad allocation of resources to give a new hip ($40,000) to a ninety year old with a bad heart but I also agree with Obama’s critics that I don’t want “death panels” to be deciding if I get to live.  BTW by calling the “review panels” “death panels” the critics won this one on the name.  Think “homeless” vs “bums” we help homeless people we didn’t help bums.

I’m not sure that we will get to review panels and I’m not sure if they can work unless the incentives to providers, receivers and allocators of medical services change significantly.   For instance in the current model: If Medicare is paying, who at Kaiser would benefit from not putting another stent in a ninety year old bedridden man?  How would the man or his heirs benefit from not having it since the stent is free?  And what allocator would be able to defend withholding the stent against a crying grandchild on CNN?

We will need to change the incentive to all of these groups before any progress can be made toward controlling medical costs.  But don’t lose heart (we have stents for that),  I have devised the ultimate triage test and I will share it with you. (By clicking on the read the rest of this entry button I agree that Simon is writing what follows as a thought provoking joke and that without training I will not try to apply the test to real world situations)The Ultimate Triage Test

1.   Can the patient wipe his or her own ass?

If yes administer the expensive life extending procedure.

If no proceed to question two.

2.   Does the patient add value to the lives of those around them?  In other words are there people who benefit from this persons existence?   This would include intangibles like happiness and love.

If yes administer the expensive life extending procedure.

If no administer only appropriate pain reducing medicine.