In an editorial article on October 25th, Chicago Tribune editorial board member Steve Chapman writes about Health care myths, both left and right I like Chapman, because though he leans toward conservative (I feel he does at least), he always sees both sides of the issue and can be critical of both sides. I call that "fair and balanced" and also "common sense oriented". Others might disagree.

In this article Chapman makes a good point about health care. The issues that become the marquee issues for reform are the big ones like 17 year old Nataline Sarkisyan, who needed a liver transplant but Cigna refused to pay for it. By the time the insurer relented, she was too far gone...in fact, I guess she died the same day as the insurer agreed to pay.

The insurer said that the "treatment would be unproven and ineffective - and therefore experimental and not covered." Her surgeons disagreed, and estimating that she had a 65% chance of surviving 6 months with a new liver. But another physician, the head of the Baylor Regional Transplant Institute in Dallas, was on record as stating that the surgery was "very high risk" and "on the margins".

Best case scenario, she stood a 1 in 3 chance of dying within 6 months.

The point that Chapman goes on to make is that no matter what, resources available for health care are not unlimited. Somewhere along the line, someone has to make a decision about whether treatment is too risky or too ineffective to pay for. It's happening now, as in the above case, and it will happen if the government replaces insurers as the final arbitrator in these sorts of situations. They're all going to be high profile.

Chapman suggests that the Republicans are just as guilty of using this as a scare tactic (albeit from the other angle - the government as the "death panel operator" instead of the insurance company). As he states, when the Obama administration proposed reductions, however modest, in Medicare growth over the years, Michael Steele, the RNC chairman, jumped all over it. "We want to make sure that we are not cutting the Medicare program," he said. "Any time you get a body of individuals that go between me and my doctor who are going to make decisions about what kind of health care I get, that's rationing of health care."

Chapman then points out correctly that as long as someone else has to pay for those decisions, you're going to get just that - someone else's input in those decisions.

(He also points out that those cuts in Medicare growth are truly modest, with total outlays being trimmed by only 3 to 5 percent over the next decade. A cut of 5% in 2019 spending, as the article states, would still leave the spending 80% higher than this year.)

Scare tactics on the RNC's part. I'm pretty sure there are some scare tactics being used on the other side, but I haven't heard as much there.

In my own office, I like to say that I work for the patient, and I do. I don't have any contracts that tell me I have to do this instead of that. I do, however, deal with insurance companies that tell me that what I feel is in the patients' best interest is often not something they'll cover. This is not to say the patient can't do it; they just have to figure out a way to pay for it themselves. In dentistry, unless you're talking about full mouth reconstructions (like what you'd see on those Extreme Makeover shows) or multiple implants, nothing is terribly expensive. Still, many patients make their decision based on what the insurance company will cover.

Also, it's pretty rare that anything we do in our office is in any way contributing to a life-and-death situation. Nothing is really an "emergency" in the same sense that a heart attack or needing an organ transplant is. So it's not an apples to apples comparison.

But we deal with situations every day where someone is, by virtue of telling the patient what they'll pay for, dictating that patient's level of dental care.

Dollars are not unlimited. Some decisions have to be made. Sometimes we can't save the tooth simply because the patient can't afford it.

Likewise, it's possible that certain cases are just not worth the dollars expended to keep someone alive for another 6 months...