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Book and Media Reviews
December 14, 2011

Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU

Author Affiliations

Author Affiliations: University of Cincinnati College of Medicine and Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (derek.wheeler@cchmc.org).

JAMA. 2011;306(22):2510. doi:10.1001/jama.2011.1811

Mark Twain once said that “The only two certainties in life are death and taxes.” Twain's “certainties” are relevant for current discussion on health care reform in the United States. The first certainty is that even if the health care system provides absolutely the best possible care, everyone will still eventually die. As such, they will always need health care.

The second certainty refers to how health care is paid for. The current US health care system does not have unlimited resources and is largely funded by either the private sector (primarily through employer-sponsored insurance) or the government (primarily through tax revenue). The costs for health care are therefore passed on either directly or indirectly to the consumer. However, consumers have little choice in how health care is apportioned. Rather, decisions are made by the providers of care and the insurers. During the recent debate that led to passage of the Patient Protection and Affordable Care Act of 2010, critics stated that the new plan would lead to rationing of health care, and “rationing” became the political buzzword of the day. Opponents of the bill further suggested that so-called death panels would have the power to approve or deny care to patients based on their social worth and the cost necessary to provide care. Regardless of all the rhetoric, Charles Camosy emphasizes in Too Expensive to Treat? that the current system already includes a substantial degree of rationing of care. Resources are not unlimited, and health care is becoming prohibitively expensive.