The Cat's Care.
(aired on All Things Considered in slightly different form on January 31, 2005)

Recently, my girlfriend's cat was near death. Something was blocking movement in her gut and her constant vomiting was getting her dangerously dehydrated. We're both medical students, so we knew that if Carrie* were a person, her situation would earn her a hospital admission. It turns out the same is true for cats. And so Carrie went to the cat hospital.

At the front desk of the cat hospital, there's a sign like you might find at a good car mechanic's. It says: "We will provide you with cost estimates of all work before we do it." And as Carrie got worse, the vets kept checking back in with estimates, adding new steps to the workup. We didn't question any of it. The vets' office was modest and they seemed kind and smart. And they have to get paid for their work, and Carrie doesn't have veterinary insurance.

When I was describing this to someone else, she said, "At this point, I'd just put the cat to sleep." From this doubter's point of view, a cat's life is worth a set number of dollars, and once you pass that mark, you stop paying. The sign in the front of the cat hospital reminds us: someone has to pay the bill.

I justified Carrie's veterinary expenses to the doubter by saying, "Well, she's only two-and-a-half," explaining it as an investment in future cat life. Perhaps more to the point, my girlfriend loves her cat, and has a bit of financial wiggle room. In a pay-as-you-go healthcare system like the cat hospital, all decisions are based on three things: the cost compared to what you can pay; how much you care about the patient; and how helpful the healthcare will be. Carrie was lucky: she passed all three tests.

We don't like the idea that a health problem might lead us into tests of our finances or of other people's concern for us. That's why people get health insurance or go bankrupt when they don't. We'd all like to think that all of us are worth every dollar we can get our hands on, and more.

But just like for a cat, there's an estimate and then an itemized bill for each piece of our healthcare, every doctor's visit, every hospitalization. At the cat hospital, it's a sign at the desk; in the people hospital, it's advance algorithms and insurance contracts. Either way, there's a cost estimate and an agreement to pay.

I like to think of medicine as a beautiful human project, an expression of our concern for each other, a culmination of the human impulse to care for our fellow sufferers. But clearly, healthcare is also a business arrangement or a political arrangement, a system of money changing hands to save ourselves or our loved ones; or, in the US, our employees.

Because of those arrangements, there are office buildings full of people deciding what medical care goes to which people. People in some parts of the world get much more care than in other parts; citizens of one country get more care than citizens of another; people with money get more care than people without.

We like to demonize health insurance administrators who limit our care, because they approve the work when the estimate comes, or they don't. We don't like being the cat, not even a little bit. On the other hand, in a nation and a world where healthcare goes mostly to cash and only a small bit to empathy, we pay into a system at least as arbitrary as the cat owner who saves her cat but not another. They say that cats have nine lives, but it's not true: some cats get more lives than others.

*Name changed to protect patient privacy.

 

copyright 2005 joe wright