In order to expand coverage to the estimated 40 million Americans
without healthcare, the Obama healthcare plan is likely to require the
assistance of all Americans. The mere availability of an increased
budget beyond the current 640 billion dollars will likely be
insufficient and instead require a more judicious approach in how care
is rendered without merely relying on increasing capacity in monetary
terms. One can envisage a triage system that would use algorithimic
modelling to identify patients with multiple organ dysfunction,
increased age, lethal comorbidities and poor predictive survival and,
from the outset, make the recommendation for a less aggressive
approach. This is likely to constitute a revolution in medical
decision making in healthcare in the US, affecting both patient and
provide alike. Might we actually have to lower our expectations about just how aggressive care can be in futile situations? Unseeming though it may sound, the judicious use of healthcare resources has been a trademark of all other OECD countries that have offered universal healthcare and if the US is finally ready to join Asian and European counterparts of similar economic stature, she may be best advised to rethink how the resources we have available are used.