I sat transfixed reading the email from a friend. I couldn’t believe what I was reading. Finally my wife broke into my thoughts. “What are you doing? I’ve been calling you for ten minutes. And when I find you, you’re staring at the computer, shaking your head and mumbling.”

“I can’t believe what I’m reading,” I mumbled. “This health care debate has turned everything on its head.”

“What ARE you talking about?”

“You know that story I used to tell about calling that lazy urologist up late one night? I asked for his help to cath a patient with a stricture and he says, ‘How old’s the patient?’. When I tell him the patient’s 81, he just growls “He’s peed enough,” and slams down the phone. Do you remember that story?”

“Yes,” she said with a scowl. “I hate that story.”

“Well, that seems to be the new strategy for reducing the cost of health care while extending it to the uninsured. This article that David sent me is about a guy who feels guilty for getting treated for his prostate cancer.”

“I don’t get it.”

“Yeah, he says maybe he should’ve just died and saved the money for the system.”

“That’s kind of twisted,” she said with a shrug. “I can maybe see someone deciding to forgo treatment if there isn’t any hope of recovery.”

“That’s OK if you are deciding for yourself. But this guy got his treatment. He has a good chance of full recovery. And now he’s trying to guilt other people into forgoing treatment in the interest of saving money.”

“Just for the sake of argument . . . ” she started.

“I can always depend on you to be the devils advocate. I can see you starting to sprout horns already.”

“No, seriously,” she said, “haven’t you always said that people spend more in the last year of life than in all the other years combined? Couldn’t the system save a lot by foregoing a lot of needless treatment?”

“Who says it’s needless? You never really know if a treatment is going to work. What doesn’t work for one person might work just fine for you. I don’t want anybody making that decision for my life, but me.”

“But what if you are too senile to make that decision,” she said, starting to warm to the debate. “You wouldn’t want us to spend everything we had on every unproven treatment, would you?”

“I will concede that we shouldn’t be using insurance money to pay for treatments that have not been shown to work. But if I’ve been paying into the system all my life, shouldn’t I get a chance to try some experimental treatments?”

“Well . . . ”

“And I hate it when you throw the ‘senile’ thing at me.” I furrowed my brow and gave her a suspicious pout. “There’s nothing wrong with a little senility.”

“Oh, come on. You don’t want to just sit around in a nursing home and drool like that lady you used to tell me about, the one you had to change a diaper for all the time.”

“The lady you’re talking about was named Gladys and she seemed perfectly content to smile, drool, and poop in her diaper. Like I said, there’s nothing wrong with a little senility. The fact is that I’m sort of looking forward to a little dementia. I want to live with one of our kids when I get senile. It will pay them back for all the years that I changed their diapers.”

“When did you ever change a diaper?” she snapped back.

“Do you remember that time that we were…you know…having a little roll in the sack and one the babies started crying. And you ran in and brought him to our bed and he threw up on me. Do you remember that? Talk about ruining the moment.”

“Talk about holding a grudge,” she said shaking her head.

“I can still feel the sensation of baby vomit running down my bare legs. I spent the rest of the night picking chunks of beets out of my chest hair.”

“That made quite and impression, didn’t it?”

“It’s a nightmare I’ll never forget,” I said, mocking her mocking me. “I’m just saying that we took care of the kids when they were babies. Why shouldn’t they take care of us when we are old.”

“OK,” she replied slowly. “But you lost me on how this relates to the health care reform debate.”

“Don’t you see? The whole debate is turning things upside down. People who haven’t paid anything into the system are claiming that they have a right to healthcare. And people who have been paying into the system for years are being guilted into refusing to take what is rightfully owed to them. The throw-up story was just a colorful aside.”

“But you’re not denying that we spend a disproportionate amount of the total health care expenditure of the country on the elderly?” she said trying to score a minor victory.

“OK, maybe we do a little. But all kidding aside. Every day of every life is valuable. And we shouldn’t be pitting one group against another in an effort to balance the health care budget. It’s not a zero sum game.”

“Well, one thing’s for sure. The country can’t continue to spend more and more on health care.”

“Do you hear what you’re saying? You’re beginning to sound just like all those bureaucrats in Washington. People should be able to spend their money on whatever is important to them. It’s pooled insurance money, or worse, government insurance money, that has people thinking that how they spend their health care dollar is the business of other people.”

“So you would like to see us go back to a purely free enterprise medical system? First, that’s not going to happen. This isn’t the 50’s. And second, what would happen to the people who don’t have enough to pay for expensive medical care. I know that you can be a cold, heartless, S.O…”

“Hey, don’t start talking about lawyers again.”

“… but I don’t think you are advocating cutting people out of the system.”

“Of course not,” I said, becoming serious again. “There’s more than enough excess in the system to pay for truly needed medical care for everyone. And if you want something that has marginal value, you should be able to get it. But you should have to pay for it. If you can’t afford something that has marginal value, then you shouldn’t get it. It’s that simple.”

“It’s that simple, huh? You seem to have it all figured out. So why is Congress having such a tough time with this?”

“They’re asking the wrong questions. And they are pitting one group against another, like they always do.”

“There’s just one question remaining, smarty pants. Who is going to decide what is ‘truly needed medical care’?”

“We are,” I said confidently. “Physicians are the only ones who can make that decision. All we need are education and ethics. The basics. And we need protection from the lawyers when we have to make a close call or when a bad outcome occurs.”

“Now you’re the one talking about lawyers.”