Moral dilemma? I'll tell you about a moral dilemma that the City of Washington, DC is putting me through right this moment.Now that's a moral dilemma.
I make my basic living as a taxi driver. But during the day, when things are slow, I supplement my income by taking patients to get their dialysis treatments. The City pays as part of it's program to assist poor people get needed medical care.
So here's the dilemma I'm in. I need the extra money. The people need to get to the care centers. But the City hasn't paid me in five months! That's right... five months. It's not a billing discrepancy. Everyone agrees that I'm supposed to get the money. They just don't have the money to pay us.
So what am I to do? Stop picking up and delivering patients who need my service to get their medical help?
Problems like that haven't gone away. A recent Washington Post editorial exposed very similar circumstances: promises made, good intentions put into governmental programs, and no (or slow) actions or funding. Think Katrina.
Or think about all the other major problems that could be remedied with foresight and preventative investments which I like to think of as strategic investments [an investment now into remedying a social problem to save a larger amount at a later date. Think Head Start programs. In venture capital terminology, strategic investors are distinguished from venture capitalists and others who invest primarily with the aim of generating a large return on their investment.]
- Alzheimer's will shortly become our biggest and costliest killer. The medical costs for a patient are phenomenally high as they become more and more incapacitated. As baby boomers age and other diseases find cures, Alzheimer's is moving quickly up the ladder to the number one spot. The numbers and costs are against us and NIH knows this as does every major health organization -- yet funding for Alzheimer's research is still meager and disorganized. There's no reason why a strategic investment today won't reap cost-saving benefits in the future. Yet... it's not happening.
- Mental health is another serious concern. In Congress they're talking about "parity" which is a spin word to defuse the issue. [Disparity between full medical coverage versus limited mental health coverage (if any).] Yet today's military can't cope with their present load (as evidenced by recent articles about an APA Task Force studying the subject). Returning Vets from Iraq and Afghanistan's have mental health issues AND head injuries that are causing VA costs to skyrocket out of budget with future years even worse. As life becomes more complex and people live longer, mental health issues become more prevalent. Yet they are still treated primitively when it comes to insurance coverage. Limited treatments, if any, may alleviate pain temporarily, but don't provide life-changing help. Other than cost, there's no reason why a strategic investment here won't reap long-term benefits. Yet... it's not happening.
- Educational changes are also strategic investments. Educating doesn't just happen in schools. Think Surgeon General Koop's condom and anti-smoking messages. Complexity, ethnic diversity, religious tolerance, compassion, and developing an understanding that we're all the same AND in the same boat are teachable and could have significant cost savings (think no wars).
- Treating addictions as a mental health issue through early education and exposure to and emancipation from the underlying causes is another cost-saver.
We all know that government is innefficient. Ours is. But this is an area that they (we) are charged to provide. Let's get the new Congress and the next administration to do their job - particularly in the area of strategic investing.