Babel and Health Care

August started off badly. Congresswomen and men seeking a broader understanding of the proposed health care legislation returned to their districts and asked for a dialogue over this very difficult and contentious issue. What they received were, for the most part, screamed questions/statements, followed immediately by orchestrated efforts to shout down any effort to answer the question. It wasn’t civil dialogue, it wasn’t even dialogue. That is too bad, but just what those opposed to significant reform wanted to accomplish. Shouting and attacking works if one does not have an alternative strategy or is protecting a special interest which runs counter to the real interests of most others -- or if the hypocrisy of the position being advanced is just so absurd that only the ensuing cacophony could cover its trail. As the President took his case for reform to Congress, the incivility only got worse.

The facts are really very simple. The US economy and society can no longer sustain the cost of the way we organize and deliver health care. Those so fearful of the dangers to them of publicly imposed euthanasia through a reformed system should consider the fact that the real threat to their health and insurance comes in six years when the Medicare’s hospital trust runs out of money. Then who gets to be called “granny killer”? This point is agreed on by the parties from both sides of the aisle. But this is a difficult point to get across to a population that does not want the government “messing up their Medicare”.

And it really is not quite the deal some people think it is. We spend at the individual and national level anywhere from half to a third more than any other country we would compare ourselves to. These countries cover everyone, so there is no anxiety that coverage will be dropped or some catastrophic event will lead to bankruptcy. Just a reminder that four of five personal bankruptcies in this country come from medical bills. In fairness, these countries all have some form of public and private mechanisms to identify those very expensive treatments that they will not pay for. We just leave most people underinsured and not able to receive treatment from which they could benefit. Unfortunately, being uninsured for many in these groups means that they and their children don’t get the inexpensive routine care that could actually prevent the need for some of the heroic measures that run up costs. Even this is too abstract a concept for many, so lets put it this way: we spend about $2,500 more on health care per person than other countries to which we compare ourselves. That means for every individual in the country, their wages are lower or their taxes higher to the tune of about $2,500. So for a family of four, this is costing them -- beyond what they see as their health care bill -- another $10,000 that is either coming out of their pockets or never makes it there.

Too expensive, doesn’t protect us from financial vulnerability, how about the quality, that must be the best in the world. Well, for some procedures and for some people nothing could be truer. In fact, pretty much everyone involved in the health care debate on both sides of the issues has blue ribbon coverage, understands how to manipulate the system, and probably is in pretty good basic health. So the best is always available in the US, theoretically. But most people find that their coverage is too thin to give them access. Or the doctor who does that procedure doesn’t accept Medicaid, or while the procedure is offered, no one is watching and the actual outcomes are inferior if not dangerous. Worse, “life-saving” miracles are sold every day with no evidence that they will actually work, but the sale is made to desperate families seeking answers. This trust in the system is often misplaced, and providers are incentivized on volume of sales -- not the health of patients or quality of outcomes.

Yes, I will grant every example of inferior care my objectors will point to in the countries that cover everyone: if they will grant me that these are stories, and just as many horror stories could be told of our medical Mecca. And one more thing they will need to grant me, because it is a fact the “grass roots” detractors keep calling for: Twenty years ago, citizens in Britain lived about half a year less than we did. Today, we live about a year and a half short of what they can expect. And to accomplish this, they have spent about half of what we have.

My sense of this debate is not very involved. The Right wants to make it complex to kill the proposals because, I believe, they have a long-term strategy to get government out of health care entirely. How else do you understand Medicare Part D? The Left explains its complexity because they want to be honest, but also because they are afraid to tell the truth in the starkest of all terms, that if we fail to change health care, our ability to be successful as individuals or as a nation will take a major blow, one I fear we will not soon recover from.