Thursday, July 30, 2009
Is it Nuts in Here or is it Just Me?
American political dialog (for public consumption) and reality are conveniently shielded from one another by a wall of fear. That fear is composed of the politician's fear of election (power) loss and the voter's fear of hearing about entitlement loss. What follows is an example of what is said and heard versus what is real but not heard.
I will paraphrase the Obama health care dialog: "We need to reform the system so that everyone can be covered by affordable insurance and can receive affordable care and no one will have to sacrifice if we do it right."
Here is a shortened version of reality: "The health care cost crocodile is eating the American way of life, currently it has swallowed an entire leg and is going for the other, so we must cut the first leg off at the hip to save our entitled ass."
Here's another example: Senator Lamar Alexander of Tennessee said on The News Hour last week that "the entire country should look to the examples of the Mayo and Cleveland Clinics where costs are relatively low and the outcomes good and replicate those models as a way to moderate health care cost inflation."
Here's the reality that he didn't mention: Both of those facilities pay their doctors--not for procedures--a salary. It's the primary reason that the care in those facilities is less invasive and less expensive. The day that Senator Alexander introduces Republican-sponsored legislation that puts all American doctors on salary is the day that Nancy Pelosi and Jim DeMint are caught in a compromising embrace in the Senate cloakroom.
You want more examples? No? Well too bad.
Here's a paraphrased version of the conservative push-back on reforming anything about American health care: "We have the greatest health care system in the world and if we change it there will be.....wait for it......wait for it, rationing!"
Here's the reality: America has great health care if you can afford it, otherwise it's mediocre at best and non-existent at worst. We already ration health care in America; we do it through cost and it's rapidly slipping out of the reach of even those with basic health insurance.
Speaking of rationing, let's do a little exercise inspired by a recent op-ed column by Peter Singer, professor of bioethics at Princeton, a small university in New Jersey (not that there is anything wrong with that).
Suppose that there is patient in your insurance pool who has aggressive liver cancer that will kill him in 12 to 24 months. There is a drug called Sutent that slows the spread of the cancer and could give this patient an extra six months of life if he starts taking it now. Whatever the insurance pool pays for this patient and others like him in the pool will impact future premiums for all pool members. Please answer "yes" or "no" to the following questions.
1. The Sutent costs $50 per month, should your insurance pool pay?
2. The Sutent costs $1,000 per month, should your insurance pool pay?
3. The Sutent costs $10,000 per month, should your insurance pool pay?
4. The Sutent costs $100,000 per month, should your insurance pool pay?
5. The Sutent costs $1 million per month, should your insurance pool pay?
If you answered "no" at any point in this continuum, you believe in rationing; you must be a realist and therefore, according to the conservative right, a leftist "socialized medicine" pinko. Otherwise, you are a strict non-rationer; you can march with Glen and Rush, gasbags who never take the "no rationing" argument to a thoughtful conclusion. You can beat the drum and argue that all life, regardless of circumstances and cost, must be paid for with everyone's last dollar. Frankly, I'm not willing to go down, along with my children and grandchildren, on that flawed fiscal ship.
The political will to do the things that would truly moderate health care cost inflation in America is not to be found in D.C. because the message contains news of change and sacrifice for most Americans and the entire health care industry. Try getting elected or re-elected on that platform.
Here's another reality,the necessary sacrifices, if designed and distributed fairly, would not ruin our lives nor wreck the balance sheets of the health care industry. However, the legislative sausage that is currently being packaged in Washington does little or nothing to curb health care cost inflation and a whole lot to place the economic sacrifice on future generations, in spite of Obama's message to the contrary. If the Republicans had a better solution than, "do nuttin' honey", we could turn to them.
Where's Ross Perot when you really need a short Texas nut case to lead a third party?
Observoid of the Day: A martini may quench many things but one of them is not thirst.