Outraged at the Politics of Healthcare

I’ve really tried not to write this. I’ve said my peace on a national health care make over (see Will Marre’s Radical Solution to Health Care), but now my hair is on fire. Those framing the debate are focused on all the wrong things. We cannot repair a completely broken model. We must re-think and thoroughly re-invent health care. Arguing about projected costs made by assumptions that can’t be validated is pretending to know the unknowable. Trying to close a $1 trillion gap is an exercise in science fiction. It is also strange that Republicans are so concerned about costs when they gleefully agreed to pay drug companies a trillion dollars in a deal George Bush made on Medicare drug benefits. They weren’t concerned about the trillion-dollar cost of a non-strategic war, but now when we want to end our Neanderthal ways of health care, they are wringing their hands. Right.

The financial interests that currently thrive on our broken system are reportedly throwing $10 million a week at keeping their flood of money flowing. The current system is constantly escalating costs and shrinking benefits for those that can afford insurance. Most people have no real idea what costs are actually covered by their policies because they are so complex. And the whopping bottom line remains—we have the most expensive per capita health care system in the world with the worst results in the developed world. Yet this is the system that is being defended by the brainless mouthpieces on right-wing radio and television. This is not the best we can do.

How bad is our system? Well, the American Medical Association estimates nearly 1000 people a day die from mistakes made in our state-of-the-art hospitals. Die. That’s not a problem. That’s a tragedy. The FDA approves drugs for wide use and promotion on television that kill people. Vioxx anyone? Last year my mother-in-law was hospitalized for four days. She never saw the same doctor twice. Instead a team of hospital-based doctors strolled through her room cluelessly looking through paper charts muttering questions about the previous doctors’ prescriptions. Their big achievement was completely disrupting her blood sugar levels that she had spent years controlling. She was released but never was able to get them under control before she died nine months later. Our current “system” is polluted with toxic self-interest at every turn. And the competition of competing self-interests has not produced high-quality low cost care, but it’s opposite—low quality, high cost industry. And the answer is not some medical version of the post office, an expanded Medicare system or a mish-mash of compromises of special interests. To re-invent the system we must revolutionize it.

First we begin with the premise brilliantly articulated by the philosophers who inspired the American ideal of life, liberty and the pursuit of happiness. The father of moral capitalism, Adam Smith, argued that the purpose of any economic system must be to maximize human benefit, to maximize the quality of life for the most individuals. He opposed slavery, child labor and all forms of economic exploitation. Jeremy Betham proposed that the best society was the one that created the most opportunities for happiness. This means that as governments form to promote public policy they ought to be focused on reducing avoidable suffering. That’s a big idea. Reducing avoidable suffering. And history is clear the most efficient way to do that is to empower individuals to be self-reliant by eliminating or controlling special interests, powerful cartels and a monied aristocracy while providing a public and private infrastructure of education, transportation, electricity, technology, access to capital, and yes, health care. This doesn’t mean the government has to provide these services; rather, our government needs to provide a system of enforced laws that prevent the powerful from manipulating and exploiting the middle class and the poor and provide infrastructure when the common good is served.

An American version of universal health care should:

1. Make each of us responsible for our own health care up to 3% of our household income each year. This responsibility will reward healthy lifestyles and promote service providers like Minute Clinics and keep us personally responsible.
2. Make all citizens part of the 300 million member group that dilutes individual catastrophic health care risks across our entire society. We need to be committed to our common good.
3. Tax harmful habits, food and beverages so that people who consume them contribute more to health care.
4. Create a non-governmental non-profit citizen co-op to manage health benefits whose employees are highly bonused to create six-sigma quality service.
5. Radically increase the number of nurse practitioners and physician’s assistants to lower the cost of routine care. Increase incentives for preventive care and eliminate incentives for redundant, wasteful testing and lab work.
6. Bring the cost of all prescription medicine to be no more than the average paid across the 20 most developed nations.
7. Eliminate the strange connection between employment and health insurance. It’s both bad for business and traps people into jobs they don’t want. It makes us less competitive internationally.
8. Allow and encourage a competing private insurance, private hospital, private doctor system to spring up so that no one can claim health care is rationed. That is, anyone who chooses to afford extra tests, extreme measures and other services our society cannot afford should be able to get it on their own terms.

Obviously these are broad ideas, but they serve as a framework for common sense thinking about American health care. Meanwhile, what are we likely to get? Most probably a hodgepodge of deals and compromises that enable the medical aristocrats to continue to make billions of system inefficiencies while ignoring the real opportunities for healthy change.

Our mutual quality of life depends on more of us understanding that the most important things in life are more than the sum total of commerce. Health care and commerce are simply not ideal partners. When we try to make it so, corruption is the sure result. This is what gives capitalism a bad name. We need bolder leadership. Moral vision and clear ideals. Frankly, regarding health care we need to go back to the beginning and start all over again.