No One Is Willing To Say, "Yes!"

Lots of people say, "No!" to President Obama's proposed healthcare reform package; mostly Republicans, whose entire legislative strategy for this session of Congress can be summed up in that one word. Unfortunately, even some Democrats are saying, "No!", too. Why they are doing this is a mystery, because if Obama's plan fails to be enacted, the Democrats will have handed the next election to the Republicans. 

Even in the contorted realm of political logic, this one defies description. Here's the situation:  the Democrats control both houses of Congress and the White House. Celebrating this outcome the day after the elections, any Democrat--be he yellow dog, blue dog (why do politicians have to have colors for everything?)--would be justified in thinking, "Now we're gonna turn things around and get this country back on its feet!"

But, hey--these are politicians we're talking about. They've got no spine or moral compass. All they care about, regardless of which party they're in, is getting re-elected. Want an example? If you were a U.S. Senator in 2002, knowing then what you know now, would you elect Harry Reid to be your leader? He's a textbook definition of gutless wonder. And Nancy Pelosi in the House? All I'll say is that she's even worse than Reid.

However, they're what we've got to unite the legislative troops behind President Obama's many initiatives, healthcare reform being the most pressing and immediate. We need people who can stand up and say, "Hell, YES! I'm gonna support my President and his programs!" Obama must feel like he's being nibbled to death by ducks. Here he's the head of a party that has all the pieces in place to go out and make real change in this country, to turn it around from the descent into Hell the previous administration engineered over eight years of rule by the foulest, most despicable, inbred, power-mad, war-hungry criminals this country has ever seen.

Even my wife, who is one of the smartest people I know, complains that she doesn't want a plan that takes her tax dollars to subsidize the healthcare of people who are obese and unexercised because they brought on their own health problems, like diabetes and heart failure. She's drunk the Republicans propaganda Kool-Aid, leading her to link this societal problem to Obama's healthcare reform package. THEY'RE MUTUALLY EXCLUSIVE! TWO SEPARATE PROBLEMS! YOU CAN WORK TO FIX THEM BOTH AT THE SAME TIME WITHOUT ANY CROSSOVER!

What do I mean? Obama's plan addresses the three key aspects of healthcare:  coverage, services, delivery. When his plan is enacted--never mind getting true universal coverage, like the rest of the civilized world--yes, fat people and their problems will be covered. BUT, THEY'RE NOT FAT BECAUSE THEY'RE COVERED. THEY'RE COVERED BECAUSE THEY'RE AMERICANS. Two separate problems. Get it?

Let me know your thoughts.

You can't make these names up!

Here's a quote from today's New York Times: "Richard Kronick, a professor at the School of Medicine at the University of California, San Diego, cautiously concludes from his own study that there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States. That doesn’t mean that it wouldn’t; we simply don’t know if it would." A doctor named Kronick--what are the odds?--especially with the topic he researched.

It would be interesting to see his research protocol for this study. After all, beyond the superficial data points that can be known--age, sex, marital status (but, how many times married? I bet not), homeowner or renter, etc.--the information one gathers is squishy at best.

For example, of what illness(es) did each person in the study die? As an example, I'll use my mother. She had kidney failure and was on dialysis three times a week for about six years. She also developed Alzheimer's, gradually and insidiously, over many years. She had pulmonary problems, due at least in part to smoking for about 40 years (she quit for the last 18 years of her life). The list continues: Macular degeneration, cataracts, migraine. But, the cause of death listed on her death certificate is acute aortic stenosis. Yes, she had health insurance, which covered just about every treatment and prescription. The question is: If you put her into your research categories of "Had Insurance" and "Lived to Age . . .", what have you learned? Very little, in my opinion.

This is a point I've mentioned before, but it bears repeating; in fact, this blog is in large part dedicated to hammering on this point until at least a majority of people in this country (and, elsewhere) accept it as valid: The people who make the decisions about your, and my, healthcare options, insurance, and eligibility are people who know the price of everything but the value of nothing. As a society, we have not evolved to the point where the fruits of innovation, discovery, initiative, and concern for the well-being of others are valued much less than the ability to show a profit. Until we do, healthcare--and education, childcare, work opportunities, etc.--will generally go to the people most able to afford them. This is a kind of rationing, which is the topic of the article from which the quote at the outset is taken.

As Damon Runyon once wrote, “The race is not always to the swift, nor the battle to the strong, but that's the way to bet.”

Let me know your thoughts.

We're in trouble . . .

. . . now that Professor Michael Porter published his new book about how to cut health care costs. To his credit, Professor Porter espouses a solution based on the principles that he lives and dies by and teaches to students at the Harvard Business School. But, as soon became clear during an interview on WBUR (an NPR affiliate at Boston University), Professor Porter's solution is a classic ivory tower confabulation having no relationship with the realities of health insurance and delivery of health care services.

His solution? Let's change the way we pay health care providers for their services. Instead of paying a fee for service, which we do now, Professor Porter proposes to pay physicians and others based on health care service outcomes. On the surface, this might seem to be reasonable. After all, when you take your car in to be repaired, you get a warranty on the work performed. Bring it back within the warranty period if anything specific to the repair goes wrong, and they'll fix it for free. Closer to the topic, a patient, or whoever is responsible for issuing payment, might determine that it took little Johnny three weeks to get over his cold rather than the "normal" recovery time of seven days. As a result, Johnny's pediatrician would be paid less. If little Johnny has a relapse (how do we know it's the same cold?), the doctor might receive no payment because of the unsatisfactory result of his treatments.

This is about as logical as Broadway Danny Rose saying to his paramour, when she tells him bad guys shot her ex-boyfriend through the eyes, "Oh, my god, he's blind!" "No, you idiot," she retorts, "he's dead!!"

A medical example might make this more apparent. Say you have a hernia repaired. How long does the doctor have to wait before h/she is paid? Well, if it's done laparoscopically, you walk out of the hospital the same day--the so-called outpatient procedure--and recuperate at home for 10 days-two weeks before resuming normal activities. If it's done with an incision, there's a two-day hospital stay, followed by six weeks of recuperation, during which you can't lift anything. Regardless of which kind of repair is done, any surgeon, if you ask (most patients do not), will tell you that the real test of a surgical repair comes 10 years after the repair. If it's still solid after all that time, you can think of yourself as "cured". Does the doctor have to wait 10 years to get paid?

Or, suppose you break a leg. Dr. Porter and a fair number of other folks with, as my father used to say, "more nerve than brains," will tell you that market forces will determine the path to the most cost-efficient solution to the problem. In other words, much as if you were buying a refrigerator or a computer, you will compare prices, brands, customer experiences, and other things that will lead to a wise purchase.

But, wait a minute! YOU HAVE A BROKEN LEG! YOU ARE IN PAIN! PERHAPS YOU CAN SEE THE BONE COMING THROUGH THE SKIN--A COMPOUND FRACTURE!! You are not going to shop around for the best price for treatment. You are about to go into shock. You must get to the nearest hospital STAT! "I don't care! Just end the pain", you tell the emergency room people as they track down the orthopaedic surgeon on call.

In that scenario, who will evaluate the doctor? On what basis will the evaluation be performed? Did you remember to ask the doctor about his warranty policy? It should be clear by now that Professor Porter and that tribe of business-oriented, cookie-cutter solution-loving people he represents--those who know the price of everything but the value of nothing--offer loopy approaches to problems that can't be measured or contained. They are squishy and fluid, not solid and of fixed shape.

So, avoid the trouble this kind of approach brings. Everybody knows the real solutions to the problem: single-payer, universal coverage, cradle-to-grave coverage. Demonstrating that they will do the job and contain the costs is the next real challenge.

Let me know your thoughts.