I listened to all of the healthcare conference call yesterday. It left me with the impression that I've been developing for quite some time. There's not going to be any healthcare reform this year, and probably the best thing we can hope for at this time is no bill at all from Congress. If anything resembling the bill that's now festering in Congress passes, we're going to take longer to recover from its ramifications than will be required to start all over again on a reform effort at some point in the future.
You see, my friends, what is emerging from all this is the sad fact that the problem is us. It's not the President, it's not Congress, it's not the insurance industry, and it's not the pharmaceutical companies. It's us, the American people. And by that I mean that what we say we want isn't attainable.
Now admittedly part of the problem is the brokenness of political institutions. (How long has it been since Congress actually did something constructive as opposed to diddling around the edges with "feel good" legislation?) But the other part of the problem is that the wish list for healthcare reform which has been endorsed by President Obama and echoed widely elsewhere is mathematically impossible. The numbers just don't add up.
Here's what I'm hearing when I piece together all the speeches yesterday:
- universal healthcare
- a single-tiered system with no limits on access or procedures
- no "discrimination" in insurance, i.e. everyone gets insurance at the same cost no matter what the person's health
- no rise in premiums that people are currently paying
- everybody gets to keep their present insurance if they like it
- no "death panels" to decide whether an end-of-life patient qualifies for every conceivable treatment that could possibly work
- no changes to Medicare coverage
There's something uniquely American about this wish list. It's egalitarianism run amok. Other countries don't engage in this kind of wishful thinking.
We've become a society that loves the "blame game." In the conference call yesterday, one of the speakers lamented a friend or relative who had died from brain cancer that had spread to many organs. The speaker said matter-of-factly that the acquaintance died because the insurance company denied treatment in a timely fashion. No, friends, the patient died of cancer. The insurance company may have behaved outrageously, and the delay in treatment may (or may not) have been a factor in the death. But death does happen, and our fantasy that every death is preventable if we just seek out the proper treatment is one of the main reasons that end-of-life healthcare costs in the U.S. dwarfs that of other countries.
Often we hear it said, "If other countries like Canada and the UK can have universal health care, why can't we?" Well, we of course could have a system like the UK or Canada has, but that doesn't match our wish list. While in the UK last spring I observed that every subway car in London is plastered with ads for private health insurance. The private system runs alongside the public system. It's a much better system than we have in the U.S., but it's a tiered system. The people who buy into the private system get access to care that isn't available to people only in the public system. And that doesn't fit our national myth.
I think the system in the UK is superior to what we have now in the U.S. But to get from here to there, we have to give up some of the things on our wish list. My own opinion is that the most feasible approach is to forego changing the private system and instead build tax-paid "almost free" clinics alongside. Doctors would be on salary, and paperwork would be reduced dramatically. Yes, it would be costly, and yes there would have to be new taxes of some sort to pay for it. But the critics are right in that there's no such thing as a free lunch. And there's something in this for everybody. For the uninsured, it would provide basic medical coverage at minimal cost. And taking the uninsured out of our emergency rooms would benefit hospitals, free up emergency rooms for actually dealing with medical emergencies, and reduce hospital costs for everyone else.
When government lies to the people it's usually because the people don't want to hear the truth. That's just as true in the present healthcare debate as it was with the Iraq war. We didn't want to be told that victory in Iraq would have huge social or financial costs. We even now don't want to be told that we can't clean up the environment while maintaining dirt cheap gasoline prices. (So our government fumbles along trying to have it both ways.) And we don't want to be told that we can't have everything on our wish list as far as healthcare reform is concerned.
Read the excellent article by Bob Herbert of the NY Times if you haven't already. It appeared in the N&O today, but I saw it in the NY Times yesterday.