By Donald
B. Ardell – November 22, 2009
The health system reform bill just passed by the House of
Representatives offers too little, too late at too much expense for too little
benefit.
There was joyous pandemonium among Democrats as midnight
neared November 7 in the U.S. House of Representatives. The Democrats,
with bi-partisan support of one Republican (an anti-abortion zealot bribed with
an amendment severely restricting the reproductive rights of American women),
finally passed a health care bill. It was a happy time for Democrats but
it's the Republicans who should have been cheering, for what passed is a foul
mess that will come back to haunt Democrats. If anything like this House
bill gets past the Senate and dodges a veto by the president, the Democrats
might wonder why they celebrated on November 7.
The House bill had a few good features. It provides
partial coverage for 36 million more Americans and basic medical care is made
somewhat more affordable for 96 percent of the population. Unfortunately, it
will also allow the government to sell insurance but only in competition with
private companies.
As noted, it's too little, too late at too much expense for
too little benefit. Permit me to summarize why I think we need something much
bolder - a 100 percent public option.
But first, let me tell you why I thought of Soren
Kierkegaard (1813-1855) while the Democrats were celebrating.
Kierkegaard, the merchant of melancholy, viewed happiness as but a hiding place
for despair. In my opinion, despair will emerge from hiding soon enough.
It will also threaten REAL wellness enthusiasts who value quality of life and
genuine reform of our disgraceful medical system.
My own despair (quickly overcome, by the way, should you be
inclined to worry about me) was occasioned by the failure of the Congress to
enact reform legislation that will effectively control costs AND grant access
to all. While these are the two objectives of the Administration and the
Democratic majority, I prefer a system that rewards personal responsibility to
stay well - a system that promotes reason, exuberance and liberty - REAL
wellness. But, the latter is so far from being detectable by the radar of
reform watchers that the omission never surprises, only disappoints.
I believe we need a 100 percent single payer plan. (Yes, go
ahead and call it socialized medicine, if you wish. This may not be such
a bad approach - we already have socialized national defense, socialized postal
service and socialized national parks - why stop there? I urge this
strategy for Democrats knowing that it will cost the president and the Party
support of their one Republican ally and the continued absence of love from
Sarah Palin, Rush Limbaugh, Sean Hannity, Anne Coulter, Michelle Bachman, Glen
Beck and other great Americans. Or, far-Right wing nuts, depending on
your mindset and orientation along the imaginary fair-minded/lunatic fringe
continuum. I say it's time to go for the gold - a single-payer option of
government-provided health care guaranteed for all.
Of course, some of us already have socialized medicine,
including Congress, citizens over 65 and veterans. Let's provide the same
benefit to the rest of the population.
Here is a short summary of pertinent facts about the current
system and why REAL reform is needed.
Consider, first of all, that the new bill would add about
1.2 trillion dollars to current spending, a spending frenzy that already
consumes more than twice as much per capita as in other developed countries.
Why are costs so high and still rising? Ask yourself
this question: If we spent TWO or THREE trillion more on health care,
would we become twice or three times as healthy? No - money is not the
crucial variable - that is and will remain the dysfunctional nature of our
system, which this bill does not change. Capitalism, as Michael Moore and
others have shown, is the basic problem, best exemplified by the worst element
of medical capitalism - the health insurance industry. That's where
most of the money is going, $2.5 trillion to be precise.
No fewer than two-thirds of Americans rely on private insurers
and entrepreneurial providers. Health care is a market commodity. It is
distributed according to the ability to pay, even though half of the money
comes from federal and state governments.
These private insurance companies set prices and benefits and
they pay the doctors and other providers of actual medical care. Their profits
are dependent upon NOT selling policies to sick people and limiting services to
policyholders who do get sick.
Does this not sound like an insane system for all but the
insurance companies and their investors? These companies are known to skim
at least 15 to 25 percent off the top of all premiums taken in. Taxpayers
are indirectly paying for insurance company profits and overhead. Doctors and
others, the people who actually provide medical care, have to compete for
what's left. Of course, doctors have their own high billing and collecting
expenses that further reduce the pool of funds for actual caring
services. Overhead business costs (e.g., executive salaries, marketing and
so on) represent 30 percent of the US medical bill. That's thirty percent of
about six trillion dollars! (Source: Marcia Angell, Health Reform: Throwing
Good Money After the Bad, Huffington Post, August 24, 2009.)
Ms. Angell estimated we would save $400 billion if our
overhead spending amounted to the same percentage of our medical system
spending as Canada's. (Warning: Be advised that mention of the word Canada in a
medical context will invite animated comparisons with Lenin, Trotsky, Stalin,
Pol Pot, Saddam Hussein and Ghenghis Klan from the likes of Palin, Limbaugh,
Hannity, Coulter, Bachman, Beck and company.) So it goes.
Medical care is also delivered, for the most part, in
investor-owned health facilities. The incentive here is to provide more services
than needed for the well-insured and less for those unable to pay top rates.
Other dysfunctional aspects of our current system that beg for top to bottom
reforms include the following factors:
* Most doctors are paid on a fee-for-service, piecework
basis. Again, bad incentives in that.
* Specialists draw the highest fees and the more
frequent and expensive the testing, (e.g., cardiac angiography, MRI's), the
more specialists make. Estimates are that unnecessary testing accounts for
hundreds of billions of wasted dollars annually.
* There are fewer primary care doctors in our system
than in comparable societies.
The cost control targets advanced by the president and
Democratic reformers, while all desirable, will make only a modest difference
relative to the amount of waste in the private, for profit and non-profit
systems. This reality applies to electronic records, disease management,
preventive care and comparative effectiveness studies. All good ideas and
needed reforms, but relatively modest in relation to the basic unaddressed
dysfunctions with the system.
Basically, the most massive source of waste in our system is
the diversion of funds needed for medical care. Funds are diverted to two
basic functions:
1) Profits and overhead, and
2) Exorbitantly priced, medically unnecessary tests
and procedures.
The House bill leaves untouched the profit-driven, wasteful,
inflationary system. The distorted incentives are essentially
unchanged. All the House bill does is pour more money into a system that
is based on maximizing private profits, not increasing health while saving
unnecessary costs.
To borrow a phrase from the musical South Pacific, the bill
passed by the House seems to be but a divisionary tactic to take the public's mind
off REAL reform- which would be a single payer, not a half-baked public
option. Did I mention that health outcomes are far better in other
nations with single payer government systems? I should have, but that's a
topic for another day.
Be well. Hard as it is, try to look on the bright side,
despite what Soren Kierkegaard had to say about despair in hiding. When
the effects of this pitiful reform package are better recognized, despair will
have no place to hide, so perk up now before it's too late. 
Don Ardell is the Well Infidel. He favors evidence over faith, reason over revelation and
meaning and purpose over spirituality. His enthusiasm for reason, exuberance and liberty are reflected in his
books (14), newsletter (509 editions of a weekly report) and lectures across
North America and a dozen other countries.