Wednesday, December 16, 2009

Health Reform and Power over People's Lives

I believe in the power of words. I am leery of the power of government to run people’s lives.

I found both of these powers expressed in an article by Senator Grassley, an Iowa Republican, the ranking member and former chairman of the Senate Finance Committee In a December 17 New England Journal of Medicine perspective piece “Health Care Reform – A Republican View.”

Here is an excerpt of what Senator Grassley had to say,

The health care system has serious problems. Costs are rising at three times the inflation rate. Many Americans are uninsured. Millions more fear losing their insurance in a weak economy or because of preexisting conditions. Doctors are ready to close their doors because of high malpractice insurance costs and low government reimbursement rates.

Everyone agrees that something has to be done. But the reform proposals pending in Congress would make a bad situation worse. These bills would cause us to slide rapidly down the slippery slope toward increasing government control of health care. They contain the biggest expansion of Medicaid since the program’s creation. They impose an unprecedented federal mandate for coverage backed by the enforcement authority of the Internal Revenue Service. They will increase government spending by nearly $2 trillion when fully implemented. They give the secretary of health and human services the power to define benefits for all private plans and to redefine those benefits annually. From a new health-choices commissioner to a center for comparative-effectiveness research, these bills create dozens of new bureaucracies, increasing the federal role in health care. All of this amounts to a lot of power over people’s lives.


This excerpt shows the power of simple language. In 195 words, Grassley cogently expresses the Republican case against Democratic health reform proposals. The excerpt's Fog Index is low. The Fog Index is defined as the average sentence length + the number of 3 syllable words per 100 words X 0.4. The resulting number is the average education required to easily understand what is written. A Fog Index of 12 indicates a person with a high school education can comprehend what is being said. The Bible has a Fog Index of about 10, and Time Magazine aims for a Fog Index of 12 to 14.

In Grassley’s piece, the Fog Index is 13.0 + 17.7 X 0.4= 12.2, meaning the language is so simple a high school graduate can understand it.

But the true power lies in its message. The Democratic proposal would give government enormous power over people’s lives. Among other things, it would limit health choices, control the content of all health plans, drive down costs by rationing care and slashing payments to hospitals and doctors, intervene in doctor patient decision-making, and guarantee a staggering burden on U.S taxpayers.

But it’s biggest problem it would do nothing to control costs, either for the system or for the insured. Further, it would raise premiums for those who are young and healthy. In some ways, it is the worst of all possible worlds – limiting access to care by driving doctors out of business and raising health costs through higher taxes and and expensive comprehensive government-dictated and mandated health plans.

2 comments:

Terence Coughlin said...

Granted it is an easy read of few words, but I was more moved and motivated by the (many) more words in Atul Gawande's recent New Yorker article:

http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande?currentPage=all

Also, I know it was only an excerpt, but was an outline of an alternative proposal in the rest of the Senator's commentary?

Richard L. Reece, MD said...

I am aware of Atul Gawande's work. He writes beautifully. I have read the piece to which you refer and his previous New Yorker article. Dr. Gawande faithfully mirrors the Boston-qcdademic and Obama-political point of view of top-down paternalism as the way to go. Gawande may be right. I simply do agree with him.