Sunday, February 28, 2010

Do-or-Die - Fundaments of Health Reform

I always test my bath before I sit
And I’m always moved to wonderment
That what chills my finger not a bit
Is so frigid upon my fundament.

Ogden Nash, 1902-1971

As I sat reading a New York Times piece in the Week in Review section, “The Cost of Doing Nothing,” Ogden Nash’s verse sprang to mind.

Then I read two other inflationary articles in the same section, “”Six Ideas for America!”with a subheading of “Agreeing to disagree on disagreement,” and the other “Six Hours of Hot Air!” with subtitle of “One had nothing, the other had nothing good. “

The three authors’ tone was the same, if universal coverage, our pet moral imperative, is not achieved, then nothing is achieved, and a pox of both Democrat and Republican houses.

What will happen to our collective fundaments if we do nothing? Will health care costs sort themselves out and save the U.S. from collective financial suicide?

Not likely says the Times,

“Far from it, health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly and indirectly.”

Doing Nothing Not an Option

If doing nothing is not an option, say doomsayers, why not Medicare-for-all? As a hospital administrator friend of mine used to say to us doctors , “Don’t do nothing, do something!”

What’s the problem with American politicians? The problem is the American people and our culture. The basic premise of uur founding fathers 234 years ago was that Americans should do individualism, not collectivism. Individuals, not government, should reign.

We Don’t Do Comprehensive Well

As Senator Lamar Alexander of Tennessee said in his opening remarks at the health reform summit,

“When I go down on the floor, some of my Democratic friends will say, ‘Well, Lamar, where's the Republican comprehensive bill?’ And I say back, ‘Well, if you're waiting for Mitch McConnell to roll in a wheelbarrow in here with a 2,700-page Republican comprehensive bill, it's not going to happen,’ because we've come to the conclusion that we don't do comprehensive well. “

Senator Alexander explained,

“We've watched the comprehensive economy-wide cap in trade. We've watched the comprehensive immigration bill. We had the best senators we've got working on that in a bipartisan way. We've watched the comprehensive health care bill. And they fall of their own weight.”

“ Our country is too big, too complicated, too diverse, too decentralized for Washington, a few of us here, just to write a few rules about remaking 17 percent of the economy all at once. That sort of thinking works in a classroom, but it doesn't work very well in our big, complicated country.”

Senator Kent Conrad later noted, Americans don’t do coordinated care well either. Conrad might have added, we don’t do care for the have-nots, the uninsured, well either.

Governor Palin, had she been there, would surely have added, we don’t do death panels well to boot.

Six Ideas

Alexander said Republicans had six incremental ideas for fixing the system,

One, adding incentives for small business.

Two, helping Americans buy insurance across state lines.

Three, ending junk lawsuits against doctors.

Four, giving states incentives to lower costs.

Number five, expanding health savings accounts.

Number six, allowing patients with pre-existing conditions to afford coverage

All At Once, Or Not At All

This list infuriated Democrats, who asserted we must do it all at once, rather than starting from scratch and doing it one step at a time.

So how do we save our collective fundaments?

Democrats say we must mandate that everyone, individuals and employers, pay so we can create one huge pool and collectively lower costs. Unfortunately, as individualists, we don’t do mandates well.

Republicans claim we can only lower costs by introducing health savings accounts with high deductibles so individual patients pay a larger load of the initial costs, thus effectively ending the free-lunch mentality. That does not leave much room for collective action.

Well, it’s a big, complicated, diverse, decentralized country. I suspect there’s room for both points of view. There had better be. Otherwise we will be up to our collective fundaments in debt. That is a chilling thought.

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