By Frank Schell on 9.2.09 @ 6:04AM
Only one thing can reform and save the health care debate.
President Obama is meeting stiff resistance from even his own
party -- and from the American people. This is evidenced by the
President's willingness to retreat on the government run option,
begging the question, what else is wrong with the
Administration's proposal?
In the formulation of national health care policy, time is both a
constraint and a resource. Time is a constraint for a President
who knows that his popularity is likely highest in the first
three to six months of his Administration. It is a constraint for
a President who wishes to strike while his iron is hot, and to
follow the advice of his chief of staff, Rahm Emanuel: "Never let
a serious crisis go to waste."
The health care industry, unlike financial services, has not
imperiled the global financial system, necessitating rapid
emergency regulatory intervention to prevent catastrophe. Few
will deny that the cost of health care and its accessibility
should be part of a national debate -- but the President is
trying in just a few months to railroad a solution, lest his
ratings continue to decline.
Time, however, is a resource for those who must perform extensive
due diligence on health care, which represents a monumental 17%
of U.S. GDP. This economic activity is equivalent to $2.4
trillion, which is slightly more than the entire GDP of Great
Britain, the 7th largest economy in the world (purchasing power
parity 2008 estimate). Why the White House wanted decisions of
colossal importance to be made by the end of August would seem a
decent question, especially when they address economic, medical
and ethical issues that have been decades in the making.
The value of an extensive national debate is to inform the public
about a complex subject that affects us all. It permits focus on
issues on which the Administration has been largely silent.
First, capping malpractice liability, also known as tort reform,
is not addressed. While malpractice insurance raises the cost of
health care to the patient, a knock-on effect is the
overprescribing of some tests and procedures, due to an abundance
of caution in a litigious culture. The Economist refers
to evidence that Americans could reduce between 10% and 30% of
health costs by eliminating unnecessary medical procedures and
prescriptions.
Second, the sponsors of the bills do not address incentives for
adopting good life style choices and a national education program
to support this. If we are to radically overhaul health care,
shouldn't there be incentives for making positive decisions about
personal behavior, and as some must be asking, in order to
improve outcomes, shouldn't there be higher premiums for behavior
that is reckless or unwise?
Third, and as reported in the Wall Street Journal, the
Pew Hispanic Center reports that about 50% of the 12 million
illegal aliens in the U.S. do not have health insurance, and they
are lawfully entitled to free emergency treatment which cannot be
denied. In view of the cited McKinsey & Co. estimate that the
same care at a primary facility would be 10% to 15% of the cost
of delivery in an emergency room, the effects of illegal
immigration on the national health care debate must be brought to
light based on present and future demographics.
Finally, the debate should take time to include discussion of
other national role models and what their effectiveness is. Level
of co-payment, rationing and waiting lists, restriction of
physicians, technology, and consistency of quality must be taken
into account with any so-called universal coverage program --
along with the level of deficit required to sustain it. To
achieve a collective understanding beyond sound bites about
countries such as France or Canada requires analysis, thought,
and dialogue on the airwaves and in print.
For a White House that prides itself in text messaging and
Tweeting, it could be more adroit at communicating its message
succinctly. The ridiculous image of "death panels" for seniors
put forth by Sarah Palin, while a grotesque misrepresentation of
the Administration's approach, has been a more effective, albeit
negative, brand moniker than all the President's mellifluous and
numerous words. Through ineffective communication, the President
has allowed his political adversaries to define him.
Until we know at the individual level what health care reform
will cost and what the benefit will be, we will not have a
well-informed electorate, and there will be vulnerability to
fear-mongering and misunderstandings.
In view of the complexity of the issue, the economic scale, and
the amount of misinformation in the mainstream, the country needs
a scarce resource in order to evaluate and assimilate: Time.
topics:
Health Care, Death Panels
