There is now an avalanche of commentary concerning the Senate healthcare bill released with much fanfare by harry Reid last night. Those in favor of the bill tout its provisions to increase the availability of care to almost all. Nicholas Kristof does a representative job by pointing out that opposition to the original Medicare program, as well as to the establishment of Social Security before it, were overblown and have in time proven to be unfounded:
... ferocious hyperbole was unleashed on the proposal for Medicare. President John Kennedy and later President Lyndon Johnson pushed for a government health program for the elderly, but conservatives bitterly denounced the proposal as socialism, as a plan for bureaucrats to make medical decisions, as a means to ration health care.
The American Medical Association was vehement, with Dr. Donovan Ward, the head of the A.M.A. in 1965, declaring that “a deterioration in the quality of care is inescapable.” The president of the Association of American Physicians and Surgeons went further and suggested that for doctors to cooperate with Medicare would be “complicity in evil.”
The Wall Street Journal warned darkly in editorials in 1965 that Medicare amounted to “politicking with a nation’s health.” It quoted a British surgeon as saying that in Britain, government health care was “crumbling to utter ruin” and suggested that the United States might be heading in the same direction.
“The basic concerns and arguments were the same” in 1935 against Social Security, in 1965 against Medicare, and today against universal coverage, said Nancy J. Altman, author of “The Battle for Social Security,” a history of the program. (The quotes against Social Security above were taken from that book.)
These days, the critics of Medicare have come around because it manifestly works. Life expectancy for people who have reached the age of 65 has risen significantly. America is no longer shamed by elderly Americans suffering for lack of medical care.
Yet although America’s elderly are now cared for, our children are not. A Johns Hopkins study found that hospitalized children who are uninsured are 60 percent more likely to die than those with insurance, presumably because they are less likely to get preventive care and to be taken to the doctor when sick. The study suggested that every year some 1,000 children may die as a consequence of lacking health insurance. [Emphasis mine-SW]
[I emphasized the may because I want to call BS on this. Those children may also be dying because their parents are neglectful. Unless Kristof can show me some data, compete with controls, all we have is a factoid of uncertain significance. There is too much of that in this discussion already.]
I don't mean to be churlish but Medicare is now going bankrupt and a sizable percentage of Doctors will not accept new Medicare patients because the compensation has not kept up with costs. Those do not seem to be attributes of a system that can work long term. Further, the innovation that has led to increased survival rates for the elderly has been fueled by the profit involved in Medical care; for most Doctors Medicare is not a source of profit but a service that is subsidized by those able to pay at closer to market (or above market) rates. However, that is not my main point in this post.
I suspect there are almost no Doctors and very few commentators who do not believe we should try to maximize the accessibility of health care for Americans. The problem with the bill(s) is that they do not do what they claim to do, they all end up costing far more than suggested, and they will do significant damage to the innovation in Medicine that can keep us all alive for longer and healthier extents.
As luck would have it, the Dean of Harvard Medical School agrees with me on almost all of these points: [HT: Roger Simon]
Health 'Reform' Gets a Failing Grade
As the dean of Harvard Medical School I am frequently asked to comment on the health-reform debate. I'd give it a failing grade.
Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama's agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health—not politics—have been left in the lurch. And as controversy heads toward a conclusion in Washington, it appears that the people who favor the legislation are engaged in collective denial.
Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.
...
In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.
As a bonus, Dr. Flier notes that our leaders apparently think we are idiots and/or fools:
Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task. It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation.
So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.
We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.
The problem for the Kristofs of the world is that the bills currently being discussed in Congress are extraordinarily complex, written by people who are hidden in the shadows and have clear ideological biases, and have been neither read nor understood by our esteemed solons. Further what they purport to do can be done much more simply and cheaply; why do we need a 2000+ page bill?
Yuval Levin (who no doubt has his own bias) sums up:
So, to sum up: the idea is to spend trillions even as our debt is mounting, inflict massive tax increases on a troubled economy, impose costly mandates on employers as unemployment hovers above 10%, squeeze money out of Medicare not to fix the program’s finances but to create a whole new enormous federal entitlement alongside it, insert the government in countless new ways between doctors and patients, and cause millions of middle-class families to lose the employer-based insurance they have today, pay even higher premiums, and find themselves herded toward a government insurance provider. Oh, and at the end of it all, if we use the methods of counting the uninsured favored by the Democrats, there are still 24 million people without health insurance.
I would add that my favorite aspect of the Congressional dishonesty is the idea that the (fantasied) cuts and revenues (taxes) start three years before the program takes effect, which allows the Congress to claim that they will save money that they know will never be saved. In fact, expanding Medicare while avoiding cuts means that the cost of our already bankrupt system will sky rocket.
Finally, please go to Maxed_Out_Mama's site and offer her a hearty "Thank you." She has helpfully posted the entire table of contents of the Senate Health Care Bill and plans to read it. I am awed by her courage and look forward to her findings. It should be fascinating.
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