This Health Care Reform Debate is Really Starting to Scare Me—What if We Were Having a Real One?

The recent stridency of this health care debate has led me to wonder what if the Democrats were proposing real health care reform?

The Democratic health care bills are hardly more than expansions of the health insurance entitlement paid for by largely insignificant cuts to existing spending and lots of new taxes. Any provider cuts to Medicare are so small they will be easily cost shifted to the private sector.

These Democratic bills are not health care reform. Nothing in them would "bend any curves" or make our system more sustainable. They are clearly not the systemic health care reform we need. At the end of the day our federal deficits, for example, are projected to be just where they would have been.

So, if these people out to scare folks more than conduct a rational debate can get away with it over such minor changes to the American health care system can you imagine the things they would be saying about real health care reform?

George Lundberg has a great post over at The Health Care Blog in which he suggests a number of meaningful changes to how care is delivered—by eliminating waste not medical necessity. Here is a portion of his post:

Currently several House and Senate bills include various proposals to lower costs. But they are tepid at best, in danger of being bought out by special interests at worst.

So, what can we in the USA do RIGHT NOW to begin to cut health care costs?

An alliance of informed patients and physicians can widely apply recently learned comparative effectiveness science to big ticket items, saving vast sums while improving quality of care.

1. Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.


2. The same for invasive angioplasty and stenting (currently around 1,000,000 procedures per year) saving tens of billions of dollars annually.


3. Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions saved here.


4. Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions saved.


5. CAT scans and MRIs are impressive art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by some capitated or packaged method that is use-neutral. More billions saved.


6. We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.


7. Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.

Can you imagine what these people would be saying about George's ideas?

The Bigger the Lie

I come from a corporate background.

A longtime ago a chief marketing officer introduced me to the term, “The Big Lie.” Apparently, this also applies to politics.

As he put it, in not a complementary way, the bigger the lie that is told the easier it is to believe.

Sarah Palin has been practicing Big Lie politics.

She recently posted on her Facebook account:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”

Now, readers of this blog know I am not enamored by the Democratic health care bills—my view is that they are about a little cost containment “lite,” shave the providers a little bit, and raise taxes by at least $500 billion and call it “health care reform.” I am more than disappointed in where the majority party has taken this.

But what Palin and a number of other right-wingers are doing is appalling.

And, too often Republican and conservative leaders have attempted to rationalize this behavior—if not outright use it for political advantage. Newt Gingrich responding to Palin's comments for example, “Communal standards historically is a very dangerous concept. …You are asking us to trust turning power over to the government, when there are clearly people in American who believe in establishing euthanasia, including selective standards.”

Rather than rationalizing this kind of thing it’s high time that leading Republicans and conservatives disavow any connection to this kind of behavior—they know better.

It looks like lots of mainstream Americans are having trouble with the Democrat’s health care plan. They should.

But these extremists who just plain misrepresent the facts only undermine credible criticism and they risk a backlash that will just bounce this debate from one extreme to another that would have nothing to do with the honest health care debate this country needs.

Just how much lower are they prepared to go?

Patriots indeed.

Sarah Palin on Health Care--A Free Market Republican

Republican vice-presidential candidate Sarah Palin has very little on her health care policy resume from her short time in office as Alaska's Governor but what she does have fits right in with Senator McCain's strategy to use the market more effectively in bringing down America's health care costs and improving access to the system.

Her health care efforts have focused on two things in Alaska:

• Eliminating the 1970s era strategy of requiring providers to file Certificate of Need (CON) applications before being able to build more health care facilities.
• Providing consumers with more information.

On the Certificate of Need issue she recently wrote in an op-ed:

Health care: Do we have too much government or too little? Should we have regulated markets or open markets?

Those are the perennial questions.

And that's what makes the state's proposal to repeal the current Certificate of Need (CON) program so contentious. Yes, there are solid arguments on both sides. But after much consideration, we believe that the program has not accomplished what it set out ultimately to do more than 30 years ago -- lower costs for the consumer. It is time to end Alaska's program in its present form. Doing so will not only reduce the cost of health care, it will also improve the access to health care, allow more competition and improve quality of care for patients.

Certificate of Need programs were required in all states in the mid-1970s by federal mandate. The goal was to make sure that health care facilities matched community need and provided access and quality care, which in turn would help reduce health-care costs. The federal mandate was repealed in 1987 -- 20 years ago! -- along with its federal funding.

The basic assumption in those days was that excess capacity, in the form of overbuilding, directly results in health-care price inflation. However, after more than 30 years of such programs, the National Conference of State Legislatures has found that there is no solid proof that the state-sponsored CON programs have actually controlled health-care costs. In fact, in 2004 the Federal Trade Commission and the Department of Justice both asserted that these programs actually contribute to rising prices because they inhibit competitive markets.

Many opponents of CON programs have argued that health-care facility development should be left to the economics of each institution, in light of its own market analysis, rather than being subject to political influence...

As I said recently in my State of the State Address to the Legislature, "Under our present Certificate of Need process, costs and needs don't drive health-care choices -- bureaucracy does. Our system is broken and expensive." Eliminating the CON program, with certain exceptions, will allow free-market competition and reduce onerous government regulation.

Governor Palin has also been calling for more price transparency, openness and competition as a solution for rising health care costs in Alaska.

A task force set up by the Governor on health care issues in Alaska recently concluded that consumers needed more information to be able to compare costs.

As a result, Palin introduced the Alaska Health Care Transparency Act to provide consumers with information on quality and cost which would be provided by a new government-run health care information office.

Both of these relatively minor forays into health care policy could hardly be described as heavyweight attempts at health care reform. But both are consistent with the McCain market-based strategy to remake America's health care system.

I expect Governor Palin will have no trouble fitting right in with Senator McCain on the health care issue.

Related posts on the presidential candidates' health care plans:

Comparing John McCain's Health Care Plan to Barack Obama's Health Care Plan--What's the Big Idea Difference?

A Detailed Analysis of Senator John McCain's Health Care Reform Plan

A Detailed Analysis of Barack Obama's Health Care Reform Plan