What Would You Do?

My good friend, David Smith, an attorney who retired (to my regret) and spends summers in Maine and winters in Texas, stays current on legislative affairs, including the healthcare debate. He read the article: "The Cost Conundrum" about Medicare cost per patient for health care in McAllen, Texas compared to the cost nationwide and the cost in a demographic similar community in El Paso, Texas, and has shown an interest in my response.

David and I have shared opinions and coments by email and Facebook for months, and perhaps haven't always agreed on certain issues, but have kept open minds and have continued to communicate. Recently Dr. Zawande, the author of the article "The Cost Conundrum" published a sequel-article based on his answer to the rash statements that have arisen lately about the Healthcare Debate and the nationwide so-called forums. For anyone interested in the health care crisis, it would be well to read both articles

David sent the sequel to me just recently with a note asking what would I do if I could write a new bill that would pass the vote in Congress and that the president would sign. I've reproduced those emails just as they were written. The dialogue between us says a lot:

On Sat, 9/5/09, Charles S. Clark, SR., M.D. <cclarksr@stx.rr.com> wrote:

From: Charles S. Clark, SR., M.D. <cclarksr@stx.rr.com>
Subject: What would I do?
To: davidlsmith35@yahoo.com
Date: Saturday, September 5, 2009, 8:34 PM

David,

An interesting query. I would do exactly what will be done: Throw a bone or two across the isle, write a bill that would guarantee universal healthcare coverage, and then—after it passes and is signed—begin an aggressive cost reduction/containment program for the next 5-10 years that would correct as many as possible of the deficiencies that have been uncovered.

Even the rightists know the status quo is doomed for self destruction. I hope the Obama administration is sensitive and flexible enough to realize they cannot ram-rod through any other program. Hasn’t that approach been the strategy that’s always been in place in this country? Can’t complain too much about the outcome of such, can we?

Always good to hear from you.

Charles Clark  

David's Reply (Saturday, September 5, 2009):

I agree!  I hope you also put that on Facebook for more to see!  A couple of weeks ago I read these comments by Dr. Charles Krauthammer and felt then it would go down pretty much as he says:    "(1) Forget the public option. Whatever the merits, and they are few[ I disagree with this clause], it is political poison. It dies by the Liasson Logic, the unassailable observation by NPR's Mara Liasson that there are no liberal Democrats who will lose their seats if the public option is left out, while there are many moderate Democrats who could lose their seats if the public option is included. (2) Jettison any reference to end-of-life counseling. People see (correctly) such Medicare-paid advice as subtle encouragement to voluntarily refuse treatment. People don't want government involvement in a process they consider the private province of patient, family and doctor. The Senate is already dropping it. The House must follow.[killed by ridiculous hype, but yes - killed]  (3) Soft-pedal the idea of government committees determining "best practices." President Obama's Federal Coordinating Council for Comparative Effectiveness Research was sold as simply government helping doctors choose the best treatments. But there are dozens of medical journal review articles that do just that. The real purpose of such councils is ultimately to establish official criteria for denying reimbursement to less favored (because presumably less effective) treatments -- precisely the triage done by the NICE committee in Britain, the Orwellian body that once blocked access to a certain expensive anti-blindness drug until you went blind in one eye. (NICE: the National Institute for Health and Clinical Excellence.) (4) More generally, abandon the whole idea of Obamacare as cost-cutting. True, it was Obama's original rationale for creating a whole new entitlement at a time of a sinking economy and a bankrupt Treasury. But, as many universal-health-care liberals complain, selling pain is poor salesmanship. (5) Promise nothing but pleasure -- for now. Make health insurance universal and permanently protected. Tear up the existing bills and write a clean one -- Obamacare 2.0 -- promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement. What's not to like? If you have insurance, you'll never lose it. Nor will your children ever be denied coverage for preexisting conditions. The regulated insurance companies will get two things in return. Government will impose an individual mandate that will force the purchase of health insurance on the millions of healthy young people who today forgo it. And government will subsidize all the others who are too poor to buy health insurance. The result? Two enormous new revenue streams created by government for the insurance companies. And here's what makes it so politically seductive: The end result is the liberal dream of universal and guaranteed coverage -- but without overt nationalization. It is all done through private insurance companies. Ostensibly private. They will, in reality, have been turned into government utilities. No longer able to control whom they can enroll, whom they can drop and how much they can limit their own liability, they will live off government largess -- subsidized premiums from the poor; forced premiums from the young and healthy. "   That's pretty much what you are saying, with a little more cynicism!   All is well with us and I hope also with you.  Fall is in the air up here and all the children are coming up for my 74th birthday in mid October, so we are excited about that!   David

It's always reassuraning to read comments by a writer with whom I agree. What would you do?

Charles Clark