Saturday, August 29, 2009

So what's happening in Washington?

The months during the parliamentary recess in the UK is known as the "silly season." Since there is no "real" news, bizarre and off-beat stories get more coverage that they deserve and fringe opinions can distort the perception of what's really going on.

The same has been true this summer in America where coverage of public disturbances at town meetings became the media focus rather than healthcare issues. These demonstrations have been as of nothing compared to the civil rights or anti-Vietnam War demonstrations of the 1960s, yet the media has inflated them to a position of importance in themselves. In advertising terms, they've been focusing on the sizzle, not the steak.

However, in the last week some important cracks appear to be devoping in confidence in the president. Two significant Washington Post articles have been critical of Mr Obama, as have other leading journalists (including Peggy Noonan in the Wall Street Journal, "Pull the Plug on ObamaCare"). Within the Democratic party, Mr Obama's wobble on the "public option" had Nancy Pelosi and others bearing their teeth.

Is the message actually getting through to Congress? Have thed long over-due meetings with constituents actually made a difference, or is most of Congress like Niki Tsongas (5th Congressional District Massachusetts) who at the beginning of her town meeting made it pretty clear that nothing those who had elected her could tell her would make her change her mind about supporting Obamacare?

Time will tell. It may take until 2010, but the majority will be heard.

Thursday, August 13, 2009

A few truths about healthcare (Part 2)

I know I've said this before but did you know there were more doctors in 11th century England (per capita) than there are in the US today?

Before getting smug about the standard of medical practice in 11th century England, ask yourself what will be thought of our medicine in AD 3009. They'll think we were pretty barbaric, too.

This lack of doctors is one of the things that pushes healthcare costs up. I am not suggesting that standards at medical schools be dropped, but merely that more people who meet them be given places. I still find it rather worrying that vetrinary school students who drop out often become doctors.

America has a wonderful schichophrenia about doctors. On the one hand, we've undeservedly put them on peditals, while on another we're appalled by the scale of malpractice, unreasonable demands (one reportedly asked for a helicopter to take him from hometo the hospital so he didn't have to wait in traffic), and often complain about our treatment.

Two generations of Marcus Welby, MD, Ben Casey, Doctor Kildare, Quincy, Doctor Quinn, Medicine Woman, ER, House and other TV shows that glorify the medical profession have given us this revernce for doctors. Only Scrubs injects a degree of reality into American medical care. Personally, I'd like to see a show about the men who install and repair air conditioning or keep the sewers running because they contribute more and more often to the quality of life of more people than doctors do.

The serious part

Why do we think we’d make better healthcare choices that a government agency?

Forget the individual freedom argument for a moment. Yes, you may have right to a degree of self-determination, but you’re not the only person in the world. Indeed, you’re not the only person in your family who might be affected by your cranky notion of what treatment you need. (I had an uncle who thought gin was the universal remedy.)

How competent are we to decide what care we need? (Forget that the government won’t do it any better; just answer the question).

This is an issue we should be debating with medical professionals, not politicians.

The old TV shows, and now the worldwide web has made phony experts of us all. How many of us would presume to debate aircraft maintenance procedures, or what a 777 needed done to it because it was burning a few quarts of oil more than usual?

I don’t have the answer to America’s healthcare problems and costs. However, I do know that the right discussions with the right people are not being held.

Wednesday, August 12, 2009

A few truths about healthcare (Part 1)

Let’s be clear: whatever we do about healthcare in the next six months will be a shambles.

This is because the time necessary to consider what the need is, what the benefits are and what the costs are have not been properly studied or debated.

The media has not been up to the task of informing the public about the above issues, nor has it reported the debate in any helpful way. It has focused on what is easy, not what is necessary. The media has spent hours discussing the demonstrations (pro and con) and, depending on the political persuasion of their sponsors, branded the different sides with unflattering epithets.

President Obama has singularly failed to explain the program to the American people, derailing his own attempt to do so by indulging in unwarranted and unhelpful comments on the Henry Louis Gates affair.

Congressmen and women have been spectacularly unwilling to engage in real discussion of the bill. Congressman Niki Tsongas, 5th Congressional District Massachusetts, for example, a the town meeting she held, made it clear that she was not prepared to change her mind, regardless of what her constituents told her.

Not about healthcare

What has become particularly corrosive about healthcare bill discussions is that they have not been about the provision of healthcare. They have been about muddied perceptions of rights and obligations; they have been about hypothetical government intervention; they have been about alleged huge costs and myriad other issues that are ill-informed on both sides, and not really about delivering basic care to people that might need it.

One of the reasons for this is the proposed bill itself that focuses more on the administration of yet another governmental bureaucracy than on health. The bill includes swingeing powers to inspect the books of private companies and all sorts of other powers that rightly demand distinct scrutiny and debate.

Congressmen have an obligation to read the bills they vote on. They should not rely on unelected assistants of unknown capabilities and experience. Too much is riding on this for it to have become such a political football.

President Obama is right about one thing: we have failed to address the healthcare issue before. The trouble is, we’re not really addressing it now.

Saturday, August 1, 2009

A Good Reason to Think Twice about the Healthcare Package?

“This government [of the United States] never of itself furthered any enterprise, but by the alacrity with which it got out of its way. It does not keep the country free. It does not settle the West. It does not educate. The character inherent in the American people has done all that has been accomplished; and it would have done somewhat more, if the government had not sometimes got in its way.”
Henry David Thoreau, Civil Disobedience, 1848

I can hear the Conservatives cheering, but Thoreau’s world is not ours. Like it or not, the reality is that the United States is a partially socialist country. Were it not, it could not have survived.

The financial industry is still in denial, blaming everything else but itself for its massive failure. The proof can be seen in companies that even now are cutting investment, services and experiencing plunging profits – but maintaining their former dividend rates. All this “delivering the best return on shareholder investment” is but self-serving schmoozing to encourage investors, while the genuinely important consideration is the product and the customer, without which no wealth would be created. Such corporate attitudes make companies little more than contemporary snake-oil salesmen.

But what is this to do with the healthcare package?

It means that there are a number of things that the private sector can do very well (if it has the right motivations), and some things that require a larger agency to oversee. The government should not be in business itself, but the oversight of the welfare of its citizens is certainly part of its remit.

What is the difference in principle between spending billions on defense systems to protect citizens, or spending billions on medical systems to protect them from disease? It could be argued that in the first case, the state was primarily protecting itself, which it has a right to do, but what about us, personally?

Like the financial industry, the medical-industrial-complex has much to answer for. A quarter of a million deaths per year due to negligence and malpractice; lower live birth rates than countries with lower overall standards of living, and a relationship between the medical profession and institutions, the pharmaceutical industries and the insurance companies that warrants greater scrutiny and regulation. I have no doubt that even the threat of closer regulation would instantly lower costs.

One of the duties of the American citizen is not the payment of health insurance premiums. Investment in a sensible, limited, healthcare program would, in the long-term, pay great dividends, just as the GI Bill has for more than half a century, but enabling its beneficiaries to lead more productive lives.