The Healthcare Debat-cle

A couple of conservative friends recently shared a pair of YouTube videos with me entitled, “Senior Citizen Speaks Out On Healthcare Bill.”  In them, John C. Crawford of Texas blasts the bill in a compelling story, but unfortunately, I think at least half of it is built upon misinformation.  I've watched these videos several times, and searched the H.R. 3200 document for the "exact excerpts," which don't exist.  Some of the citations appear very similar to a viral email that FactCheck.org debunked most of in "Twenty-Six Lies about H.R. 3200."

It's amazing to me how someone can say, with a straight face, that something is not being taken out of context, when that's precisely what is being done.  I'll accept that this man is a genuine person, and that his story is real.  But what irks me is that he seems to be reading from some right wing interpretive (and creative) document and taking it at face value.  Opinions are like epoxy: they start with a combination of basic elements, and harden when a strong catalyst is added.  It’s ironic that as humans, we are endowed with the incomparable ability to think for ourselves, but many of us are encumbered by the incomprehensible tendency to avoid doing so.

Mr. Crawford makes a big deal of the "Death Counseling" concept which sounds an awful lot like the "Death Panels" we've heard so much about.  The death counseling provisions of H.R. 3200 are as innocuous as a summer breeze and as common sense as coming in out of the rain if you want to stay dry.  They merely allow payment to doctors if they provide counseling on end-of-life issues.  I recently lost my father after a 5-year battle with lung cancer and its side-effects.  He went through so much, and so much of it proved unnecessary.  If he, and we, had known what was in store for him and what his options were, his suffering would have been greatly reduced, he would have been more at peace, and it would have cost a whole lot less.  He had a living will, but it wasn't really clear.  He was lucid to the end, and I tried to have a discussion with him about what kind of care he wanted.  His hearing was just about gone, and he asked with a quizzical look, "What kind of stairs do I want?"  When we finally cleared that up, he said, "You'll know what to do when it's time."  Well, I didn't, and I wish we'd had professional help.  A couple of his doctors hinted at things regarding end-of-life, but when we pressed them for recommendations, they backed off quickly.

A couple of things President Obama said in his address to Congress about healthcare reform keep me optimistic.  First, he said, "I am not the first President to take up this cause, but I am determined to be the last."  Second, he pointed out the obvious, that the spiraling cost of healthcare (like our deficits) is unsustainable.  Third, he acknowledged that there are people on both side of the aisle who are obstacles to progress.  And fourth, he said, "I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch."  I'm very much for healthcare reform, and support the concepts that Obama spoke of in his address to Congress.  However, I have a healthy skepticism, and want to know more precisely how things will work, and more precisely how they will be paid for.  Being told that it will work and that it won't cost taxpayers a dime doesn't do it for me.  The idea of offsetting much of the cost by stopping excesses, abuses and fraud in Medicare and Medicaid doesn’t do it for me either, since we shouldn’t be paying for such waste in the first place.  It also doesn’t give me much confidence that government can manage a new program any better.

In reading some of the misquotated citations from H.R. 3200, I actually found that I was impressed with the depth of understanding of the authors.  Instead of finding some covert, clever language, designed to create a foundation for socialized medicine, I found some reasonable concepts to allow individuals to make up their own minds (if they'd only choose to do so).  For those who find the terms of H.R. 3200 to be deleterious to their health and welfare, I'd encourage them to read the terms of their free market insurance policy.  That would be an eye-opener.

I think the root of our healthcare problem is in misapplied incentives.  Doctors are incentivized to prescribe unnecessary drugs and perform unnecessary procedures to protect themselves from lawsuits - a perversion of preventive medicine - prevention of lawsuits trumping prevention of disease.  Pharmaceutical companies are incentivized to make as much money as they can in the short time that they have market exclusivity, due to the pressures that are building to allow more and earlier generics and foreign sources; as a result of the short term thinking, R&D is suffering, and new products aren't forthcoming.  Hospitals and clinics are incentivized to perform unnecessary procedures to pay for the expensive equipment they have and the fancy new facilities they're building to meet the needs of a clientele that wants the very best.  And on and on...

I don’t agree with a “government option.”  Government has no business running a business when there are plenty of businesses that are capable of providing service.  What is needed is regulation - government’s insurance role should be to insure that there’s a level playing field and that nobody is denied coverage; any insurer must provide coverage for high and low risk alike.  To allow the greatest competition, purchasing of insurance across state lines should be encouraged, not forbidden.  Government should define a minimum (not minimal) standard of care (including end-of-life) that insurance companies must comply with.  Beyond that, people can pay for whatever additional services they want, either through additional insurance or out of their own pockets.

Government should also define or adopt medical practice standards for all conditions, which doctors’ practice or malpractice should be measured against.  Malpractice lawsuits should be strictly limited to illegal practices and gross negligence.  Any punitive damages should go into a fund to pay for insuring those who can’t afford it.  As long as doctors adhere to defined standards of practice, they should be protected from suit.

While I share the concerns and skepticism of many, I don't subscribe to the notion that healthcare can't be fixed so we shouldn't try.  There is a lot of misinformation out there, on both sides, but the great thing about our country is that everyone gets to have their say.  Out of that, I hope, will come a compromise solution that does the greatest good for the greatest number of people.  But my hopes will only be realized if we think for ourselves, and “build on what works and fix what doesn't."