Llewellyn
King
Read Llewellyn's bio and previous columns
January 14, 2008
Needed: An American
Solution to the Horrible Health Care Status Quo
I
find few subjects as contentious as health care. I put it right up there
with the war in Iraq, creationism and the role of the Supreme Court.
Perfectly mild-mannered people can get extremely exorcised about health
care.
I
was reminded of this a couple of weeks ago, when a friend of 30 years
and I had our first disagreement – and it was heated. I said that we
were spending too much of our gross national product on health care, and
it needed to be reformed. My friend either did not hear what I had said,
or he inferred what I had not argued. He believed that I was advocating
a national system of state-funded health care, like the one in Canada or
the United Kingdom. I am not sure that those are valid models for the
United States, but I am sure that the system we have needs an overhaul.
It needs an overhaul on two basic grounds: It is too expensive and it
does not deliver.
Most industrialized countries spend between 6 and 8 percent of their
gross domestic product on health care. We spend a whopping 16 percent
for the best medicine and the worst “delivery” in the industrialized
world.
When I first got interested in the health care debate many years ago, we
were spending less of our national wealth on health care, and there were
fewer complaints about delivery. But as medicine has gotten more
sophisticated and life expectancy has increased, costs have gone up, and
the burden of managing delivery has gone up for patients, health care
professionals and insurers. Sometimes the system melts down, as when
insurers deny critical care to patients or when hospitals refuse to
treat the indigent.
The dirty little secret about all health care is that it is rationed
either by commission or omission. In those state systems with which I am
familiar, like the one in UK, complex treatments are lavished on the
young and denied to the old. If you are British and you want artificial
knees after the age of 70, you either have to pay for them yourself or
settle down to life in a wheelchair. The national health care system
will put you on a very long waiting list; so long that you will not get
the surgery with normal life expectancy. But a young child will get a
kidney transplant as fast as a donor can be found. In the U.S., a great
deal of expensive surgery is performed on elderly patients, including
that paid for by the government under Medicare. Although I am now old
enough to be the beneficiary of this skewed system, I find the ethics of
it appalling.
Much of the health care debate now centers on extending coverage to the
uninsured, but there is another problem – the quality of the coverage
provided by insurance. Those who favor the current situation have sought
to deny the validity of anecdotal evidence. This is nonsense. To deny
anecdotal evidence is to refuse to look at the problem.
My
interest in health care began seriously in 1973. That was the year I
started my own publishing company and began providing health care
insurance to employees. For the 33 years that I operated the company, I
struggled to provide reasonable health care at a cost I could afford.
Health care became my largest expense after salaries. It was also
unsatisfactory. Almost every year we changed the carrier to contain the
cost, putting the burden of trying to learn the new system and find new
doctors on the employees. When the insurance companies refused to pay
for some services, the employees tended to blame me and my managers'
constant efforts to contain the costs. The experience was horrific.
Some examples: One of my press room workers wanted money in lieu of
insurance. He said insurance was not necessary because he could get free
health care for his family at a hospital emergency room. The worst case
was a talented executive who developed a rare cancer. The insurance paid
for the treatment but refused to pay for expensive pain killers. The
patient protested, my insurance agent protested and I protested. The
solution was to have relatives in Europe procure the pain killers and
bring them to the U.S. So do not tell me that getting people insured is
the only problem. Getting the insurers to live up to their part of the
bargain is also part of the problem.
The newspapers are awash with anecdotes of care denied to critically ill
people. Finally, the anecdotes are being heeded.
Unfortunately, the health care debate is politicized. Democrats tend to
lean toward a federal solution, and Republicans tend to defend the
status quo. But in his new book titled, “Comeback: Conservatism Can Win
Again,” David Frum writes: “Who agreed that conservatives should defend
the dysfunctional American health care system from all criticism? Who
volunteered to take the bullet for every crummy HMO and overpriced
surgeon in the country? Who decided that it was OK with us that tens of
millions of Americans should lack health care coverage?” Right on.
If
we can disengage from the old political orthodoxies on health care, we
can come up with a solution for the future. Not a Canadian solution, nor
a European solution, but an American solution. Federalized education has
not worked, so why should a national health care system work? Let the
debaters enter the arena.
© 2008 North Star
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