Thursday, March 5, 2009

President Obama's Health Care Summit

President Obama delivered the key message at today's health care summit - controlling costs is a moral responsibility as well as an economic necessity. He described our out-of-control health care costs as "one of the greatest threats not just to the well-being of our families and the prosperity of our businesses but to the very foundation of our economy."

By stating that health care costs lead to a bankruptcy every 30 seconds (!) and could make another 1.5 million families lose their homes by the end of the year he made clear the human toll out-of-control costs are taking.

Because he's speaking in the context of daily economic news that keeps getting worse I think the public is prepared to see health care costs as a societal cancer. This has to be the starting point of any serious engagement with health care reform.

House Republican leader John Boehner has indicated what the two prongs of pushback will be.

First, Boehner makes this ostensibly reasonable statement - "We believe families and their physicians should make decisions about what treatments are 'appropriate,' not government bureaucrats."

This may be a good sound bite, but it's dead wrong. There is no way to control costs without some form of management of the ways in which we use medical care. If we leave care decisions to each physician and each family we'll just continue on the same bankruptcy-every-30-seconds spiral. President Obama will soon have to start educating us about the anarchy of misuse, overuse and underuse created by leaving decisions to each physician and family.

The second sound bite missile Boehner will invoke is the spectre of rationing. President Obama will need all of his rhetorical skill to respond, because mere invocation of the word "rationing," like "Nazi," is intended to be a trump card conversation stopper.

I'm no politician, but my leaning would be to say something like this: "The only place where there are no limits is paradise. The opposite of 'rationing' is 'irrationality,' not 'unlimited access.' Those who try to sandbag health care reform by shouting 'rationing' prefer to set limits by shutting almost one in six Americans out of health insurance and bankrupting a family every 30 seconds."
What's being launched today is a struggle about values, not an intellectual exercise. We've been miseducated about health care for so long that the President will have to be a patient teacher, repeating the key lessons in slightly different form day after day.


Anonymous said...

How about you point out the fact that Obama's comment about a medical bankruptcy every 30 seconds is wrong and has been proven as such by reports dating back to 2006.

Jim Sabin said...

Dear PaulG78 -

Thank you for these references.

They make a strong case that the "every 30 seconds" claim is misleading at best and flat-out-wrong at worst. But even if it is a bankruptcy every 5 or 20 minutes I think the fundamental analysis holds - (1) health care costs are out of control, (2) they are strangling business, government and many individuals, and (3) containing costs is therefore not just a fiscal necessity but a moral requirement for a civilized society.



Rob Duncan said...

Should we write, debate and eventually pass a 28th Amendment to the Constitution? Until we do, health care will not be a right afforded to every citizen in our country. Instead it will remain what it is... a privilege attainable by the wealthy, a benefit provided solely at the discretion of an employer, a government subsidized insurance plan for the elderly or a charitable gift provided based on the goodwill of others.
Value and cost
Our health care system is now extremely expensive, costing us over a trillion dollars a year and consuming 13.2 percent of our gross domestic product in 2000. Over the years as the costs and complexity of health care rose, we responded by developing interim methods to fund health care for most of the citizens. Now, even as the capability to relieve suffering and prolong life is growing, the financial ability to provide these services to all of our citizens is steadily declining.
The disconnection between valuable health care and the financial ability of every citizen to access that healthcare brings into focus the essential question of health care as a right or a privilege.
Health care funding
The answer is found in a series of interesting and temporary solutions to funding health care that developed over the past 100 years. Prior to the turn of the century, health care was almost exclusively paid for directly by cash by the consumer. Fortunately, health care was very affordable and accessible to virtually everyone. Physician office visits were 25 cents and house calls 50 cents.
Uninsured growth
Employers are steadily retreating from full coverage for all employees to a position of shared coverage for a smaller number of employees. Not even tax advantages are sufficient incentives to continued support as the costs continue to spiral upward in excess of inflation and eclipsing almost all other portions of the economy.
Because of the haphazard development of funding and financing health care in this country, a large and growing number of individuals are in the precarious situation of being unable to access and afford basic health care. This situation arose not by intent but by a sequence of circumstances in which the methods of paying for health care were devised in attempt to match the pace of health care development and rising costs.
The funding mechanisms often came late, were ill conceived and only offered temporary solutions. These stopgap measures allow us to defer addressing the issue of whether health care is a right or privilege.
As long as most of our citizens have most of their health care needs met, we are satisfied with putting off the difficult and basic question. As the costs for health care again rise beyond the ability of the current funding system, we can again look for a stopgap interim solution or we can take this opportunity to lay a solid foundation for the future and declare health care a right for all citizens.
If basic health care is declared a right, two issues will need immediate attention: content and funding.
We must first decide what are the goods and services that constitute basic health care. In the process of defining a basic health care package, we will inevitably deal with issues of quality, cost, value and access. A system built on strong values and principles should be more enduring and satisfying to the nation than our current system that has little foundation and is held together with Band Aids and bailing wire.
Where will the money come from to support a universal health care system? The politicians will assure us that the country does not want any more taxes. Undoubtedly, giving access to health care to everyone will cost more overall. Will the decision to make health care a right be decided on a purely financial basis?
Ultimately, providing more health care will cost more money. But currently it is costing more money each year even as fewer citizens are able to access health care. Are we willing to invest more money in universally accessible, measurably high quality, health care serves to build a stronger, healthier nation?
As a nation, we have little hesitation in paying more into a health care system that provides us with measurable increases in the quality and quantity of our lives. Our health care system has been able to provide those benefits for a relatively small societal investment in the past.
Only recently has the relative size of the investment increased and the return on the investment faltered. If we can focus our investment in health care on those modalities that improve measurable quantity and quality of life endpoints, it will be possible to again improve the return on our investment.
For example, if we are able to add on the average one year of productive quality life to every citizen--and if that extra year meant that the average person could stay in the workforce until age 66 earning income and contributing to the tax base and not taking social security benefits--there would be a considerable return on the societal investment.
Even as we define the health care goods and services that must be afforded to every citizen, we will have to redefine the manner in which we fund health care. If we find that health care is a right, then it will become the clear imperative of our government to provide the funds to support health care benefits for every citizen.
We are so accustomed to the current system of public and private funding that we have difficulty envisioning a radically different method of funding. In the process of finding universal funding, we may find that the old and failing systems of marginal taxes on employee wages for Medicare, matching state with federal tax contributions for Medicaid and employer funded health insurances become obsolete. We may find that HMOs and insurance as a means of paying for health care also become unnecessary.
We may discover that a specifically designated, single health care tax may simplify, clarify and provide greater efficiency than the current mixed bag of taxes. We may find that it is more beneficial to the economy for employers to provide higher wages and other benefits than making the enormous contributions to health insurance.
It is time to answer this question clearly as an amendment to the Constitution and begin to build a system that supports what we know to be our true belief.
If it is our belief that health care is a right, we should declare that belief in a clear, unequivocal and enduring manner. Once health care is declared a right, we will be able to address the issues with much more purpose and clarity and find ways in which to allow the American health care system to find its place among the systems that support our other unalienable rights.

Jim Sabin said...

Hi Rob Duncan -

Thank you for this very eloquent comment. I think that even those who find it philosophically difficult to apply the concept of "rights" to health care will find your analysis persuasive. A civilized society with the financial resources that the U.S. has (even in a recession) should see itself as obligated to provide the kind of health care you envision to its citizens.

In the debates we'll see in the next year or so I doubt that anyone will argue that health care is best understood as an optional privilige. I expect the main issues to be (a) what can we afford and (b) how afraid are we of the bugaboo of "socialized medicine."