Last night I had the utter joy of mixing together some of my most very beloved things: one of my favourite people and I went to the Constitution Center and listened to Tommy Thompson and Tom Daschle discuss the political ramifications of health care. Because of the size of lectures at the Constitution Center, we were also able to speak with the Senator and the Secretary afterwards. Absolute heaven! (And believe me when I say, great for us, great for Tom, not so great for Tommy.)
When we talk "Health Care" people want to talk about the cost of their prescriptions, or the waits in the ER, or whether the "right" answer is free market or "single payer". And that wasn’t what they were discussing. Nope -- better.
Secretary Thompson and Senator Daschle talked about the POLITICAL ramifications of health care to us as a society. What it means for us as a country to have a health care system as broken as ours, and what choices we must consider as a country.
They were both in singular agreement when they spoke of the problems which currently exist, pointing out that when the US is measured against everyone else, by almost every objective measure, we lose. Big time. And because these guys are both consummate politicians who have worked on health care policy for years, they didn’t even hand out all the bad news. For those of us who have ever worked in health care, we know it is even worse than they pointed out.
They cited statistics which pointed out that we rank 15th out of 19th of industrialized countries in our ability to prevent deaths in people under 75 years of age, dead last in our infant mortality rate. They both spoke on the issue of chronic diseases, and our unwillingness as a country to do anything about prevention.
They both made the automatic error of saying that 75% of our "health care dollar" goes to the treatment of chronic care. What they actually meant to say was that "75% of the part of the health care dollar spent DIRECTLY on health CARE is spent on chronic diseases and its secondary manifestations, exclusive of the part of the health care dollar spent on administration, advertising, profit, fraud and waste."
Although their statistics diverged somewhat, they both pegged the cost per capita for health care at between $8,200 and $11,500 per annum. That is, the total spent last year, on average, for each American on health insurance premiums, health care costs, the amount we each pay in to cover health care for people with no insurance, plus what we pay in to Medicare and Medicaid even if we’re not using it yet. They are both in lockstep about how this number will double (to 21% of GNP) over the next several years.
They diverged in their individual assessments of overall health care in America -- Thompson contended that no matter what, the US has the best health care SYSTEM in the world because "If you need to be treated for cancer or some other disease, where would you go: England? Canada? No, you’d come here." (Mr. Secretary was not correct in his assessment). Daschle explained it far better: he explained that the health care system in America is "Islands of excellence in a sea of mediocrity." (All quotes and paraphrases are from the notes I scribbled.)
Daschle framed the problem by saying that everywhere else in the world, health care is like a triangle, where the bottom: the most money, the most care; is spent on preventive care, and you spend up the triangle to the most specialized care until you run out of money. Here in the US, he said, the reverse is true, we spend first on high tech. I could go on for 3,000 words on how right he is, and why that leads to fully 50% of all American adults dying of some form of cardiovascular disease, but I digress.
In terms of talking solutions, Doug Kmiec, the moderator, asked them to frame things against the health care proposals of McCain and Obama.
Thompson’s solution has to do with buying pools on the state level. (And if you want to see his earlier proposals, Google "Badger Care" and look what he did while Governor of Wisconsin, and then check out what he tried to do as Secretary of HHS). He is also a big fan of electronic medical records, paid for by the money collected by the government for fraud and abuse ($2.5 billion last year).
Before the lecture, moderator Doug Kmiec had come out to see if anyone in the audience had any questions they wanted him to ask the panelists. He asked Thompson my question: how does McCain’s denial of insurance to those with pre-existing conditions fit in with this program? Thompson said that his plan was different from McCain’s -- it only works if everyone is in the pool, albeit it sans legal mandate.
Daschle looked at some solutions in a similar light to Thompson. They both agreed on the need for preventive care, as do all of us in the field.
But Daschle took it one level further, speaking to the idea that we must reintegrate "health" into our schools, and our society. He said that while the government says "If you want a car, you must have auto insurance, if you want to own a home, you must carry homeowners’ insurance, why not health insurance?" He said "while health care is not a legal right, it is a moral right." He pointed out that the government is not in the banking business, we ceded that to the Federal Reserve. We need something akin to the Fed for health care. When asked about a single payer system, he seemed to be in favour, but pointed out that there is not the political will to enact it.
Thompson pointed out that every GM car has $1,725 built into the price to cover health care, while Toyota only spends $225 per car. And while that statistic is correct, he neglected to mention that the reason WHY is that health care costs are underwritten by the Japanese government.
So what ARE the political ramifications of the crisis of health care provision in the United States?
Start with a simple numerical fact: In Iraq, we have lost an average of 2 Americans a day since the invasion, or about 700 people a year. Here at home, we lose 100,000 Americans a year due to drug errors. As Thompson said, this is the equivalent of a 747 crashing every day and a half.
While we can talk about the financial ramifications of uninsured Emergency Room patrons, and monies available for drug research, and a zillion other things, the simple political ramification to ALL of us is that our current health care system is just what Tom Daschle implied - great for those of us who can afford great care, and a death sentence for those who cannot.