Opinion

Opinion

U.S. health care needs systemic change

August 19, 2009

Advertisement

— Reading the transcripts of President Obama’s “town hall meetings” this month on heath care reform is painful. He’s preaching the right gospel, but the parishioners are getting restless. The harder he tries to sell his program, the louder and angrier the debate gets — and the more the general public tunes out the politicians. It reminds me of the polarizing Iraq debate of several years ago. Forgive the analogy between war and health care, but maybe Obama needs the medical equivalent of a Gen. David Petraeus — that is, a professional who can break through the political chaff and describe a strategy for reform that can unite the country.

I have a nomination for the medical commander role, and it won’t surprise anyone who follows this issue: Dr. Denis Cortese, the chief executive of the Mayo Clinic. He’s already doing what the nation needs — that is, providing high-quality health care at relatively low cost. Every time I listen to Cortese explain what’s wrong with the system, I have the same reaction: Let him and other smart health professionals lead us out of the political morass.

Talking to Cortese this week, I heard two themes that cut to the heart of the current debate. First, he thinks Obama has made a mistake in moving toward the narrower goal of “health insurance reform” when what the country truly needs is health system reform. Imposing a mandate for universal insurance will only make things worse if we don’t change the process so that it becomes more efficient and less costly. The system we have now is gradually bankrupting the country; expanding that system without changing the internal dynamics is folly.

Second, Cortese argues that reformers should stop obsessing over whether there’s a “public option” in the plan. Yes, we need a yardstick for measuring costs and effectiveness. But we should start by fixing the public options we already have.

Cortese counts six existing public options that should be laboratories for reform: Medicare, with its 45 million patients and a fee-for-service structure that all but guarantees bad medicine; Medicaid, with an additional 34 million beneficiaries; military medicine, through which government doctors deliver state-of-the-art care; the Department of Veterans Affairs, which has improved performance at its hospitals by embracing new technology; the “Tricare” insurance plan for military retirees; and the Federal Employees Health Benefits Program.

Adding a new public option for insurance, as congressional reformers are demanding, would be useful. But it’s not necessary now, and it is creating a poisonous debate that’s undermining the more important reforms — which are in the delivery system, not insurance.

If liberals really want to show they are serious, they should begin with our existing single-payer behemoths, Medicare and Medicaid. Cortese argues that the White House should mandate that, within three years, these programs will shift from the current fee-for-service approach to a system that pays for value — that is, for delivering low-cost, high-quality care. If doctors performed unnecessary tests that ballooned costs, their compensation would be reduced. And doctors would be compensated by regional formulas, to encourage them to work cooperatively in local networks where they could all make more money by practicing better medicine.

What difference would such Medicare reform make? Take a look at estimates prepared by the Dartmouth Institute for Health Policy and Clinical Practice (which developed the national “health atlas” that was the basis for the widely read New Yorker article by Dr. Atul Gawande). At current spending rates, Medicare will run a $660 billion deficit by 2023. But by cutting the annual growth in per-capita spending from the current national average of 3.5 percent to 2.4 percent (the rate in San Francisco, for example), Medicare could save $1.42 trillion and post a big surplus.

This “pay for value” approach would amount to a cultural revolution in American health care. It would take our bloated system and make it both cheaper and better. The adjustments wouldn’t be easy, and the medical profession would balk unless respected doctors such as Cortese led the way.

Obama has been campaigning furiously in this crazy summer of bogus debates about “death panels,” but he’s losing traction. Reformers aren’t helping by drawing a false line in the sand over a “public option” when we already have one, in Medicare, that provides a laboratory for systemic change. I hope that Obama understands that his health plan is in mortal danger — and that it’s time to call for the doctor.

Comments

Mixolydian 5 years, 7 months ago

Excellent article.

Obama said it best....Look at the United States Post Office versus Fed Ex or UPS and you'll see what waste and bloated bureaucracy get you.

Prove that you have the political backbone and demonstrate that medicare and medicaid can be ran efficiently and effectively first.

Why should our taxes rise to pay for the public option (soon coming single payer system) when other single payer countries pay far less for their system than we do for only a fraction of our citizens under medicare and medicaid? Anyone of these hastily trotted out bill would be a disaster for this country.

If a a loud shout down "NO" at every town hall and public meeting is necessary to stop this, we should all grab a bullhorn.

tbaker 5 years, 7 months ago

I for one am thankful Mr. Obama's health care plans are about to fail.

No - I'm not happy to see our President embarrassed or his effectiveness weakened. Frankly I'm saddened by the arrogance displayed by many of our elected officials that has not only led us to this wretched condition, but has caused most of them (once again) to miss the point - just like this author did. Its not about health care.

The visceral and growing public anger towards the health care proposal has less to do with health care more every day. It has everything to do with being fed-up. It has everything to do with the fact the normally silent majority has finally been awakened.

Most of us work hard everyday and play by the rules, but then we watch our government give our hard-earned tax money to people and corporations who have failed because they didn't play by the rules. We watch winners and losers being picked by their cronies in DC, and avoid their just treatment in bankruptcy court. Why does the union autoworker get my tax money to save his job, but my neighbor the house builder with three kids who (used to) work 80 hours a week, gets nothing? Where does our constitution say the US federal government can take an ownership stake in a private company?

We watch our politicians "ram through" enormous amounts of deficit spending, adding insult to injury to an all-ready out of control national debt without even reading the bill. We watch them manufacture "crisis" to scare ordinary people into supporting their looting - making sure not to let the crisis "go to waste."

We watch our elected leaders ridicule and insult honest Americans trying to exercise their right to free speech.

I could go on. The bottom line is people are mad at the government because the government treats them like ignorant serfs who need to be told whats good for them because they are too stupid to take care of themselves, and if they ever dare to stand up and speak for themselves they must be denigrated.

People are sick of the condescending tone coming from people who have already failed at government-provided health care. MEDICARE and MEDICADE are both tens of trillions of dollars in the hole and teetering on the brink of insolvency, yet we're expected to take it on faith that some massive new government health care program would break the long tradition of dismal big-government failure and be some stunning success? Yeah - right. Lets bet 1/6th of the US economy on the same people who can't even hand-out a couple million bucks for some used cars.

Give me a break, and sign me up for a bull horn.

just_another_bozo_on_this_bus 5 years, 7 months ago

Well, who are you going to hand it to, tbaker? GM? AIG or some other failed (but bailed) insurance company or bank?

Flap Doodle 5 years, 7 months ago

Health care in America is so horrible that life expectancy is at an all-time high. "The report, “Deaths: Preliminary Data for 2007,” was issued today by CDC’s National Center for Health Statistics. The data are based on nearly 90 percent of death certificates in the United States. The 2007 increase in life expectancy – up from 77.7 in 2006 -- represents a continuation of a trend. Over a decade, life expectancy has increased 1.4 years from 76.5 years in 1997 to 77.9 in 2007. Other findings: -- Record high life expectancy was recorded for both males and females (75.3 years and 80.4 years, respectively). While the gap between male and female life expectancy has narrowed since the peak gap of 7.8 years in 1979, the 5.1 year difference in 2007 is the same as in 2006. -- For the first time, life expectancy for black males reached 70 years. -- The U.S. mortality rate fell for the eighth straight year to an all-time low of 760.3 deaths per 100,000 population in 2007 -- 2.1 percent lower than the 2006 rate of 776.5. The 2007 mortality rate is half of what it was 60 years ago (1532 per 100,000 in 1947.) -- The preliminary number of deaths in the United States in 2007 was 2,423,995, a 2,269 decrease from the 2006 total. -- Heart disease and cancer, the two leading causes of death, accounted for nearly half (48.5 percent) of all deaths in 2007. -- Between 2006 and 2007, mortality rates declined significantly for eight of the 15 leading causes of death. Declines were observed for influenza and pneumonia (8.4 percent), homicide (6.5 percent), accidents (5 percent), heart disease (4.7 percent), stroke (4.6 percent), diabetes (3.9 percent), hypertension (2.7 percent), and cancer (1.8 percent)." http://www.mydesert.com/article/20090819/LIFESTYLES03/90819012/CDC++U.S.+life+expectancy+at+all-time+high

tbaker 5 years, 7 months ago

Dear "Just"-

Hand "what" to whom? Do you assume I favor government bail-outs? I do not. I wouldn't "hand" anything to anyone.

There is no such thing as company that's "too big to fail." The idea which posits our government must "bail out" this or that business interest to avert some apocalyptic financial melt-down is a false - or at the very least - unproven thesis. The recent stimulus provides ample evidence pouring borrowed money into our economy does not have the advertised effect, not to mention the fact the entire concept is flatly unconstitutional.

The government "handing" out money, or providing services which cost money to people requires money to be taken from other people. Those in our society who, by way of the freedom we have in this country, labor through self-confidence and hard work and acquire wealth. The wealthy in this country did not become so by depriving others. They acquire what they have by developing and applying their own God-given potential.

Unfortunately there are those who believe they cannot achieve success and prosperity in their life unless they deprive others of the fruit of their labor. They smugly believe the merits of their arguments justify diminishing the freedom of others, spreading fear and dependence among others, and by making others poor.

Such is the case for health care. How heartless must I be to dare to think no one is entitled to a penny I sweat for least the spirit of charity move me to offer it of my own accord? Why should I stand silent as the government takes portions of my life - those portions devoted to earning the money they take from me anyway.

"The democracy will cease to exist when you take away from those who are willing to work and give to those who would not." -- Thomas Jefferson

storm 5 years, 7 months ago

Greedy insurance companies are the ruin of this great nation (not credit-card companies). Those arrogant egg-heads at those town-hall meetings are not patriotic, and they should be ashamed. Someone tell them that a government run system will be just as bad as insurance companies but without sky-rocketing rates. In fact, it will better, because they won’t be rejected because they’re fat.

Richard Heckler 5 years, 7 months ago

People denounce Medicare as some evil kind of medical insurance without acknowledging what great service it has provided to millions of senior citizens and millions more who lost their retirement plans to many many white collar criminals.

Think savings and loan rip off, ENRON, the high tech scandal and the recent Maddoff ripoff.

Does anyone believe that all of the white collar criminals waiting to steal retirement plans are in jail? Get real.

This is how Rep John Conyers perceives HR 676 aka Medicare Insurance for All. Which is the most comprehensive,fiscally responsible and would be a great help in making millions of jobs a reality in america. So what would the new HR 676 Medicare For ALL Insurance offer to americans?

Coverage365 days a year 24/7 employed or not moving on to a new job or not single mom or not *struck down with cancer or not

A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. About $225 per month. Today the below insurance coverage actually costs about $1,100 per month going to about $1,500 in 2010. long term care such that cancer would require prescription drugs hospital surgical outpatient services primary and preventive care emergency services dental mental health home health physical therapy rehabilitation (including for substance abuse) vision care hearing services including hearing aids chiropractic durable medical equipment * palliative care

Again a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. About $225 per month. Today the above insurance coverage actually costs about $1,100 per month during year 2009.

HR 676 ends deductibles and co-payments. If a deductible and/or co-pay policy is in effect this usually indicates under-insured.

HR 676 would save hundreds of billions annually by eliminating the high overhead of the private health insurance industry and HMOs. The privatized medical insurance industry is anything but efficient.

Richard Heckler 5 years, 7 months ago

People denounce Medicare as some evil kind of medical insurance without acknowledging what great service it has provided to millions of senior citizens and millions more who lost their retirement plans to many many white collar criminals.

Think savings and loan rip off, ENRON, the high tech scandal and the recent Maddoff ripoff.

Does anyone believe that all of the white collar criminals waiting to steal retirement plans are in jail? Get real.

This is how Rep John Conyers perceives HR 676 aka Medicare Insurance for All. Which is the most comprehensive,fiscally responsible and would be a great help in making millions of jobs a reality in america. So what would the new HR 676 Medicare For ALL Insurance offer to americans?

Coverage 365 days a year 24/7 employed or not moving on to a new job or not single mom or not *struck down with cancer or not

A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. About $225 per month. Today the below insurance coverage actually costs about $1,100 per month going to about $1,500 in 2010. long term care such that cancer would require prescription drugs hospital surgical outpatient services primary and preventive care emergency services dental mental health home health physical therapy rehabilitation (including for substance abuse) vision care hearing services including hearing aids chiropractic durable medical equipment * palliative care

Again a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. About $225 per month. Today the above insurance coverage actually costs about $1,100 per month during year 2009.

HR 676 ends deductibles and co-payments. If a deductible and/or co-pay policy is in effect this usually indicates under-insured.

HR 676 would save hundreds of billions annually by eliminating the high overhead of the private health insurance industry and HMOs. The privatized medical insurance industry is anything but efficient.

Richard Heckler 5 years, 7 months ago

Our Kansas delegation is receiving campaign funding and may well be a shareholders all connected to the medical insurance industry.

How can canTihart, Brownback,Roberts,Moore,Jenkins or Moran be objective?

And why are all of our elected officials protecting the most corrupt and expensive medical insurance system in the world?

5 substantial reasons why Medicare Insurance for All should be the choice for all in america

  1. *Eliminates Politicians as shareholders: http://www.washingtonpost.com/wp-dyn/

  2. *Eliminates Paying More Getting Less http://www.dollarsandsense.org/archiv

  3. *Eliminates Leading Cause Of Bankruptcy http://www.consumeraffairs.com/news04

  4. Eliminates medical insurance dollars going to special interest campaign money jars.

Why use Medicare? It eliminates reinventing the wheel therefore saves a big bundle of money and time = efficient use of existing resources.

Medicare is in place therefore it is ready to roll which is convenient.

The only major change necessary is reimbursement numbers which the author and the 87 cosigners are perfectly aware.

The USA needs to STOP being be the most expensive insurance/health care of the industrialized nations if americans want jobs back.

HR 676 Medicare for All insurance coverage is key to creating new wealth for america.

The most expensive health insurance in the world is not the answer for keeping business costs down and keeping our cost of living somewhat in check.

Flap Doodle 5 years, 7 months ago

“It's almost as if the President has absolutely no experience in dealing with the United States Congress whatsoever. “ http://www.realclearpolitics.com/horseraceblog/2009/08/amateur_hour_at_the_white_hous_1.html

BTW, HR 676 has joined the choir invisible.

Richard Heckler 5 years, 7 months ago

Here's the deal. Why are the media, blue dogs, repubs and their loud mouth rebel rousers coming out against medical insurance reform?

Are they truly concerned about wait times? No way we've been making medical appointments for 70 years or more. We have been waiting at least 50 years for fiscally responsible,fiscally conservative,practical and comprehensive medical insurance. So the wait thing is nothing but crap.

Are they truly concerned about cost? Hell no! The USA has been plagued with high cost for at least 30 years so that obviously is not their concern.

Are they concerned about government take over? The government has been involved for at least 70 years. The med insurance industry is receiving at least $1.2 trillion medical insurance tax dollars as we speak. Nope that is not a real concern just more crap.

What the hell are they concerned about?

*Shareholders only give a damn about dividends that which includes many legislators which prevents legislators from remaining objective.

*Legislators against reform and on all sides of the aisle are concerned about corrupt special interest campaign money pure and simple.

*Repubs only concern is having enough corrupt money to win upcoming elections so they can come back and wreck our economy further.

*The media would just hate to lose all of those healthcare advertising dollars and they are just loving all of the money spent because of the insurance reform campaign.

In a nutshell it is all about money money money which is to say consumers and taxpayers are being taken for fools.

Richard Heckler 5 years, 7 months ago

Is protecting the most expensive medical insurance in the world good for business? No it is anti business and anti new jobs and industry

Is protecting the most expensive medical insurance in the world good for keeping the cost of of just about everything we buy in reasonable check? Absolutely not it increases our cost of living across the board just like high dollar gasoline.

Did we elect people to office to protect the most expensive medical insurance in the world from a more reasonable and fiscally responsible insurance program? No way jose' That is corrupt.

Did we send elected officials to Washington to accept special interest campaign money from the most expensive medical insurance program in the world? Heck NO that increases the cost of insurance!

So it seems the loudest voices against Smart Medicare Insurance for All are those who are profiting from the misfortune of others.

a_flock_of_jayhawks 5 years, 7 months ago

What I found simply incredible was the July 31 editorial in the Investor's Business Daily that claimed Stephen Hawking "wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

Lie after lie after stupid lie. One must ask, why? Thank heaven the Internets are available this time around and that some people (apparently not them) know how to use it. If the HCR opponents can't even do some simple research, what makes anyone think that they could read much less understand the bill(s) under consideration? They don't even seem to get the fact that it will help them, too (unless, of course, they are a health insurance exec).

A debate with the kitchen table, indeed.

Don't think there's a problem? Read:

http://www.nchc.org/facts/cost.shtml

Eileen Jones 5 years, 7 months ago

If those against reform have to resort to lies, fearmongering, racism, bigotry and threats, let alone violence, then maybe they do not have much of a position at all.

a_flock_of_jayhawks 5 years, 7 months ago

What's really sad about the state of the discourse on this issue and others of late is that I believe and have heard some conservatives that have brought some ideas to the table and, with the importance of the issue, we should hear the best ideas from people regardless of their political belief. It's a shame that the conservative movement has been hijacked and drowned out by a few, loud lunatic fringers that aren't contributing anything meaningful. They disgrace themselves and with the MSM coverage they are getting, they disgrace America in the eyes of the world. There was a day when America's grace and dignity was admired around the world. These yahoos have hijacked that America and have put it on display as a sheer freak oddity. I guess the promising aspect to this is that even the crackpots have a voice and place at the table. Too bad they don't bring anything of substance to it, especially at a time when we have a dire problem to solve.

Blog entries

Commenting has been disabled for this item.