Healthy Skepticism on Healthcare 4

Kausfiles senses a perilous weakening in the Congressional momentum for health care reform. He refers us to these lines from Jonathan Cohn at the New Republic:

[T]here's reason for concern… On Thursday, as Politico details, the leadership got hit with a flurry of letters from several groups of extremely unhappy members. Some were objecting to the design of the public plan. Some were objecting to proposed tax hikes. Some thought the bill didn't do enough to control costs. Some thought it did too much (although, of course, they didn't quite put it that way).

But lurking behind all of these complaints, according to several sources I consulted Thursday evening, is a general wariness of taking a political plunge on health care. Like their counterparts in the Senate, House members don't like taking hard votes. Raising taxes, cutting spending, anything that takes money ouf of people's pockets--these are not things they want to do, even in the service of a greater, more popular cause.

And now they're getting nervous. They're seeing the president's popularity dipping, however incrementally. They're watching the Senate chase its tail over the same controversies. And having just taken what were--for many of them--similarly tough votes on an energy bill, they're not exactly thrilled about "walking the plank" again.

If Cohn is right, the Democrats are getting cold feet. One of the problems with having a nominal veto-proof majority in the Senate along with control of the House and the White House is that you are pretty much responsible for whatever the government does. If Health Care reform turns out to be deeply unpopular, the Democrats could easily find themselves trading places with Republicans on the is you is or is you ain't the people's baby scale.

There are two big worries here. One is that the Democrats will pass radical health care reform, and it will be very expensive but won't do any good. David Brooks, writing in the New York Times, thinks that's what all the pending plans amount to.

Over the past few decades, health care inflation has exceeded the general rise in prices by about 2.5 percent a year. These inexorably rising costs are bankrupting the nation, walloping businesses and squeezing middle-class salaries.

Fortunately, the country now has an excellent opportunity to change that. We have a president fervently committed to reducing health care inflation. We have a budget director who is perhaps the nation's leading expert on the issue. We have a fiscal crisis staring us in the face, just to focus the mind.

And what is the result so far? Failure. Overwhelming, amazing failure.

The health care bills now winding their way through Congress would cover many of the uninsured. They would pay for most of the costs associated with that expanded coverage. But they would do little to change the fundamental incentives that drive health care inflation.

If confidence in this reform agenda is fading, it's largely because the people at large are getting very worried about the expansive government/massive deficit dimensions of the whole Obama package.

But Brooks point is that, despite President Obama's focus on the health care cost issue, none of the plans addresses the real cause of health care inflation. Critics of the American system incessantly point out that American spends a lot more on medicine than any comparable nation. That is the problem to be solved. If it were solved, there would be plenty of money left over to cover the uninsured and get basic health care to everyone. So why do we spend so much more money than we apparently need to spend?

The answer is that Doctors recommend more tests and more treatments than make sense in any cost/benefit analysis. Why do they do that? Part of the reason is the tort law system. If a doctor doesn't order a test or treatment, and the patient loses an elbow or kicks the bucket, she risks a massive lawsuit. But that's only part of the reason. More tests and treatments equal more money for doctors, hospitals, pharmaceutical companies, lab rats, and so on. So any cost effective reform of the system will run against the interests of the tort lawyers (a major Democratic interest group) and pretty much the entire medical industry.

But those obstacles, potent though they are, aren't the real obstacle to reform. The real obstacle is Denzel Washington. I didn't see John Q, the film in which Washington plays a father who takes an emergency room hostage because his insurance company won't pay for a transplant for his ailing son. The movie's premise, as I understand it, was pure fantasy. What is pure reality is this: we Americans consistently demand the best health care possible for ourselves and our loved ones, beyond any rational cost/benefit calculations. Our system provides a lot more of that than any comparable system. We are the problem.

Ask yourself this: what if a treatment costs $250,000 and saves the life of one of four persons suffering from a specific disease? That's a million dollars per life saved, and a 25% success rate. Suppose 1,000 people suffer from that disease. That's two hundred and fifty million that can't be spent on education, highways, or homeland security, to save 250 people. Anyone who says we shouldn't spend it will be asked what a human life is worth.

European state-sponsored health care systems are a mixed bag. Some are pretty good; others, not. In terms of survival rates, the United States ranks very high on some measures (cancer survival rates are better than any European system), and in the middle on others. But the European systems are better at cutting people off. You just can't have this bypass operation because you're too old, sorry. We aren't very good at that, and that is why our system is so much more expensive.

Advocates of reform like to imagine that more treatment will be extended to people who now are denied it. This is fantasy. Any real reform of the system will mean denying treatment to people for whom that treatment is the only hope. Is the Democratic Congress courageous enough to do that? Not if current legislative proposals are any indication. The cause of healthcare reform looks hopeless.

Comments

[P. Chirry]

What would happen if the government eliminated pharmaceutical patents and funded R&D of new drugs through government grants instead? Is that reform ever considered?

[Mark Anderson]

You left out insurance agents and companies, why would you do that?

[KB]

P. Chirry: Easy answer. Progress in pharmacy would come to an end. How much progress in medical research goes on in Totalitarian regimes?

Mark: The insurance industry pulls in the other direction. They don't want to pay for more treatment than they have to. Beyond that, how is this industry relevantg to my point?

[P. Chirry]

But is the historical lack of progress in totalitarian regimes because totalitarianism is inefficient or because totalitarian regimes tend also to be evil and murder off their most brilliant scientists?

[Walter Grant]

Dear South Dakotans:
As a Proud Canadian, it is appalling to hear members of the U.S. Congress trashing our most precious Legislation-our Health Care System. Please ask Members to provide reliable Statistics-NOT individual complaints in this-America's Most Important DEbate since IRAQ!
In November my Gallbladder was removed just 24 hours after my 2nd Attack. Cost to me $0.00 Nil. Nada. Please tell all your Legislators. CANADIANS LOVE OUR SYSTEM and IT WORKS!
Why are US Seniors crossing into Canada to buy prescription Drugs?
Walter Grant
CANADA!

[KB]

Walter: sorry, but your operation cost you plenty. Government sponsored healthcare is payed for by taxes on people and on enterprises. Both have consequences. Go to a medical supply store and price out a hernia belt. We don't have them down here, because we don't have to wait for that kind of operation. If American seniors go north for drugs, a lot of Canadians come south for treatments they are tired of waiting for.