Friday, July 24, 2009

The Health -Care Debate

Give President Obama credit. In tackling health-care reform, he is opening a can of worms that he doesn’t need. With Afghanistan going badly, with the economy on life support, with political sniping from all sides, why stir up the health-care hornets’ nest?

On the other hand, maybe his crusade isn’t as courageous as it seems. Although he claims that we can pay for reform mostly by eliminating waste, he refuses to touch one of the biggest waste-makers of all: defensive medicine undertaken to avoid lawsuits. This deference to the power of the lawyers’ lobby can’t be explained by anything other than political expediency. It smells bad.

The waste argument is flimsy on other counts. It is said that the insurance system creates an incentive for needless tests, and that is undoubtedly true - in hindsight. But if you have a medical problem and the doctor prescribes four tests, and two are said to be unnecessary, how does the doctor know – in advance – which two are valid? By studying outcomes, they say. So your doctor suggests four tests, runs them by a computer, and tells you that you qualify for only two of them. There. You feel a whole lot better, don’t you?

A modern jetliner has two sets of avionics. One set is almost never used. Yet we pay for the redundancy – the inefficiency – because human lives are at stake. So it is with the health-care system. You want it to be efficient, but if it’s your life we’re talking about, you want all the tests your doctor thinks you need. Period.

The health-care debate boils down to a couple of issues. First, most people in the U.S. are satisfied with the health care they receive. They are being asked to pay for the addition of 30 or 40 million people to a government-run insurance system. Because we are a generous nation, we think it’s a good idea – if the quality of our own health care doesn’t suffer in the process. There’s the rub. The idea that my primary-care physician can increase his patient load by 15 percent by working more efficiently is nonsense. He already works hard and makes full use of his computer. And we can’t magically increase the number of medical professionals by 15 percent. The math is inescapable: Universal health care will mean longer waits to see one’s doctor. Maybe we are willing to tolerate the inconvenience in order to do the right thing. Maybe we’re not. No one is raising the question.

The strongest case for health reform is the financial case. Medicare and Medicaid are in big trouble, and something must be done. Delaying retirement till 67 or 68 makes sense, given increasing longevity (itself an argument for the quality of our health care). Reducing the incidence of malpractice suits makes sense, too. And yes, there is some waste, though almost certainly not as much as the President claims. The financial argument is bulletproof, but it applies only to Medicare and Medicaid. There is no financial case for universal health care, only the moral case. And that, given the state of today’s economy, is a hard sell. So the President is trying to package it as a financial imperative, and that’s disingenuous or dishonest, depending on your politics