Wednesday, May 27, 2009
The Democratic Blue Dog Coalition has announced its agenda for reforming American health care. Not surprisingly, heading the list is controlling costs in the current systems. The Blue Dogs, you might recall, are Democratic moderates whose mandate is to reduce the nation's deficit.
"Comprehensive health-care reform must be deficit-neutral," the group said in a release. "Finding savings within the current health-care system is a critical first step to achieving this goal."
While one can hardly quarrel that the current system is too expensive for what it delivers, one can question whether looking for ways to cut costs is the "critical first step" to reform.
n fact, the Blue Dogs' "reform" may be exactly the wrong way to solve the problem, because at its core, their solution keeps the current system of private, for-profit monoliths in place, merely "tinkering around the edges" of the issue instead of kicking the current system's ass out the door with a little tough love.
American health care has been co-opted by Big Business, which means its very reason for existence is, in fact, profit and growth, not service, care or even health. Between Big Pharmaceuticals, Big Insurance and Big Providers, patient needs have slipped far, far down the hierarchal totem pole.
"Many patients receive recommended care only half of the time," the release continues, adding "we are not getting an adequate return on our health care investment."
America's per capita health-care costs are higher than any other nation, including those that provide coverage for every citizen. But the Blue Dogs talk about the health of the American people in exactly the wrong terms: as a commodity. Health has value, of course, in terms of giving us a strong, engaged citizenry, but talking about health like we talk about mutual funds is exactly the mindset that has given us the system we have today; the same "inside the box" thinking can't be used to fix it.
To be fair, there are items on the Blue Dog agenda worth considering, among them: loan assistance and forgiveness to increase the numbers of providers in rural and underserved areas; elimination of coverage denial for (the increasingly all-encompassing) "pre-existing conditions"; additional investment in research and treatment; emphasis on prevention and wellness. Those are all worthy goals.
But ultimately, no sweeping, comprehensive change will come until the profit motive is removed—or at least, severely curtailed—from the equation. We need to talk about eliminating drug advertising and lobbying efforts, for example, instead of about giving patients payment incentives and businesses tax credits. Patients unmotivated by poor heath to follow their doctor's advice will not have a sudden change of heart for pharmaceutical discounts. And tax credits will not motivate small businesses that can't afford insurance payments from month to month. Those "solutions" are attempting to fix the wrong end of the problem. It's like putting a Band-Aid on the toe of a person with a head wound.
We need health care for the millions of working poor who can't afford coverage, along with lower deductibles and co-payments for everyone. We need coverage for wellness programs, including weight-management, smoking cessation and comprehensive exercise education for those who need it. We need rigorous physical education to become a standard, required part of school curriculums again. We need to make school-lunch item decisions by what's healthy, not by how much profit vending machines can make for school systems. We need to include alternative therapies in our care arsenal and lighten up on the traditional Western approach of pharmaceuticals and surgery as the answer to every health problem.
Until the primary motivation to provide health care is actually the health and care of patients, no tinkering "reforms" have a snowball's chance in hell to actually make a difference.