November 15, 2009
The healthcare dance
By Bill Kraus
Two great political adages are at play in the prolonged, complicated, contentious attempt to put together a new health care system for this country.
The first is that no one should have to witness sausage or legislation being made.
The second is that when major, complicated legislation is in the making (which you shouldn’t have to witness) the important thing is to get Mathilda on the dance floor.
Turf wars are what the health care bill is about, and it is a virtual golf course.
For openers, health care spending is 17 percent of our gross national product. This means that people and companies who are in the health care business are getting paid that 17 percent. That is the status quo that is being protected by insurance companies that do the paperwork, doctors and their helpers who do the mostly fee-for-service healing, hospitals that house the ailing, drug and device manufacturers that provide the stuff of which medical miracles are composed, administrators and managers who orchestrate this melange, and a collection of bystanders and outsiders whose interests are improved or threatened by the health care system and practices.
My own views on this collection of sausage makers:
1.) Insurers don’t belong at the table.
2.) Fee-for-service incentives rarely if ever lead to less of either.
3.) Physical facilities need to be kept full.
4.) Drug companies produce and promote the things they invent and sell; the cost of the former is irreducible; the cost of the latter is arguable.
The outsiders are too numerous to list but a small sample is that the ideologues led by groups as diverse as the Catholic Bishops, the anti-immigrationists, and the free marketeers are weighing in on medical practice policy in ways and with demands that mostly make change almost impossible.
With the lobbying costs running in the neighborhood of $4 million a day (an amount that is added to the “cost” of health care) and with the job protecting legislators being threatened or seduced by money and votes, it is impossible to produce anything approaching an ideal sausage out of the box.
Which gets us to Mathilda.
If anything is to happen, it is going to have to be imperfect, even a half measure.
The judgment that will have to be made is whether what does come out of the box is better than the status quo ante.
It is hard to believe that it will not improve on a health care system that costs twice as much as what is available in every other first-world nation and that delivers results that are no better than average and in many categories very much worse.
So let’s take what we can get, and, over time, improve on and expand the inevitably flawed sausage that is being assembled.
We couldn’t do worse. We can get a small or even a significant step in the direction of lower costs and better results, and once on that path we can do better and better and better. We will probably never get the kind of perfection the purists insist on. As for me, I’ll settle for, at long last, getting Mathilda on the dance floor.
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Ditto! Its time to get something rolling. Yes there will be a learning curve. We can only hope that it not be tilted or skewed towards a partisan outcome.
-LaFay | Belleville, WI | November 16, 2009
Are we done fighting? Have we given up? This legislation:
* promises a massive payday to health insurance companies
* does not provide health care for all Americans
* increases the deficit
* punishes non-compliance with a tax penalty
* has NO provisions to reduce costs
* will still require copays and deductibles to be paid out of pocket
* DOES NOT EVEN TAKE EFFECT UNTIL 2013!
By 2013, the U.S. Centers for Medicare & Medicaid Services and the Office of the Actuary project our total annual health expenditures to be $3,396,000,000,000. How can we afford to wait?
This debacle is but another symptom in the ailing health of our once great Nation. Time to wake the sleeping lion that is the American people. Time to take back our country. I'm not done fighting.
-Lex Tinker-Sackett | Eau Claire, WI | November 17, 2009
Hmmm . . . what would "Fighting Bob" say?
"But in legislation no bread is often better than half a loaf. I believe it is better to be beaten and come right back at the next session and make a fight for a thorough-going law than to have written on the books a weak and indefinite statute."
". . . if this is radicalism then indeed I am a radical; but I call it common sense. It is simply the clear comprehension of the principle involved, and the clear conception of the utter destruction of that principle if only part of it is applied. I have always believed that anything worth fighting for involved a principle, and I insist on going far enough to establish that principle and to give it a fair trial. I believe in going forward one step at a time, but it must be a full step. When I went into the primary fight--and it has been my settled policy ever since--I marked off a certain area in which I would not compromise, within which compromise would have done more harm to progress than waiting and fighting would have done."
Robert M. La Follette: A Personal Narrative of Political Experience
-Oliver Steinberg | St. Paul, MN | November 19, 2009