Friday, July 31, 2009

Swift-boating the healthcare reform in the month of August*

Do you know the kids' book "Officer Buckle and Gloria" by Peggy Rathmann? It is a story of a police officer and his dog Gloria, who, as a team, go around the local schools giving such useful safety tips as "do not stand on a swivel chair". They are a big hit: they teach and make kids laugh, and their popularity soars to the point where a news team films one of their presentations. Watching it that evening on TV, officer Buckle has an epiphany about the etiology of their popularity: it is Gloria's charming antics, acting out his tips while standing behind him on the stage! Naturally, officer Buckle feels like a fool and slips into a depression and refuses further engagements, but it's OK, because Gloria is the real attraction, and she is still invited to talk, and she fails miserably without her buddy to the point that both she and her audience are depicted in the auditorium in a peaceful slumber. Z-z-z-z-z...

This is how I am beginning to feel about this whole healthcare "debate": z-z-z-z-z. The public is bogged down with worsening economy, the press are colluding with the Republicans in spreading mis-information, a la the Swift Boat gate. Members of Congress are day-dreaming about their summer recess, and the President is busy chugging Bud light at a teachable summit. So, among these doldrums, in walks Paul Krugman with his Nobel Prize in economics, and in a few computer strokes says as much as Tolstoy could say in a novel, and just as eloquently: Get your facts straight, you anti-government conspiracy-theory bile-spewing idiots! You owe whatever small amount of success exists in our current healthcare debacle to government regulation. Between Medicare and Medicaid, caring for the elderly and the indigent, respectively, and tax incentives for employers to cover their employees, while taking away their ability to cherry pick the healthy ones and rescind those with "pre-existing conditions", the government is already responsible for the parts that work.

This over-$2-trillion behemoth, and many of those feeding at its trough and promoting inefficiency, inequity and overuse, needs to be reined in! With the economy in the slump, and the US index of production, the GDP, continuing its nose-dive, our healthcare spending is continuing to increase, and I would not be surprised if it came in around 25-30% of the total GDP by the end of 2009. This would be a good investment, if the health of the population was improving. But with the rates of obesity on the rise, the threat of a tough flu season ahead that we are ill-prepared for, and fully 40% of the population carrying a chronic disease diagnosis, this does not appear likely.

So, let me reiterate a few points. If you worry about reduced incentives for innovation, don't: manufacturers' own risk-averse attitudes in response to market pressures have already squelched innovation. If you worry about the government getting into your affairs, don't: the role of the government will be well defined and limited to providing the funding and the tools necessary to make rational care decisions. If you worry about rationing, don't: we have a long way to go in cutting away the fat of unnecessary care before we get to the lean mass of what is useful and effective. And please, do not confuse "rational" with "rationing". Rational is what you will get if comparative effectiveness research is allowed to do its job. Rationing is what you are getting now from the suits in the boardroom who refuse to pay for your care.

So, as any doldrums, these too will pass. In the "Officer Buckle and Gloria", as you can imagine, officer Buckle sees the light and understands that he and Gloria are a team, and without him the schtick does not work. So, in the all's-well-that-ends-well fashion of children's books, the two friends get back together to the delight of their fans. Will our reality end well? I do not know, but what I do know is that without our involvement this healthcare schtick will not work. So, during the August recess we need to resist the slumber of summer and continue to pressure our elected officials to do the right thing: bring us quality equitable healthcare that will not bankrupt our children's future.

*I cannot take credit for this "Swift-boating" terminology, which I have respectfully borrowed from the Chairman of the DCCC, Chris Van Hollen

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