Making Sense of it all

The rhetoric has reached a point now where we’re beginning to see articles that attempt to summarize or outline the key issues.  In today’s Washington post, Alec Macgillis provides a  cheat sheet which presents, in the first paragraph, the two key issues:  Coverage for the uninsured.  Still quoting the old 47 million figure, tho with unemployment, the current number is certainly higher.  How do we provide healthcare for these people?  And, most important, how do we pay for it. Cost.  Macgillis lists cost control as a way of paying for the uninsured, but there are other issues: “Medicare and Medicaid are badly straining the national budget.”  I think Peter Orzag would use stronger terms and would argue that cost control (“bending the curve”) transcends healthcare reform.  Our total healthcare spending represents 20% of our GDP, more than any other country.  Medicare alone is predicted to crowd out other discretionary spending in the federal budget.
In the same  Washington Post, Fred Hiatt writes about “Three Camps” that really please no one: Cover Everyone, a.k.a. universal access.   Bend the Curve. a.k.a. control costs via demand.  Consumerism.   The idea is that if patients could see how much individual healthcare services cost (and had some skin in the game), they would  make wiser and less expensive choices.
The volume of rhetoric breeds confusion, and that is indeed what some factions want.  Others endorse covering the uninsured but don’t want the cost controls that would be necessary to pay for it.  Look at the last slide in the Washington Post Interactive and ask which of these players/interest groups would benefit from 47 million new paying customers in the healthcare system.   (Answer:  all of them.)
So what’s a poor consumer to do?  Where do you get reliable information to even think about healthcare reform?  The Post provides an index to their coverage, and reading the writing of reporters and pundits can help.  Always ask, tho, what benefit would accrue to this writer or his employer or his interest group by passing the reforms he advocates.  It’s not that advocacy groups are inherently evil, but they do have an agenda, and you need to interpret what they write in view of that agenda.
What about “experts,” the gurus, the oracles?  Surely, if we asked a very wise person, they would know everything and tell us what to do.  But there is a chink in the armor of academia:  smart people don’t always agree.  Yep.  It’s true.  All Supreme Court opinions are not unanimous.  And smart people sometimes make bad decisions.  Still, it’s worth listening to what they have to say.  As a friend of mine once said, “It is a fact that you have an opinion.  That doesn’t mean your opinion is a fact.” Reminds me of some lines from Phyllis McGinley:

“When blithe to argument I come, Though armed with facts, and merry, May Providence protect me from The fool as adversary, Whose mind to him a kingdom is Where reason lacks dominion, Who calls conviction prejudice And prejudice opinion.”

Below, there’s a link to experts, at least to a list of people the Washington Post thinks are experts.  Their list includes–are you ready for this–Newt Gingrich.  Now Newt is a very smart guy, and he has thought a lot about healthcare, so I’m willing to listen to what he says.  But he, like some others in the list, talks in generalities that are so vague that it could be said he supports everything, or nothing.  The entries are short, and all are worth reading.  Nuggets here and there but no magic bullets.  And guess what?  They don’t all agree.  Imagine that.
Want agreement?  Here’s an Op Ed piece in the New York Times by a group from academia who all agree with each other.  That, of course, doesn’t make their opinion a fact.  Their opinion is, however, well developed, well written, and worth reading.
The Dartmouth approach advocates looking at low cost regions of the country where there is good quality healthcare but lower per capita expenditures.  One fallacy of this approach is that their definitions of “quality” have little to do with healthcare.  This is a trap shared by many who cite the high cost of U.S. healthcare but the limited quality of outcomes.  Life expectancy, for example, has almost nothing to do with healthcare and more to do with genes and the environment.
As you read and listen, keep you eye on the prize:  How can we reduce the cost of the healthcare services we provide?
Some links cited above” Fred Hiatt:  Three camps, but few happy campers. 16 Aug09 Macgillis Your Handy Health Care cheat sheet. of “experts” Health-Care Reform 2009.  Index to articles. & Graphs.  Recording.


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Retired: physician, civil service employee, consultant.

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