Health Reform For The Late 20th Century

I have to complement our Congressional leadership for its political fortitude and wisdom in preparing 2010 health reform legislation which is well suited to the 1970s and 80s. The late Richard Nixon, who brought us HMOs in a serious effort at health care reform (which became fouly mutated under the counter-evolutionary pressures of insurers, hospitals and other providers) would have been proud to see the 2010 reform just before "le affaire Watergate"cut his presidential career and his interest in American health care short.

What is being trumpeted as health reform is more of the old health system, redressed and reworked, with the old guard in control. The program has been shaped by pharmaceutical companies, insurers, chambers of commerce, hospital associations, device manufacturers, health care unions, high-roller physicians and other providers, through their lobbyist minions to be certain that their controlling interests and their profit centers are not perturbed, their stock prices ever climbing, their executive salaries not  diminished, and the care, which Americans will receive, not improved.

[Remember: a pharmaceutical (and other company which makes its money in health care)  profits by selling drugs over a long time for a chronic disease, not by efficiently curing a disease early in its course. An insurer makes money by keeping your doctor on the phone for 45 minutes, hoping that she will hang-up the phone,  rather than promptly authorizing the care you need.]

How are we going to staff the clinics and hospitals to provide the facilities and office visits that adding more than 30 million Americans to the insured list will demand ("the doctor is completely booked for the next ten weeks, but we have one appointment 71 days out with our new physician's assistant")?  Will the legislation's effect on doctors' offices cause them to look like overcrowded hospital emergency rooms where only visibly dying patients get immediate attention?

Under the 2010 health reform proposal, where are the skills neeeded to diagnose and treat cancers, degenerative diseases, trauma and neurologic disorders in our aging population to be gained?

Where are the financial incentives which will drive our younger generation to acquire an interest, skill and understanding of chemistry, math, physics, biology and the other sciences which will provide the springboard to careers in the healing professions? Is our "health reform" simply training generalist doctors to take care of sore throats, blood pressure elevations and type 2 diabetes using duplicative drugs purveyed by pharmaceutical companies?  Will the recruitment and education of coming generations prepare them to understand complex scientific concepts of statistics, DNA, genetics, epigenetics and their interrelationship with disease and health or is there concern among political and industrial leadership that a bright, well-trained and informed health care leadership will be too hard to control?

In a country which prides itself on its capitalist tradition, the proposed 2010 health reform incorporates few capitalist incentives to recruit the people and brains who we will need to make the system work and few capitalist incentives to improve the quality of care available to Americans.  It rewards the same individuals, interests, companies, systems and institutions which have traditionally lined up at the trough for slop.

It's perverse. The Republicans are less capitalist than the Democrats, the the conservative Democrats are less capitalist than the Republicans. Go figure!