The Debt Ceiling, The Civil War and Health Care

When the Tea Party, the Republicans, the Democrats and our nation's leaders take political positions based on their articulated fundamental principles, they demonstrate that they have learned nothing from American history.

Our Civil War,  fought on the basis of deeply held non-negotiable principles, scarred our country and its families, leaving  the South with a deep sense of tragedy from which it has never fully recovered. Fundamental beliefs cannot be negotiated and cannot be compromised.  Individuals and parties, unable to walk away from their articulated fundamental beliefs, cannot move the political process forward.

Today, we have a debt ceiling impasse based, not on common sense and the need to solve our problem, but on "fundamental beliefs" which are not to be compromised - which, for the Democrats, means an attachment to social policies which ameliorate perceived societal wrongs and needs (including changes to our health care system) - and for Republicans, become tightly glued to beliefs about the unfairness of taxation, redistribution of America's resources, and "private" enterprise.

I hope that politicians make the political process work. Failure to move compromise forward will have serious national consequences, at a time when many American families are already touched by a national sense of tragedy. 

Who Will Fill The Ethical Void?

We have heard the substantially different demands articulated by spokespersons from each major national political party concerning health reform, and today we heard that two federal courts have said that the Patient Protection and Affordable Care Act of 2010 is constitutional and two have declared it unconstitutional, moving the ACA in the direction of America's highest court which will be asked to offer a raised or lowered thumb.

In my earlier blogs, I asked the Democratic administration for a simple explanation of its ethical basis for moving ahead with health care reform.  Neither I, nor - more importantly - the American electorate, received an answer.  So now, it's the Republican party's turn: what is the ethical foundation for the Republican party's opposition to health care reform?

I can't figure out whether what is at stake is pragmatic politics, a sophisticated view of the health care needs of America's men, women and children, a greater respect for material wealth than human values, or exactly what each political party's ethical standards are.  Where we are going? What are the points on the ethical compass we are being told to follow?

Will someone from the Republican party fill the void left by the Democrats? What are the ethical considerations of the Republican party in formulating its opposition to health care reform?

Health Reform: Upset WIth Democrats, Afraid of Republicans

My take, based on conversations with professionals and just plain people, is public apprehension about the impact of the 2010 health reform package. On the one hand, people complain about the threat of federalization of health care and on the other, they demand that their Medicare program not be affected by health reform.  While there is recognition of the need to clean up the the old inefficient expensive system which provided economic rationing of care, there is a sense that the political parties are at odds, and that any gains made since passage of health reform in March, 2010 will be undone by Republicans should they gain control of Congress. The uncertainty created by Democratic passage of reform is threatened by the fear that - if the Republicans can control health care - it will be the bad old days again and people will sit in movie theaters (or in front of their big home TVscreens) booing insurance companies, HMOs and any theatrical reference to institutions that control of health care.

The Democrats haven't exactly made it easy for the public to understand what is happening and what will happen under health reform. A recent posting of a letter from Kathleen Sebelius  calling on Health Insurers to Stop Misinformation and Unjustified Rate Increases, said

"Any premium increases will be moderated by out-of-pocket savings resulting from the law.  These savings include a reduction in the "hidden tax" on insured Americans that subsidizes care for the uninsured.  By making sure insurance covers people who are most at risk, there will be less uncompensated care, and, as a result, the amount of cost shifting to those who have coverage today will be reduced by up to $1 billion in 2013.  By making sure that high-risk individuals have insurance and emphasizing health care that prevents illnesses from becoming serious, long-term health problems, the law will also reduce the cost of avoidable hospitalizations.  Prioritizing prevention without cost sharing could also result in significant savings: from lowering people's out-of-pocket spending to lowering costs due to conditions like obesity, and to increasing worker productivity - today, increased sickness and lack of coverage security reduce economic output by $260 billion per year."

Walk into any hospital Emergency Department and you may observe terribly sick and injured people who, because they are not insured American citizens, may still run up substantial costs which will be shifted to the insured population making the Secretary's claim of dubious validity. We need the facts to substantiate claims of savings as an offset to the doubts proclaimed by the political and corporate opponents of health reform.

Otherwise we will have more upset which will outweigh fear.

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!

Make The Call

Whether you are a Republican,  Democrat, or an independent, call your U.S. Senators' offices and ask:
1. How much campaign money have (he,she, they) raised from pharmaceutical companies?
2. How much money  have (she, he, they) raised from insurers and insurers'associations?
3. How much money have (they, he, she) raised from hospital associations?

The fact that you called and raised these questions will make a difference. Just do it.

A Sort-Of Historical Speech

It was a textbook, "let's make a deal" speech, aimed at obtaining concensus on the principles which President Obama laid out, so  that later, the principles could be expanded to provide the real muscle and meaning behind the vague wording. For its purpose, it was well done. I found myself asking for more specifics, but having watched/listened to several of Obama's internet-based presentations, knew that I and other Americans stood no chance of getting specifics  tonight. It was not what I had hoped for in my blog of September 6, 2009.

Having spent a long afternoon today at a biomedical ethics meeting dealing with serious issues of life and death, I resented the failure of Obama to discuss anything other than the business of health reform.   I also found myself resentful of the Republicans, massed and unsmiling in their dark blue suits, unwilling to let their politics yield to human and national needs, and almost expecting someone among them to stand up to demand that Social Security be repealed.

In all,  it was  not a memorable night.  Perhaps there will be substance soon to come.

And don't forget  ethics.

Fannie Mae, Freddie Mac & Your Family's Health Care

America is in a severe economic slump. Concurrently, the nation's health care costs, for a growing and aging population, are increasing. When the denominator (gross domestic product or GDP) shrinks or stalls, and the numerator (health care costs) grows, we will devote an increasing percentage of the gross domestic product to health care, giving politicians an excuse to vote against meaningful health care reform with health services for all Americans. I expect to hear the refrain "we don't have the money just now" from state capitals and Washington, coupled with the inference that health care is taking too big a bite out of America's economic apple.

The collapse of Wall Street, the exposure of our government to default on $5.2 trillion in mortgages (which you, the taxpayer, will be expected to underwrite), the lack of overall government credibility with its effect on individuals' and business' purchasing plans, and dismal newspaper headlines all affect the GDP denominator. A decrease in preventive medicine, early diagnosis and treatment, childrens' services and health technology, coupled with accelerating pharmaceutical costs, will eventually inflate the numerator.

As we move into the Democratic and Republican conventions, listen critically for realistic discussion of serious health care reform. It's your family's health and well-being they won't be talking about.