The following is a reader take by S. Robert Snodgrass.
I want a better American healthcare system. I scan blogs for plans and wisdom, but I mostly find slogans. Paul Krugman’s columns, the Archimedes Movement and current proposals to repair the healthcare system frustrate me. They have different political philosophies, but each considers healthcare in isolation and repeats the same stale incantations.
Our political system is broken, with state and national legislators catering to special interest groups. They prefer slogans to priorities, because honest talk about money angers people. Consider that military costs consume more than half of our federal budget, crowding out spending for social needs. Why does Congress keep funding massive supplemental off-budget appropriations for Middle Eastern wars? They want us to believe that we can fight a war on the cheap, without the need to follow a budget.
The same applies to healthcare. Turn to Massachusetts, whose underfunded health plan began last July. Over 340,000 people are newly covered; 176,000 receive subsidized insurance – far more than expected. Another 55,000 are newly enrolled in Medicaid. The governor’s 2009 budget ignores these increased costs, looking for better healthcare on the cheap. A proposed tobacco tax increase may cover the deficit, but only if Massachusetts legislators don’t use it for other priorities.
A recent Boston Globe op-ed spoke of the plan as a “second Big Dig”- a well-intentioned, thoughtless financial disaster. The subsidized part of the plan will probably double in size and cost over the next few years. Only cost control and honest budgeting can save the Massachusetts plan. It’s more than blaming the drug companies. The op-ed recommended the old shibboleth of cost control by curbing frivolous lawsuits and railed against marketing bans or restrictions on pharmaceutical companies.
Can the program survive? Of course it can, but only if it is a priority for the voters and legislators. Collapse of the Massachusetts plan will derail national healthcare reform.
The failure of the pundits and politicians like Clinton, Krugman, or Obama to honestly discuss costs is disgraceful. Recently, the New York Times wrote about the need for more Massachusetts primary care doctors. This is true, but it considers the trees and not the forest. It doesn’t address costs.
Primary care should be at the center of the system, but it stumbles in our complex world unless networked to specialists. This means teams of providers with defined group responsibilities, communicating by secure email in an orderly manner, not playing phone tag. Most providers should belong to teams of specialists and primary care physicians. That’s not true today. A better system will cost more, not less. Preventive care reduces hospitalizations but it doesn’t save money.
We want premium healthcare for ourselves while we grudgingly offer generic care for others. To truly control costs, we must accept limits in order to do more for more people.
Without priorities and honest talk about budgets, healthcare reform is an empty slogan.
Like victory in Iraq.
S. Robert Snodgrass is a pediatric neurologist at Harbor-UCLA Medical Center.
