Mister Moleman and his Friends

OK, now where was I?  Oh yes, health care reform.

Finally, a subject I understand well enough to know what things I don’t understand about it.  I have lots of questions, and I see several concerns that any reform plan needs to be able to address in a plausibly reassuring manner.

First off, let me say this is a real problem.  As a union guy, I’ve negotiated health insurance benefits for a long time. I’ve felt the lash of premium costs rising much faster than inflation. I’ve seen the discomfort of workers having to choose between higher out-of-pocket premium costs and lesser coverage.  I’ve seen plans move to $2000 deductibles per person, just to retain some degree of affordability.  And I’ve seen workers gradually educated to the hard reality that every dollar for health care is a dollar that isn’t available for salary.

Worst of all, I’ve mediated intra-union generational warfare in its ugliest.  Younger workers fight for higher pay instead of driving money into insurance. Middle age workers fight for family coverage so their kids can be insured, while older workers fight for full coverage for employees and spouses only, even as they also try to figure out how to afford retirement pre-Medicare.

So I am not surprised that the pressure for health care reform is coming not only from the uninsured (whoever they are), but also from middle-class insureds who see the escalating cost of their coverage and wonder how long they can afford it.

But I’ve also been a health care consumer, and here it seems to me the reformers are way off base.  I’ve been to doctors, clinics, and hospitals; I’ve had expensive tests and procedures, and I’ve come out alive.  More than alive, I’ve come out marveling at the quality of the health care I’ve received.  When Michael Moore touts Cuba’s system, or the NY Times’ editorial stable bemoans America’s “broken system”, I wonder what planet these guys are on. 

Has anyone with a life-threatening illness ever voluntarily left the US to be treated in Canada or Britain or France?

The US system is the world’s locomotive of medical innovation, whether in new drugs or advanced bio-mechanical treatments.

And this is needs to be a major concern.  Any reform needs to be structured so that it will not inhibit innovation and technological advancement.

We all know drug costs are skyrocketing, faster than any other health care cost.  So a few years ago, we had a big campaign to follow the Canadian system and to simply set government price controls on drugs, or (better yet) allow us to import price-controlled US-developed drugs from Canada, thereby proposing the shabbiest example of government out-sourcing ever.  The proponents got some great political theater out of Lourdes-like bus caravans of the old and sick to Canada, but fortunately the idea got nowhere. US price controls would have upped the Canadian pin-prick into a vampire’s deadly blood-letting for the US drug companies (“Big Pharma”, as some Democratic enemy-targeters like to call them). 

Which brings up the biggest question of all.  What is driving health-care cost inflation?  We need to ask that before we can talk about fixing it.

It appears that two factors are primary.  First, as we’ve been discussing, new druga and technological innovations are pricy.  So they are the problem.

But they are also keeping us alive and well to an extent that has never been dreamed of.  Diseases that people routinely died from even 20 years ago are now treated easily with drugs.  As an example, the Make-A-Wish foundation grants last wishes to children with terminal diseases.  They have recently removed Leukemia from their list of terminal diseases eligible for last-wishes.  Why?  Because leukemia, that nightmarish death sentence of the young, is now routinely survived.  New drugs, new treatments.  How much overall health care cost increase is that worth?

How many middle-aged people do you know who are able to walk because they got new knees?  How many grandparents are still alive because of a heart bypass?

Speaking of grandparents brings us to the other principal cost driver. We are getting older – not just individually, but collectively and on average.  Every employee group I ever bargained for was getting steadily older.  So is America.  Partly, this is a result of medical improvements, so there is a positive feedback loop here.  Health care lets us get older, older people need more health care.

But is this a problem?  What do we want? Less care?  Less old people?  What?

In a very real sense, health care cost increases cannot be considered inflation.  Inflation means paying more for the same product.  In health care, we are paying more for steadily improving products and outcomes.  Increased longevity is a valuable commodity.  Improved mobility and easily cured diseases are a valuable commodity.  If we think of them as problems rather than successes, we are headed for some very ugly outcomes.  Rationing care is only a bureaucratic term for rationing life.

There are a lot of additional issues to consider.  Who exactly are the 47 million uninsured?  Whay are they uninmsured?  How much would it cost to insure them?

We have considerable experience with some government-run and managed health care.  Why aren’t we talking more about that? 

Medicare is a successful plan, if you ignore the cost escalation.  Is Medicare’s cost explosion simply the result of the phenomena described above – new drugs, aging demographics?  Is Medicare a model or a disaster warning?

The VA (Veterans Administration) is a classic single-payer plan that should be studied.  How is it working?

Medicaid is the current effort to insure those who can’t afford insurance.  It seems to be another cost-exploding program.  What is driving its costs?  How many of the 47 million are or could be covered by Medicaid?  Are we looking at re-structuring health care for 300-million Americans when perhaps some Medicaid adjustments would do the trick?

What about tort reform?  We don’t hear much about malpractice lawsuits and insurance costs for doctors anymore; is that because we have a Democratic regime, or has the problem gone away?  Are malpractice insurance costs and needless tort-defensive testing and procedures a major cost factor?  If so, is anyone (except lawyers) ready to defend them as “valuable commodities”? 

I think I’ll  have to give all this some more thought.  In the meantime, let me know what you think.

It is reported by Eric Trager on Contentions that Defense Secretary Gates, obviously speaking at the president’s direction, has announced that the US has no military ability to destroy the fast-developing Iranian nuclear program.  All we would do would be “send it further underground.”

So, the penultimate obstacle to Iran’s holocaust plan has been removed. The world’s powers have now informed Israel that she is on her own. The 6 million Jews living in the Iranian crosshairs must now decide if they have any alternative to “learning to live with an Iranian bomb” as one realist advises (See the “Conversation on Iran with Frankie Sturm” below). They may decide that “sending Iran’s nuclear program further underground” is not a bad idea, if you keep doing it.

This may turn out to represent as dark a day for freedom as the Munich pact, when “silent, mournful, abandoned, broken Czechoslovakia receded into the darkness” as Churchill put it. But Israel is unlikely to recede quite so quietly. A people whose cherished shrines include Masada will not go down without a fight.

America has suffered a humiliating defeat without a shot fired. As commenter Lester puts it, “America can’t afford to have a foreign policy anymore.” But money isn’t the problem; the will to defend freedom is our real deficit. Recently, Obama spoke the all-too-easy words: “Never Again.” Now he has retracted the words.

This is a tragic day for free peoples everywhere.

George W. Bush is about to become officially only a memory. (Though in all likelihood he will become the kind of obsessing memory that Nixon immediately became for liberals.) 

His tale is of course complicated. Many knocks against him are legitimate.  So what can you say to his credit?

Simply this.  George W. Bush fought hard against the enemies of his country, and never let popularity or politics distract him from doing so.

That accomplishment will be put in perspective by the subsequest performance of his successors.  Let us pray that it comes to be seen as a matter of course.