February 26, 2010

The Health Care Summit

I watched a little, in the morning, for about an hour. I had awakened at 5 am anyway (one of those developments in the aging process, I presume), I was caffeinated on Peet's 91 Octane, and it was on TV. What the heck.

Prez O is getting better and better at whatever it is he's doing in all these meetings with Republicans. Is it strategic? It must be, at some level. I guess the idea is to show the Republicans up for the no-idea obstructionists they are. Although, in truth, once the idea was reached by the O Admin that the fix would consist of maintaining the present system of an unholy marriage between private, for-profit medicine and insurance with government involvement as regulator and partial reimbursor, the game was over anyway. It's just not going to work, because the fundamental premise is wrong. We're really the only modern, industrialized democracy that tries to do things this way, and it's a failure. If you read Paul Krugman's column today, you'll see he has contracted his hopes to a single point: no more "preexisting condition" exclusions. That's it. That's why he supports this bill, because it has that provision.

So while it looks like a lively argument between humane Democrats, and cold, callous Republicans, it's really an argument about which irrelevant approach ought to be passed or not passed, so that, respectively, the Democrats can claim they passed Health Care Reform, or the Republicans can claim that President Obama Has Met His Waterloo. I think the O Man was attempting to demonstrate, on TV, that his ideas are up against irrational obstruction, but that does not come through very clearly because he's championing a tepid, sell-out program in the first place.

I actually thought Tom Coburn had some interesting comments about "defensive medicine" and its contribution to cost overruns. Doctors perform most of their tests so they won't get sued for not performing them. He went on to estimate the cost for such an approach as "$850 billion per year." ?? If health care costs 17% of GDP (the usual number), then medicine in its various forms comes in at about $2.4 trillion. Coburn is saying that 1/3rd of all costs are waste because of the tort system. It's possible there's something to that. If you add wasteful spending to the condition in which the American patient presents himself to the doc in the first place (obese, diabetic, eating a regular diet of toxin-laced processed food), maybe we could begin to get a realistic picture of what's going on, and discover that socialized medicine would not be so terribly expensive after all, if coupled with tort reform and public health proactivism.

For my part, I've always thought that the whole system of private recovery for medical malpractice should cease. This is not to say that medical malpractice does not occur, because it occurs regularly. The question is whether our system of redress does more harm than good for society as a whole. Whether Coburn (who is a doctor) realizes it or not, his argument backs into the regulation of medicine as a public and social utility. Medicine should be regulated, with peer-group review of doctors as the enforcing agents, instead of trials by jury. The various boards of medical quality assurance should take over, and the tremendous savings to doctors allowed by never buying medical malpractice insurance again should in part form a compensation fund for victims of medical malpractice as determined by such panels or other administrative boards (similar to worker's comp). Then doctors could focus on competence and realism instead of looking over their shoulders, and leave it up to medical quality assurance to determine whether a doctor should retain his license.

But as I say, I don't think yesterday's meeting will lead to any paradigm shift, and that's the kind of transformation we need. A colloquy of pontificators is not a method for devising intricate or creative work. Maybe when Woody Allen, Mel Brooks, Carl Reiner, Neil Simon, Larry Gelbart and Sid Caesar sat around a table coming up with ideas for "Your Show of Shows," this sort of collaboration provided a creative synergy where the whole was greater than the sum of the parts. When it's Lamar Alexander and John Boehner on one side, and Nancy Pelosi and Harry Reid on the other, not so much.

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