Llewellyn

King

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January 14, 2008

Needed: An American Solution to the Horrible Health Care Status Quo

I find few subjects as contentious as health care. I put it right up there with the war in Iraq, creationism and the role of the Supreme Court. Perfectly mild-mannered people can get extremely exorcised about health care.

I was reminded of this a couple of weeks ago, when a friend of 30 years and I had our first disagreement – and it was heated. I said that we were spending too much of our gross national product on health care, and it needed to be reformed. My friend either did not hear what I had said, or he inferred what I had not argued. He believed that I was advocating a national system of state-funded health care, like the one in Canada or the United Kingdom. I am not sure that those are valid models for the United States, but I am sure that the system we have needs an overhaul. It needs an overhaul on two basic grounds: It is too expensive and it does not deliver.

Most industrialized countries spend between 6 and 8 percent of their gross domestic product on health care. We spend a whopping 16 percent for the best medicine and the worst “delivery” in the industrialized world.

When I first got interested in the health care debate many years ago, we were spending less of our national wealth on health care, and there were fewer complaints about delivery. But as medicine has gotten more sophisticated and life expectancy has increased, costs have gone up, and the burden of managing delivery has gone up for patients, health care professionals and insurers. Sometimes the system melts down, as when insurers deny critical care to patients or when hospitals refuse to treat the indigent.

The dirty little secret about all health care is that it is rationed either by commission or omission. In those state systems with which I am familiar, like the one in UK, complex treatments are lavished on the young and denied to the old. If you are British and you want artificial knees after the age of 70, you either have to pay for them yourself or settle down to life in a wheelchair. The national health care system will put you on a very long waiting list; so long that you will not get the surgery with normal life expectancy. But a young child will get a kidney transplant as fast as a donor can be found. In the U.S., a great deal of expensive surgery is performed on elderly patients, including that paid for by the government under Medicare. Although I am now old enough to be the beneficiary of this skewed system, I find the ethics of it appalling.

Much of the health care debate now centers on extending coverage to the uninsured, but there is another problem – the quality of the coverage provided by insurance. Those who favor the current situation have sought to deny the validity of anecdotal evidence. This is nonsense. To deny anecdotal evidence is to refuse to look at the problem.

My interest in health care began seriously in 1973. That was the year I started my own publishing company and began providing health care insurance to employees. For the 33 years that I operated the company, I struggled to provide reasonable health care at a cost I could afford. Health care became my largest expense after salaries. It was also unsatisfactory. Almost every year we changed the carrier to contain the cost, putting the burden of trying to learn the new system and find new doctors on the employees. When the insurance companies refused to pay for some services, the employees tended to blame me and my managers' constant efforts to contain the costs. The experience was horrific.

Some examples: One of my press room workers wanted money in lieu of insurance. He said insurance was not necessary because he could get free health care for his family at a hospital emergency room. The worst case was a talented executive who developed a rare cancer. The insurance paid for the treatment but refused to pay for expensive pain killers. The patient protested, my insurance agent protested and I protested. The solution was to have relatives in Europe procure the pain killers and bring them to the U.S. So do not tell me that getting people insured is the only problem. Getting the insurers to live up to their part of the bargain is also part of the problem. 

The newspapers are awash with anecdotes of care denied to critically ill people. Finally, the anecdotes are being heeded.

Unfortunately, the health care debate is politicized. Democrats tend to lean toward a federal solution, and Republicans tend to defend the status quo. But in his new book titled, “Comeback: Conservatism Can Win Again,” David Frum writes: “Who agreed that conservatives should defend the dysfunctional American health care system from all criticism? Who volunteered to take the bullet for every crummy HMO and overpriced surgeon in the country? Who decided that it was OK with us that tens of millions of Americans should lack health care coverage?” Right on.

If we can disengage from the old political orthodoxies on health care, we can come up with a solution for the future. Not a Canadian solution, nor a European solution, but an American solution. Federalized education has not worked, so why should a national health care system work? Let the debaters enter the arena.

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