Archive for November, 2009

Disinformation, Division, and Delaying the Inevitable

Wednesday, November 11th, 2009

Oh, boy did Obama get an earful this summer!  Whipped up by Sarah Palin, Glen Beck and Rush Limbaugh, gun-toting seniors turned out in droves to protest Obama Death Panels.  “Get the government out of my Medicare” became the clarion cry (say what?).

It reminded me of my old one liner:  “I grew up in Glasgow, Scotland.  In Glasgow, healthcare is a right, carrying a machine gun is a privilege.  Maybe America got it the wrong way round.”  Weirdly prophetic.

The age of disinformation is upon us.  Walter Cronkite is dead.  Mainstream news anchors are competent, Teflon vessels for synthesizing press releases.  Newspapers and investigative journalists are a dying breed.  Everybody with a computer or a cell-phone has become a blogging, tweet freak.  It is as if everyone in America has become a New York Times columnist, only without the brains or training.

And then came health reform.  Against the backdrop of mainstream media in disarray, we are supposed to be having a civilized debate about healthcare reform, that has turned into a national shouting match without any referees.  An old mentor of mine used to say “there’s no penalty for lying in the US.”  Loony positions persist, ideas long discredited are given new life.  Disinformation and lies are rampant.  Despite valiant attempts by the New York Times and other credible news and public policy organizations to do fact checking and “keeping them honest” comparisons, nobody believes the fact checking stuff unless it confirms your biases.

Making national policy in an ideologically divided country is tricky enough, but as media fragment and as we retreat into our Rush or Rachel corners, it is hard to see how the national shouting match becomes a national dialogue.

The Loony Right believes:

  • All the uninsured are illegal aliens or extra-terrestrials
  • Paying doctors to discuss End of Life Care options with their patients is a death panel
  • Government can’t run healthcare except for Medicare, Medicaid, the Veterans Administration, Tri-Care, the National Institutes of Health, the CDC and so on
  • Incremental expansion of coverage on the existing employer-based health system is socialized medicine
  • Obamacare is evil
  • The French are even more evil
  • The British are evil and godless

The Loony Left believes:

  • If we can’t have a single payer we need a public plan, and that
  • Public plans will automatically reduce costs without changing coverage or payment methods
  • Profits of insurance companies and drug companies account for all of healthcare costs
  • The Congressional Budget Office is a front for United Healthcare’s Ingenix division
  • Health industry lobbyists are running the government
  • Some people from Alaska are evil
  • The French are OK, but are turning evil because they are raising co-payments and deductibles to try and balance their budget
  • The British have free care paid by someone else (possibly the French).

As temperatures cool in the fall and deliberative bodies like the Senate Finance Committee finish their work, we may still have meaningful health reform that includes expansion of coverage and promising pilots on payment reform, and relief in the form of subsidies for many that have had no access to insurance coverage.  But it is but a small start on the path to transformation of healthcare delivery and payment.

The basic problem, as I try to emphasize over and over, is that the average American family cannot afford the average costs of healthcare.  Affordable insurance can only exist if we have an affordable delivery system.  There are not enough rich people to subsidize poor and middle-income people.  We are living beyond our medical means, and it will sink our collective ship.

Health insurance is viewed as a magic source of money that can pay for all the care that anyone could possibly receive to prolong life or ameliorate disability, disease, discomfort or disfigurement.  But, that endless source of money comes from all of us who pay premiums and taxes.  And we cannot afford it.

If we cannot have a rational dialogue about a 3% increase in annual healthcare expenditure to cover the uninsured, how do we imagine we are going to deal with the more difficult questions of making healthcare cheaper than it is today, or how we collectively consume less of it given an aging society and relentless scientific progress.

It is not going to be easy.

We are inevitably going to have to deal with the simple arithmetic of healthcare, namely:  healthcare costs equals the sum of healthcare incomes, which in turn equals the number of services we receive times the price of those services.

This means that we will have to have a long run change in the delivery system that:

  • Emphasizes primary care and prevention over procedural interventions
  • Expands the supply of primary care resources while restricting the supply and utilization of expensive and marginally effective high-technology interventions
  • Emphasizes palliative care solutions instead of expensive futile care at the end of life
  • Creates environments that encourage healthier behaviors and greater personal responsibility for managing personal health
  • Simplifies the administrative mess by standardizing payment, measurement, and review systems
  • Encourages medical technology innovators to produce new technology that is better, faster, and cheaper not more expensive and worse
  • Encourages competition based on the creation of risk-adjusted outcomes for whole populations and individual patients rather than paying for procedures based on provider preference.

I would call it the Bring Back Managed Care and Regional Health Planning in a Competitive Consumer Directed Framework that Pays for Outcomes not Procedures so We Can Ration Care Effectively and Fairly For All Americans Plan.

Catchy eh?  Do you think I should run for office? Or become French?

Ian Morrison is an author, consultant and futurist based in Menlo Park, Calif. He is also a regular contributor to H&HN OnLine.