The Health Care Debate

I’m getting so tired of being yelled at on cable TV and talk radio and blogs by yahoos who are upset about everything and taking it out on health care. They don’t have jobs anymore or their homes have been foreclosed or they can’t use their McMansion as a piggy bank anymore because it’s worth less than they paid for it. Or they’re old and afraid of change – especially if it comes with an Obama label.

Almost no one is talking about what we as Americans should be talking about. Things like how to cut costs in a way which won’t really harm people and which might actually help them. Things like what DO we do with the 46 million uninsured Americans if we don’t have a government plan for them. Things like whether everyone has a right to the most expensive medical care and if so who should pay for it. The debate has become one about health insurance reform – not health care reform.

First off – anyone with a 3rd grade education must know that in an aging society, any program which now absorbs 16 percent http://www.forbes.com/2009/07/02/health-care-costs-opinions-columnists-reform.html of the GDP and is projected by the Congressional Budget Office to double in the next 25 years isn’t possible to sustain. Most of our health care dollars are spent in the last years of life as diseases which might have been prevented must instead be managed. We also have a growing younger population, thanks to immigration and religious groups which still encourage oversized families. Those two extremes of the age scale are real; we can’t stick our heads in the sand and pretend they’re not.

So what do we do about these escalating costs? Yes – we do need mandatory electronic medical record-keeping. And some legal restraints on insurance companies. The phrase “pre-existing conditions” should be outlawed. Profits should be capped along with top managers’ salary packages. Insurers can’t be allowed to deny payments for medically necessary treatments, procedures and drugs. A good model might exist in the Czech Republic. Although Czechs still have a form of government-run health care, they pay premiums to one of several private insurance companies. Private companies which aren’t allowed to make a profit. They also have a small co-pay for each doctor visit, day in the hospital and prescription drug. No one is denied care and Czechs can choose their doctors and hospitals. But there are no unnecessary tests or procedures. And doctors are salaried. As they are at some exemplary US medical facilities like the Cleveland Clinic.

I’m not totally convinced another Medicare-like government-run health insurance plan –at least as the Obama administration has explained it – is the right move. But if we don’t have a government plan, we need to make all health care plans portable. So you don’t have to change doctors when you change jobs or when your company decides it can get a cheaper plan from another insurer. And if you lose your job – as hundreds of thousands of Americans have in this recession – there should be some kind of government subsidy that kicks in along with your unemployment insurance. Perhaps you would have to pay back some of that subsidy through a small payroll deduction when you’re employed again. Or pay such a small deduction while you are employed to build up a subsidy fund. Something along the lines of New Jersey’s tiny but required payroll deduction for a fund which now provides a short but paid work leave when a baby is born or a parent needs care.

And now here comes the biggie. The one the very powerful drug lobbies will fight tooth and nail. And it isn’t what every other country does – negotiate drug prices down. We need that too – but it would become a lot less important if we simply didn’t need so many expensive drugs.

Right now the medical system is geared toward fixing what’s wrong with you. Instead of preventing the illness in the first place. Yes – we need to pay for preventive care. Lots of it. And it doesn’t have to be expensive. Think about something like obesity. More than two thirds
of Americans are now overweight or actually obese. http://www.nytimes.com/2009/08/11/health/11stat.html?_r=1
The Centers for Disease Control say one third of children fall into these categories. Drug companies make zillions on insulin and related drugs as fat people develop diabetes. A disease which is totally preventable in this population. Add in the anti-cholesterol drugs, the heart procedures and drugs, the high blood pressure drugs – all stemming from too much food and too little exercise.

If we spent just a little money on health education –starting in nursery school – it would pay off big time. Instead of the current emphasis on expensive team sports – which benefit only a few well-coordinated athletes, let’s teach every kid lifetime personal nutrition and exercise habits. Instead of letting school districts slash physical education classes when budgets get tight -- make them mandatory. As sacrosanct as basic English grammar. The proposed tax on sugary soft drinks and fruit drinks would be a good start toward paying for that. A similar “sin” tax has certainly helped reduce cigarette smoking even as it helps pay for smoking-cessation programs and the health ravages smoking causes.

Let’s give doctors financial incentives to push their patients into healthier lifestyles instead of simply handing out prescriptions. And if all doctors had the same incentives, they couldn’t complain that their patients will simply find another doctor who’ll let them take the easy way out with a pill for high cholesterol instead of a prescription for fewer burgers and fries.

If we simply make good health a national passion, instead of an afterthought, medical costs will stop rising. And eventually, as new, healthier generations come along, costs will fall. Fixing the broken health care system doesn’t require brain surgery. Just a little brain power. And some heavy lifting.

Czech Politics Unczeched

Sitting here in New Jersey -- wrestling with our own US train wreck - health care reform - it's hard for me to criticize the politics of another country. Or the voters here or in the Czech Republic who, it seems, are too easily led or too apathetic or too uninformed -- or all three.

But truthfully -- if someone were trying to write a political whodunit novel--- he or she couldn't possibly imagine the current Czech political disaster. For those who haven't been following the debacle --it started last spring in the middle of the Czech Republic's 6 month rotating Presidency of the European Union. CSSD (center left Social Democrats) called a vote of confidence in the lower house of Parliament which failed and brought down the center right government led by ODS (Civic Democrats). A caretaker government of supposedly apolitical technocrats was appointed to serve until early elections set for October. About a month ago the election campaign began. Then a deputy challenged the early elections in the Czech Constitutional Court, claiming he had the constitutional right to serve a full term. The Court ruled in the deputy's favor. Chaos ensued. Politicians hatched another plan for elections in November but then that was torpedoed when CSSD withdrew its initial support. Are you dizzy yet? Now no one knows what to expect.

I've seen all kinds of unsourced editorials and columns from Prague about which party or corporation or lobby influenced the other and why CSSD (The Social Democrats) changed its stance on early elections and what the true motive of the Czech Constitutional Court might be etc. etc. I hope one of the more journalistically inclined newspapers or magazines or even TV operations has a crack team of investigative reporters hard at work to peel back the opaque political layers and get at the truth of what happened and why. Most importantly why!!! I'm returning to Prague in November to watch what I hope will be a big celebration for the 20th anniversary of the Velvet Revolution which ended Communism in then Czechoslovakia. But if this political circus is all 20 years of "democracy" has wrought --- Czechs themselves may well ask -- "why bother?"