Wednesday, January 18, 2006

Health Care: The Agenda and the Alternative

As promised yesterday, Terry McKenna is back to continue his expose on the Bush administration's attempt to make our citizenry a little sicker than it already is, through an act of blunt robbery that they call "tax reform". Today, he reveals the agenda behind this half-decayed skeleton in the Bushies' closet, and offers a truly progressive alternative.

By the way, stay with us for the rest of the week on this topic—there will be more. And if you've missed the earlier posts on this subject, look here, here, and here.

Mr. McKenna, take it away:

Yesterday, we asked: "Why would you change the deductibility of employer paid benefits unless you had an agenda?"

And what would the agenda be?

Well, here it is. “They” believe that only if we each pay directly for our own health care will we make more responsible choices and thus begin to reduce the costs. The vehicle of choice is individually owned, high deductible health insurance, coupled with tax advantaged health care savings accounts.

It may be an earnest notion, but that is all that it is, an unproven notion. Behind it further is the idea — central to conservatism — that, no matter how grave the matter, the government should not undertake to provide the solution (except via tax savings). They believe that we are all better off when we rely on ourselves (our families — and “faith based” groups).

Self-reliance was the grand notion behind welfare reform. It has helped motivate some of the poor – disabusing a few of the notion that they could manage their lives around government benefits. But this works only for the most capable and healthy among them. For the rest, especially for the hard-core poor — those who have never held a regular job, or for the chronically ill (including substance abusers) — they have not done so well. Yet the news media have forgotten about welfare reform as the national debate moved elsewhere. Welfare reform is old news now, and its initial success is now part of the national memory. But the failure to impact deep poverty has been unreported until Hurricane Katrina exposed the sad truth – that there is a desperately poor underbelly to our society – no matter how prosperous some of us may be. And neither welfare reform, nor the trickle down theory have made a difference. It may be true that we cannot afford to do more, but there is no reason to lie to ourselves about the consequences.

So… tax reform will not reduce health care costs – except gradually as the system becomes impoverished (as it collapses) and it won’t deliver health care to more of us (as I’ve already said in one of my previous missives). Nor will it help individuals to make more informed health care choices.

Here is what will work to reduce health care costs:

1. Stop the advertising of prescription drugs to consumers;
2. Put a stop to the drug patent shell game: keep pharmaceutical companies from extending patents by a simple reformulation of an already patented drug. (See Malcolm Gladwell in the New Yorker on how Prilosec morphed into Nexium);
3. Use non-doctors (statisticians and economists) to review data on the effectiveness of new treatments and drugs. We must prevent the scandalous waste of money for limited gain (thus we spend many thousands on implanted defibrillators that save little more than a regimen of diet of diet and exercise);
4. Test new drugs against existing drugs, not just against a placebo;
5. Mandate that ALL drug study data must be presented to the FDA for review and approval (create accounting controls for ALL raw data);
6. Mandate that all health care must follow NIH guidelines if it is to be covered by insurance;
7. Study how we use hospitals. Most are now part of profit-making corporations, but the free market has not made hospital use cheaper. Implement the recommendations;
8. We spend significant dollars on the last 2 months of life. This makes no sense. Study the problem and implement the recommendations.

The cost of health care behaves very differently from how every other good or service behaves. Whereas for a typical product, innovation leads to lower costs, for health care, innovation drives up costs.

Then, take the money that is currently spent on health care (including all group insurance premiums) and find a way to channel it toward a new single payor system.

—T. McKenna

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