Making Sense of the Healthcare Debate

Thursday, August 26, 2009
Baton Rouge, Louisiana

WHAT DO WE DO IN LOUISIANA
ABOUT THE COST OF HEALTHCARE?

Riots at town hall meetings, threats for an abrupt ending to congressional careers, patrician political posturing and some of the most vitriol rhetoric in recent memory. All this and more has been churning up continuing controversy in the national healthcare debate. Each day seems to bring renewed charges of the dastardly consequences that will take place if proposed healthcare reform either passes or does not pass. So what’s the real story? What‘s the straight scoop on the present condition of the maligned patient, the American Healthcare System? And where does Louisiana fit into the mix? Are we better off or in deeper trouble than the rest of the country? Here’s the skinny.

Is there really all that big of a cost problem? Unfortunately, despite what some naysayers are bellowing, yes. Escalating costs are taking a major toll on families, particularly in Louisiana. Several recent studies found that since 2000, health care insurance premiums rose more than 83% in Louisiana with little or no gain in additional earnings for Louisiana workers. In actual dollars, premiums for both employer and employee combined went from $6,536 to $11,913. Yet in many cases, deductibles have gone up and coverage has included fewer benefits. And with employers absorbing increased costs, there is little left for employee age increases.
What kind of care are Louisianans receiving? Good, but at one heck of a price. The U.S. spends 60% more on healthcare than do most of the other industrialized countries in the world. We have more equipment, run vastly more tests, and there are less waiting times. But when you look at numerous world rankings, the U.S. comes in at number 37, behind such revered healthcare bastions as Costa Rica, Malta, Columbia, Cyprus, and all those socialistic European countries like (gasp!) France and England. Life expectancies? Japan leads the list with an average age of 82 years. The U.S. is number 27th at 78 years. Louisiana has the second lowest life expectancy in America, second only to Mississippi.

Is the healthcare system in England as bad as many pundits say it is? Well, no. I have personally had extensive care in England while in school at Cambridge in the 1960s, as well as a number of treatments while in the country on both business and pleasure for the past 50 years. The care was on par with anything I have received in the U.S. An occasional co pay, but little cost to me. Yes, one waits a little longer for doctors appointments and medical procedures, but the waits are vastly exaggerated. And by the way, I need some shots for my knees to deal with arthritis. I waited for two months to get an appointment with my orthopedic doctor (who happens to be a friend), and am now on my third week waiting for approval from the insurance company.

I happened to pick up an issue of an American financial newspaper recently, Investor’s business Daily, and read their editorial that claimed: “People such as scientist Steven Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.” Professor Hawking, who has fought Lou Gehrig’s disease for 40 years, just happened to have been treated this past April at the same NHS hospital where I was treated, in Cambridge, had this to say: “I wouldn’t be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would have not survived.”

And how about the terrible Canadian healthcare system? Well, when our government gets into a pinch, they of course call on rogue intelligence agent Jack Bauer in the hit series “24.” Bauer, played by actor Kiefer Sutherland, uses torture and all kinds of illegal methods to help the president fight the terrorists. Rush Limbaugh loves the show and has visited the “24” set. Sutherland also happens to be the grandson of the guy who founded the Canadian healthcare system. Here is what Sutherland has to say about Canada’s single payer approach: “Private health care does not work. America is trying to change their system. It’s too expensive to get comprehensive medical care in the U.S. Why on Earth would we in Canada want to follow their system here? I consider it a humanitarian issue. This is an issue about what is right and wrong, what is decent and what is not.”

Does the present Obama plan have legs? Right now, they are real shaky. And for two reasons. First, the President is offering few ideas for cost control. Most Americans feel that the cost of any expanded system will be enormous, and so says the governmental accounting office. The President’s stimulus plan has yet to see much positive light, individual savings are still way down in value, and there is too much apprehension of the part of a large segment of middle class taxpayers. Secondly, the “public option” also raises the fear level. The fear, to many, of the unknown. The President just bit off too much here and moved too quickly on what is perceived to be a radical new concept, even thought his proposal is little more than an extension of Medicare.

Are the Republicans playing politics and opposing any efforts by the President? So far, it looks that way. Here is the Republican dilemma: There are competent GOP legislators who have some good proposals to offer. But if anything substantive passes, Obama, who began the whole debate, will claim all the credit. So if a serious effort is made by Republican congressman to give better care and reduce costs, they, in effect, give the President a victory. So do you fight to win a victory for your ideas, or fight to get a victory for your party by defeating the whole effort?
Is there a State role to play in the whole debate? Definitely. Texas Governor Rick Perry has been a leading pro activist for state solutions saying this week: “It really is a state issue, and if there was ever arguments for letting states find a solution to their problems, this may be at the top of the class.” Louisiana Governor Bobby Jindal offered a package of ideas recently in a Wall Street Journal Op Ed piece that included much discussed proposals including pooling for small businesses, pay for performance and refundable tax credits. So go ahead Govs. Play this thing out on the street level and put your proposals on the table before legislators. Whatever you think of the President’s plan, at least he is doing more than just proposing. Jindal is missing the chance to gain much national traction by not calling a special session of the Louisiana legislature to implement his plan. The Republicans are offering little so far, and Jindal could make his proposals an alternative to the President’s solution. This also gets Jindal firmly back on the national stage in a more favorable light.

So in the end, what will congress do? A watered -down version of the plan presently in the Senate Finance Committee should eventually be adopted by congress in late fall. Limits will be placed on pre existing conditions and more restrictions of employer’s ending medical coverage. Look for one national mandate, eliminating the 50 individual state systems now in place. Right now, just a few companies dominate the healthcare market in each state. In some states, companies like Blue Cross control as much as 75% of the market. So look for more Wal Mart’s and fewer mom and pops. More regulation will go to the feds with a goal of more completion in each state by a larger number of national insurance companies. Medicare won’t be touched, but Medicaid for the poor will be expanded.

Remember that the health spending portion of the Gross Domestic Product is now approaching 18%. It’s just too big an undertaking to structurally change the system in a matter of a few months. This whole debate has a ways to go. The President can scale down a good bit, build a consensus with his Democratic majorities in both housed of congress, and declare victory.
But while all this posturing is going by both parties, the costs of our healthcare system, particularly in Louisiana, continue to rise at a dramatic rate. And the piper is demanding to be paid. It’s like the mechanic said in those old commercials for oil filters: “You can pay me now, or pay me much more later.”

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“My fear is that we as a nation have forgotten how to have a conversation without lying. The end game seems to be to use whatever it takes to mislead people. Whoever can yell the loudest.”
The Average Joe

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Peace and Justice

Jim Brown

Jim Brown’s syndicated column appears weekly in numerous newspapers and websites throughout the south. You can read all his back columns by going to www.jimbrownla,.com. You will also see a number of relevant videos and current updates on this website.