Kimberly Krautter: Part 2: Un-Spinning Healthcare Reform

The need for healthcare reform has been a brewing storm for decades. It became an emergency in December, 2007 when the U.S. economy entered into the worst recession in seventy years because of the disastrous economic policies of the George W. Bush administration. Their policies not only inflicted a class warfare, several unfunded deficit-bloating mandates and a war of choice on taxpayers, but their penchant for de-regulation institutionalized greed to Biblical proportions. Add to that a stubborn refusal to recognize signs of impending disaster, and you had an economic firestorm that doubled unemployment and caused millions of Americans to lose their healthcare.

I daresay that 80% of Americans would appreciate it if President Obama would ask Congress to reduce their 5 week vacation by one week so that — as a team — they could focus on nothing but healthcare reform. Order pizza or Thai takeout. Roll up their sleeves and bang this bill out.

That said, let’s give credit where credit is due. In the last 36 hours — even since I posted Part 1 of this blog — the House Democratic Leadership and the Blue Dog Coalition have made an earnest effort to really move this ball forward. It proves the point that deadlines do make a difference. Perhaps if they all agreed to just keep this positive momentum going for another week, we might actually a worthy bill in the House and a worthy bill in the Senate so that all they have to do is reconcile the two when they return in September.

Yesterday, in this blog we began to un-spin the healthcare reform debate, examining some of the hyperbole and wild claims that are being circulated in the press and through advertising. We continue that dialogue today. (Again, the last names of some sources are withheld as a courtesy.)

The Best System In the World: Can we risk reducing our quality of care?
The Claim: People all over the world flock to the U.S. for healthcare because it’s the best in the world. Sure it has problems, but the government is not the answer.
The Truth: Technologically, the U.S. has the best care, but only for those who can afford it.

You’ve heard the numbers: “46 million people are uninsured.” Do you realize that is 15% of the U.S. population or roughly 1 in every 7 people you know? As we discussed yesterday, millions more are inadequately covered, and they subsist only one serious illness away from bankruptcy. Match these facts with some more: The United States ranks 30th in the world in life expectancy, behind Jordan, South Korea, Bosnia and nearly every European country. We rank 33rd in the world in infant mortality rate.

By every measure, our current system clearly is not the best in the world.

Conversely, it is definitely the best system for physician specialists who can command extremely large fees for their services and high tech diagnostic and surgical technologies. Of course only the very wealthy or those with “Cadillac” insurance plans can afford to consult with such specialists.

On the one hand, considering the stratospheric costs of medical training and the continuing education that is required to maintain proficiency, why shouldn’t these doctors charge high fees? The problem is not these few highly specialized physicians as much as it is the gaping maw between the few zip codes where they practice and the rest of the country. This is the real class warfare.

Meanwhile family physicians and OB/GYN’s — the primary care providers — cannot afford to operate practices in rural areas where lower population densities and lower household incomes make it economically unfeasible to run their business. And yes, although a benevolent one, medical care in this country is a business. It is a cultural distinction that significantly keeps our chronic diseases high and our life expectancy low. Couple this with the exorbitant debt from medical school with the cost of malpractice insurance, and you cripple the doctor while sending the cost of healthcare out of the stratosphere into orbit somewhere around Mars. No wonder healthcare costs $6500 more per capita in the U.S. than in Europe. The burden of malpractice insurance is even more onerous when you consider that only 0.4% of all cases result in a malpractice claim.

In both the U.K. and in France, malpractice insurance is taken out of the equation. One of the major benefits of a single payer system is that the government, as the care provider, is the party at fault, for lack of a better term, when medical malpractice is alleged. A lawsuit is brought before the government appointed review board which determines if compensation is warranted. If the judgment is awarded to the plaintiff, the award is drawn from a national compensation fund. Of course the gonzo multi-hundred million dollar awards are not given, but the patient is well remedied, and the doctor in question loses his license. By taking that burden off the doctor, it frees her up to invest in advanced personal or staff training and to deliver ever higher quality of care (or just leverage the malpractice insurance savings as revenue).

Rationed Care: Is it less costly just to let some people die?
The claim: Government bean counters will limit the kind of care you can receive based on your age and prior health. Old people are allowed to die rather than getting the care they need.
The truth: That suggests government ordered euthanasia. It is ridiculous.

Here’s a tale of two English octogenarians and an American colon. John Winchurch of Cornwall, England shared these stories with me. He lives in a rural village, and one of his neighbors is an 87 year old man with a long history of heart problems. Each time he experiences arrhythmia, the first responders arrive right away, and when needed, an air ambulance is sent to immediately dispatch him to the nearest cardiac care center. Every life saving and sustaining effort that we would expect in the U.S. is provided to this man. And, as it was pointed out yesterday, because he is covered under the National Healthcare System, he suffers no charge for any procedure or prescription. His limited income is not threatened, and he is able to return to the pleasantries of his life. He never has to choose between food and medicine.

John also shared the story of his 83-year old cousin who recently collapsed at the beach. The life guard and other first responders immediately resuscitated him (a process that was required three times), and they kept him alive until the air ambulance arrived. At the hospital, a battery of tests was run by the neurological and cardiac M.D.s (as opposed to non-physician staff as some would have us believe). A nutritionist even consulted on the case to determine if an adjustment could be made in his diet to help him improve his health.

Sadly, unlike John’s neighbor, his cousin died. But he died of natural causes and not because he was allowed to die as some of the most egregious anti-healthcare reform rhetoric would have us believe.

By contrast, in the U.S. rationed healthcare happens every day. My friend Claudia lives in Manhattan. Her father is dying of colon cancer, thus a regular colonoscopy exam is critical to her health. When she had her exam this year, the technician was unable to get the scope through her colon, and the doctor recommended she that receive a virtual colonoscopy. Her insurance company has refused to approve or pay for the virtual colonoscopy even though it is a medically necessary procedure in her case. Thus, her healthcare has been rationed by insurance company bureaucrats.

Tomorrow I’ll share insights on Healthcare Reform from a doctor who operates a family practice in Colorado and who teaches medical health economics at a university there. We had some good movement from the Blue Dog Dems since yesterday. Perhaps another bran muffin to their brains, and we’ll have even more progress on this issue by tomorrow. One can only hope.


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