Now that the Obama administration has worked down the laundry list and arrived at health care reform, I suppose I need to start writing about it obsessively again. Sort of a civic duty. I really don't know what more I can say about it, but I suppose not every post here has to be completely innovative and new.
As I noted yesterday, the key battles now seem not to be over whether something will happen, but whether that something will include:
- A public insurance option open to all;
- Some variation on a National Institute for Clinical Excellence that promulgates guidelines for effective and cost effective clinical practice. As of now, opponents have drawn their line in the sand well in front of the real target, by opposing even trying to learn what treatments work best. Contrary to the imperishable values of Faber College, Republicans once again proclaim that "Knowledge is Bad.";
- Top-down reallocation of resources away from specialty care and heroic interventions to primary care and preventive services.
What all of these elements have in common is that they are about stopping somebody's gravy train. The medical-industrial complex is more than willing to go along with covering everybody, if that just means 45 million more "covered lives," as they say in the insurance biz, from which to render more gravy. But what we have to understand is that covering everybody is insupportable and unsustainable if we don't put the fat cats on a low-cal diet. (Sorry about that -- you try being clever every morning at 9:30.)
I am truly afraid that we will squander this historic opportunity by settling for a Massachusetts-style reform -- which is already failing in Massachusetts -- that just puts more money into the system; forces people who happen to have just the wrong combination of age and income to buy crappy insurance that just vacuums money out of their pockets and then doesn't pay for their health care; continues squandering a quarter of the whole pile on insurance company profits and boondoggles and half of the rest on ineffective, overpriced, and or futile services; and fails to keep people healthy, is not equitable or consistently humane, and is not affordable. The bastards are just going to rip us off once again, with a good segment of the left cheering them on in the name of compromise and bipartisanship.
I will address each of these elements in turn in coming days, I'm not sure yet in what order. Meanwhile I still have the backlog of Housing First, dog bites, and the length of primary care visits to deal with. Should be busy.