Map of life expectancy at birth from Global Education Project.

Wednesday, November 13, 2013

Hey Indeedy . . .

Donald Berwick was Obama's nominee to be head of the Center for Medicare and Medicaid Services but served only during a recess appointment because the Republicans in the Senate called him a socialist. (He had praised the British National Health Service, among other evidences of Commie sympathies.) He has an essay in today's JAMA, which I think you probably can't read because you don't have the magic cookie. He says stuff I've said here before, but better, beginning with:

It could be exciting. The ambitious nation that rallied to create the Marshall Plan, get to the moon first, and birth Medicare and Medicaid decides to move toward the health care it needs: universal, responsive, and affordable. But that task does not unite the nation; it rends it into political tatters.

But why? What's his diagnosis? As he points out, we're spending twice what other affluent countries are spending, and getting less. They give quality care to everybody, with better patient safety, better outcomes and more investment in prevention. Here are his explanations:

Vested interests: We pay more than any other country, which means that people and institutions are on the receiving end of all that money. They happily invest some of it in lobbying and political contributions to keep the gravy train flowing.

Diffuse interests: The majority of ordinary people who would benefit from sensible reforms aren't organized or powerful. I will add that they are also misled.

Abdication of professional responsibility: The American Medical Association opposed Medicare and every other proposal to provide government-sponsored insurance throughout most of its history. The AMA has changed on that point but doctors still don't advocate for universal, comprehensive health care, single payer or otherwise. They're more interested in keeping their incomes high.

Public distrust of science: Don't get me started. It's easy to convince people that evidence-based guidelines discouraging overtreatment and overdiagnosis are a conspiracy to "ration" health care and murder grandma, because they think science is an elitist conspiracy against the people. Thank the Koch brothers.

Contempt for the poor: If people can't afford health care, it's obviously their own fault.

There's a bit more but those are the high points. Look, the Affordable Care Act isn't the greatest policymaking ever, by a lot. It was cobbled together so as to keep the insurance companies and hospitals and AMA from torpedoing it. But it will make things a bit better, and creates a base for substantial progress in the long term.

Bill Clinton needs to shut up and butt out. The Democratic panic and instinct to retreat in this situation is just pathetic. Stand up, stand your ground, wait out the tempest. In six months, it will be a fait acompli, and there will be no going back. 

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