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THE HEALTH CARE
BY SY SCHECHTMAN
Back in 1993, as now in 2009, we began to face the growing medical health meltdown in the escalating cost of providing for health care. In the Clinton years of the mid nineties there was already much talk of a radical change in health care delivery, similar to those already in place most European countries. Back then there was already growing realization that health care costs were exceeding the general price inflation by 2.5 percent a year. That medical price inflation has continued up till now. As President Obama has currently stated: “Make no mistake about it: the cost of our health care is a threat to our economy. It’s an escalating burden on our families and businesses. It’s a ticking time bomb. And it is unsustainable for the United States of America.”
Yet as of now our current president is not committing the same blunder that assured the ultimate defeat of Hilary Rodham (!) Clinton’s first medical go round with new all inclusive medical horizons. Empowered by her husband, then fledgling President Bill Clinton at the beginning of his first term, as the new leader in the search for comprehensive health care she impaneled a large prestigious group of academic authorities, but no “hands on” physicians, scientists or well known political people. They met in camera for months and produced an almost 1500 page document which few studied in its full complexity. Coupled with a very skillful TV campaign by “Harry” and “Louise”emphasizing its negative or rather dubious implications for both their fiscal and physical health this plan was soundly thrashed in Congress and in the l994 mid term elections the Democrats lost control of both houses of Congress and Bill Clinton’s presidency seemed in dire straits.
This time President Obama is proceding much more cautiously, even though stressing the urgent need for swift action. Now all the legislative details are, ostensibly, out in the open, wending their way through both the Senate and the House of Representatives as we watch expectantly. And on the sidelines, industry, labor and the general public are involved and reacting to the evolving legislative struggle. A democratic birth process and struggle of joy and sorrow but not ,we hope, an ultimate miscarriage of economic rationality or sound medical care. We are already stirred and stressed by cost projections of a trillion dollars over the next ten years to expand health care to all the nation. And this over and above the looming current recession incurred deficits of almost a trillion dollars in stimulus money to jump start our stagnant economy. Most of us remember the time when you put together “a million dollars here and there and soon you were talking about real money”. Then we realized that with persistent if insidious inflation and so called “bracket creep” it took “at least 16 million to live like a millionaire”! So now we throw around billions instead of millions. But now trillions?! And less than a century ago, before World War One, our country was a creditor nation, and the dollar became the universal currency of the world after World War Two, after Britain lost its hegemony as the “world’s banker”. Now the United States is the largest single debtor nation in the world, seemingly dependant on the largesse of China, who now hold almost two trillion dollars of our bonds. But we still are the most the most powerful in many crucial respects---certainly in unbridled military power.
But this is not a plea for isolationism, but merely to “make haste slowly”. And harvest more of our national assets more successfully. One of which is more involvement of the our loyal citizens and health care recipients in the financing of our health care commitments. There has been a not so splendid silence on all fronts about the efficacy of the simple term and practice of “co pay”. The time honored political “third rail” of politics has been, up till now, social security. But, now, obviously, the this looming medical entitlement has to be another almost sacrosanct, untouchable concept. But it needs help from its putative recipients if the final fiscal jolt will not be too electrifying---a lethal “third rail” effect . As the several House and Senate bills to finance our glorious(?) new medical entitlement wend their way through various involved committees the air is filled with tax abatements, subsidies, exemptions, new insurance exchanges to trade differing health plans, and a competing government plan to restrain the possibly overpriced private insurance purveyors. All this must be balanced and compromised. But surely somewhere in this vast sea of monetary repayment plans a significant sum of money can be raised by gradually escalating co-- payments from many of the patients receiving the needed care. Most lower income people, of course, would be exempt. Most people in the work force would still covered by mandated employer based plans, but the concept of direct out of pocket patient involvement financially can be an inhibiting and restraining factor as the patient has to consider his share of the cost, minimal as it may be. Optional or “frivolous” procedures would thus be mitigated, and review boards could easily assess the validity of such procedures. These co-pays would only apply to higher level incomes, of course. This incentive to scrutinize the cost because of personal involvement to some extent is still a vital aspect of our hopefully still nascent free enterprise system. And it is cause for some wonderment why our loyal minority party opposition—the Republicans--- do not urge any bill that encourages individual participation even if it might require some cost. It is the complete opposite of the dreaded “socialism”--- that bugaboo of increasing government control hoisted by clueless Republicans who do not have much positive ammunition on their side. Only the accumulating massive debt!! Which unfortunately might be a sufficient overload to abort this effort, as in the Clinton era, even though we do have Obama’s splendid speechifying rhetoric to keep it alive as all the small print details now seem to be dimming the enthusiasm quite a bit.
Much has also been made of salaried and not fee for service physicians. Clinics such as the Mayo in Rochester, Minnesota and the Cleveland Clinic in Ohio have impressive quality performance at lower than average cost per patient than the national average. A group approach for each patient is deemed to be the goal; better health for the individual that is more than the sum of individual procedures, which may increase the cost and line the pocket of the physician more than wise, watchful care of the individual with the a successful outcome with the less financial outflow. However much more research into this delivery approach has to be done before its more universal feasibility can be assessed.
Not much, however, has been made of tort reform and so called defensive and excessive medicine to avoid malpractice suits. The sacred right to sue in this country seems still inviolate and an essential part of the pursuit of happiness. After all, we have the most litigious society in the world, and more lawyers in this country than in all the rest of the world combined, and a lot of Congress men and women are lawyers, and contribute heavily to the Democratic party.
Ultimately we still have the best system in the world to resolve this very vital matter, with the absolute certainty of getting the best system that we deserve. We are really trying and not just going through the motions!! And if we need more work and improvement another elected Congress will be around to improve on the good foundation being accomplished. Remember that good old maxim of Jaw! Jaw! and only verbal War! War! and we can live almost happily ever after. Also that good old Latin proverb Festina Lente applies. --- Make haste slowly!! Maybe only a sizable portion of the uninsured can now be covered, and perhaps we must wait hopefully for our seriously wounded economic system to be fully reinvigorated an be able to avoid the twin hobgoblins of inflation and deflation and thus be able to succor and sustain a resurgent healthier nation!