President Obama is sick and tired of the way his health care initiative has been twisted and misrepresented. He is especially annoyed that anyone...anyone... would suggest that he wants to euthanize poor old Granny. The problem is there are a lot of people, including some of his supporters, who want to do just that. Consider this line from a recent op-ed in the New York Times: "shouldn't we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers?"
Talk about a slippery slope! Richard Dooling, author of the above comment, points out that we spend a huge amount on "yet another trip to the surgical suite on the slim-to-none chance that by-pass surgery, a thoracotomy, an endoscopy or kidney dialysis might get her off the ventilator and out of the hospital in time for her 88th birthday." I wonder how old Mr. Dooling is. I also wonder how his granny might feel about not getting end-of-life care.
President Obama has made a complete hash of explaining the need for health care reform. He argues that we need legislation to control the growing cost of medical outlays, and also to provide insurance and care for another 40 million Americans. This is his problem -- those two goals do not mesh. Americans are not stupid -- they get this.
Obama needs to focus on the inefficient way in which our country provides care to the uninsured, and solve that problem. The whole dialog about how much medical expense this country can afford overall sets off alarm bells and is, in any case, irrelevant. It has become an article of faith for reformers that we spend too much. Some 17% of GDP is said to flow into health care, though interestingly there is but one source for that figure, and few details attached to it. It is, actually, a projection made by the National Health Statistics Group; the last firm number showed that 16.2% of GDP in 2007 went into medical products and services. Few realize that this all-important data point includes the cost of teenage boob jobs, of Viagra prescriptions, prescription sunglasses, Botox and extremely costly dental veneers. In other words, this 16% figure encompasses a whole lot of discretionary spending that is only remotely connected to our health.
Though ignorant of the underlying data, what everyone in this debate is absolutely sure of is that we spend too large a slice of our American pie on health care. We know this because the president and a million other folks have told us so, and because other countries spend less.
All this figure really tells us is that Americans are spoiled, and up until now we could afford to be. We want it all, we want slim bodies that can hold up to rigorous exercise and satisfying sex for at least 80 years, while we continue to look 50 years old. If your knee hurts -- get it replaced! If you don't like the jowls that showed up at your last birthday -- get them removed! If your sex life isn't all it should be -- take a pill! Teeth out of line? Get braces!
Just as some of these "fixes" may seem self-indulgent (or ridiculous) to those fighting tooth and nail to get a life-saving mastectomy, giving Granny every last shot at prolonging life may seem unnecessary -- but it may be simply how we Americans want to spend our money. Up until now, we have had the luxury of providing the best of care to those we love. The argument that most medical outlays are expended in the last year of life -- pointlessly -- is spurious; all that says is that the monies we have paid into medical insurance over our lifetimes earn a return which is paid out at the end. That's how it is supposed to work.
There is no doubt that medical outlays can be reduced through the introduction of new technologies and through better management. The same is true of all huge sectors of the economy, and especially those where the government plays a significant role. I don't know why the town hall protesters don't ask why government-sponsored programs like Medicare and Medicaid cost more than equivalent care from the private sector. A study by Jeffrey Anderson of the Pacific Research Institute notes that "since 1970, Medicare and Medicaid's costs have risen one-third more, per patient, than the combined costs of all other health care in America -- the vast majority of which is purchased privately." That alone seems to undermine the notion that more government oversight is the way to go.
I also don't know why Republicans have not bargained for some restraint on medical malpractice awards. Personal experience, and much data, confirms that doctors over-prescribe tests and procedures from fear of being sued. Why isn't Congress discussing this reality? Are Republicans as squarely in the pocket of the trial lawyers as Democrats are?
There are many roads to reducing our outlays on health care, but the surest dead end is to attempt to limit what we do for Granny. After all, people are living longer and longer, so that many folks in their 90s are active and productive. What might have seemed reasonable twenty years ago -- limiting joint replacements for octogenarians for example -- makes no sense today. Bottom line? Go fix health care, but hands off my Granny!