Robert Stein 1924-2014

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Thursday, January 21, 2010

Radical Surgery for Health Care

Once, under local anesthesia on an operating table, I overheard doctors in heated disagreement on what to do next. It was not reassuring, but compared to Washington squabbling over health care reform after the Massachusetts debacle, restful.

The Surgeon-in-Chief wants to "move quickly to coalesce around those elements of the package that people agree on. We know that...health insurance companies are taking advantage." He cites the need for "essentially a patient's bill of rights on steroids."

As he complains about "a fixation, an obsession in terms of the focus on the health care process in Congress," the President still insists "I'm not going to get into the legislative strategy...my job is to as president, is to send a message in terms of where we need to go...to set direction."

But how do you set direction for an unharnessed team of horses going every which way while tethered to another that is dug in not to move at all?

Paul Krugman translates Obama's prescription as “Run away, run away!" but when the finger-pointing is over, there will have to be a fallback consensus. In the Washington Post, Ezra Klein proposes something "real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy."

But it's unlikely that anything "real simple" will pass in today's climate. If Congress wants to get back to basics, there are elements of reform that would have widespread public approval--among them, the requirement that insurance companies spend at least a fixed percentage of premiums on patient care rather than maximize profit; that they stop cancelling people out for pre-existing conditions; and, perhaps, most crucial of all, that everyone have access to some form of affordable catastrophic insurance to keep families from going bankrupt when serious illness strikes.

That doesn't seem like too much to ask but, as Washington quacks keep gabbling to make political points rather than heal the health care system, who will get them to focus on the operating table?

1 comment:

Fuzzy Slippers said...

Funny how republicans suddenly seem willing to talk to dems about healthcare reform, isn't it? Gee, couldn't possibly be that they've always wanted in on the discussion? Naw, that's not it. The Brown win in Mass didn't change the dems' approach at all; naw, the loss of their supermajority didn't change their arrogant refusal to consider discussion with republicans. Must be some other explanation for why they're open to listening now . . .