Wednesday, October 28, 2009

Health Care Talking Points

By Mark Ross, Contributing Writer

Sixteen years ago I was asked what I thought of Mrs. Clinton’s machinations on the health care front. I told the questioner that every member of Congress who backed the reinvention of American health care, as Mrs. Clinton was proposing, was booking a stateroom on the Titanic. What Americans want, I added, was for the price to go down and for there to be fewer other patients in the waiting room. Including the heretofore uninsured into the system and reducing the career appeal of the practice of medicine does exactly the opposite on both fronts.

In spite of sixteen years of further study and technologic advancement, nothing has changed. The American political establishment is proving once again that it is profoundly ill equipped to deal directly with such a complex and important subject. It is not just a lack of expertise on the technicalities of medical practice… but a disconcerting tendency to completely misrepresent the current situation. I just recently visited an old, old friend who is now the medical director of a regional HMO. I had some limited success in picking his brain on this matter. The following thumbnail statements may be useful in undoing some of the erroneous notions that pollute the debate:

1) The ranks of the “uninsured” do not represent anything like a crisis… and especially do not justify screwing around with the existing system. The Right has appropriately debunked the inflated numbers used by the Left. The burdens placed on hospital emergency rooms by uninsured drop-ins could be easily managed except for bureaucratic inertia and unrealistic state and local statutes. (More later)

2) The most profound problem facing American health care is completely ignored in the political arena today. Many doctors, nurses, pharmacists and other technicians… just like the rest of the population… are baby boomers who are approaching retirement. They are poised to go from being providers of health care to being consumers of such. To suppress price inflation and maintain a semblance of quality of care it is necessary to allow the supply of health care professionals to keep up with increasing demand. Fostering turmoil scares away the needed recruits. A simple improvement would be to make it easier to pay for medical school, etc. Grants, cheap loans and such are the normal fare of rational political involvement.

3) The Right errs in sounding the alarm on rationing and pulling the plug on grandma… but politics ain’t beanbag. Rationing is a fact of life in health care… as is the quandary of end of life decision making. The Left wants to make things worse in this regard… by creating a national monolith that would replace various medical ethics committees, hospital and HMO corporate policies and state laws. It’s a human dilemma… we have developed capabilities such as organ transplanting without also developing the concomitant wisdom to consistently make flawless decisions about how to best use these capabilities.

4) The several states have heretofore been the sole authority over medical practice. The inventors of America included a marvelous political safety valve called the federalist system in their grand design. Not only is it technically illegal for Congress and the Administration to essentially take over health care… it’s also not a good idea on practical grounds. Diversity of approach allows for beneficial innovation and limits the damage from well intentioned mistakes. Doctors, nurses, pharmacists, etc. can only practice with state licenses. Let the states remain in control, I say.

5) Health care can be broken down into three competing aspects: Financial… how to pay for everything. Technologic… the continually evolving influence of science on the capabilities of the system. And, ethical… the decision-making process by which finite resources are juggled. Within the medical community the financial aspect is considered to be the most problematic. Our ability to treat sick people is outstripping our willingness to relinquish ever more of our individual fortunes for that purpose.

6) In acknowledgment of political reality I suggest the establishment of a minimum standard of care. To divert uninsured drop-ins away from hospitals, portable triage clinics can be set up in parking lots. No doctors… except on line. Staffing by trainees (paramedic, nurse, med student, etc.) and a few nurse practitioners. Palliate the non critical. Isolate the infectious. Stabilize the critical. This does allow the camel’s nose of the Left into the tent. But it also dampens the zeal for which this agenda continues to be foist upon us.

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