Monday, August 24, 2009

An Honest Debate?

In his 22 August 2009 Internet and radio address, the President called for "an honest debate" on health care in this country.  Specifically, he called for one not "dominated by willful misrepresentations and outright distortions, spread by the very folks who would benefit the most by keeping things exactly as they are."  At the same time, he rather facetiously claims that "we've had a vigorous debate about health insurance reform, and rightly so."

To quote one of his erstwhile allies in the Congress, Barney Frank, that last statement invites the question of the President: "On what planet do you spend most of your time?"

What "vigorous debate about health insurance reform" is he talking about?  Is he referring to the reform (the meaning of which is, after all, "to change things") which pledges to allow the 84% of Americans with insurance who actually like what they have to keep things exactly as they are?  Is he referring to the reforming of health care costs, with the goal of "bending the curve down" towards lower costs overall, which commits the federal government to spend an additional $1 Trillion over the next 10 years?  Is he referring to the reform of extending insurance to the much ballyhooed 47 million in this country who do not have insurance--which includes some 10 million illegal immigrants and about double that number of people with incomes well above the poverty line who, for whatever reason, simply choose not to purchase health insurance?  Is he referring to the reform of expanding the use of diagnostic procedures and tests to catch disease early in hopes of reducing costs of care--the cost of which increase overall health care spending?

Of all the "outrageous myths" being spread about health care reform, the most outrageous is that there has been any debate at all on the topic.  Insurance reform that begins with promising 84% of Americans that nothing will change cannot be reform by definition--if nothing is changing, nothing is being reformed.  Cost reform that does not seek to alter the dynamics of health care economics cannot be reform by definition--if nothing is changing, nothing is being reformed.  Reforming treatment protocols by using more tests to identity more sick people to apply existing treatment regimens cannot be reform by definition--if nothing is changing, nothing is being reformed.

A true debate on health care reform would openly question the status quo in American health care.  One such question, which gets only scant attention, either from the Congress or the media, is "why must health insurance be an employment benefit (and thus employer-subsidized)?"  Another such question, which has received equally scant attention from the Congress and the media, is "why are health care providers paid for each test and procedure, regardless of its ultimate utility in treating the patient (the reimbursement scheme generally summarized as "fee for service")?"  A question that is not being asked at all is "how well have existing regulations served in facilitating quality health care delivery?"

I am no doctor, I am no politician, I am no lobbyist.  My interest in health care reform is my own health, and how I will care for my own health.  My interest is in health care that is affordable, that treats illness and promotes my good health without draining my bank accounts in the process.

I want the President and the Congress to return to Earth and address these real questions about health care.  I want health care reform.  I want a debate on health care reform.  I have yet to see one.