In the introduction to his new book,
Things That Matter, the Pulitzer Prize winning editorialist for the Washington
Post, Charles Krauthammer, discusses the elementary and fundamental importance
“You can have the most advanced and
efflorescent of cultures but get your politics wrong and everything stands to
be swept away. This is not ancient history. This is Germany 1933.”
As readers of this blog know, I totally
If the political debate surrounding
health care reform that began during the 2008 Presidential campaign had been
about health care—whether it is a right or a privilege—it is reasonable to
suppose that by 2013, the United States would have had a plan in place to
provide the majority of its citizens with some degree of health care and freedom
from staggering health care bills with the country as a whole spending less
than the 17.6% of GDP it does now on this endeavor.
That could have taken the shape of a single payer Medicare
for all model or it could have been a combined private-public system of
insurance, subsidy payments for medical education tuition to increase the pool of potential doctors, control of the number of specialists
vs. generalists to increase access to primary care, and some new program in which public service in areas of
greatest health care need would reward young physicians with loan forgiveness
if tuition to medical school remains high. There are lots of variations on the
themes. TR Reid has outlined many different successful systems in his book The
Healing of America in which he describes how all the rest of the industrialized
world provides its citizens with health care.
The rest of the world used politics to solve a problem
perceived to be in the national interest of the countries involved and did so
with a series of systems consistent with the unique national character of the
individual nations. We just haven’t. (You could argue that this hopeless
conflict is our national character, but I cannot believe that the country that
saved the world from the Nazis cannot save itself from outrageous health care
The politics got sideways.
Instead of having a discussion about health care, we had a
discussion about money and how each sector of the health care-industrial
complex could preserve its revenue stream. My suggestion now is let’s try again
and this time stay on task.
MD Anderson has had the same problem.
Our mission statement is just fine, eradicating cancer. The “Making
Cancer History” stuff is just a cute
adaptation of the basic mission statement, so nothing wrong there if you don’t
take it too seriously as in, this is going to happen tomorrow or even in the
foreseeable future. It might. We just don’t really know and we don’t even know
what we don’t know so as to choose a direction to pursue.
That brings us to Moon Shots—then and now.
President Kennedy (then) most certainly knew where the moon
was and could have cared less. He just wanted to beat the Russians as audio tapes
from his presidency revealed.
Since we don’t know where the answer to cancer lies (now), MD
Anderson’s real purpose is to provide the best care possible today for the
patients in the clinics now and pursue better solutions in the labs and
clinical research venues that have allowed MD Anderson to be a leader in cancer
research for over 75 years.
In golf, we would call what MD Anderson has to do, grinding
it out. The putts aren’t falling. You are not getting any breaks, but you have
to try to score anyway. That’s cancer research on Earth in 2013. And make no
mistake about it, cancer research and all the accompanying politics is taking
place on Earth, not in outer space.
The Moon Shot Program is, above all else, terrible politics.
It over-promises like President Obama’s claim that “if you like the health
insurance you have you can keep it”. Simply not true. Nepotism, fancy videos
starring dead Presidents (Imagine?), pronouncements of an outrageous ethical
nature on national television and recurring and continuing problems with
conflicts of interest add to the bad politics. So does not apologizing for the
above and not owning the dreadful morale that haunts the very people who make
MD Anderson run. At some point, the strong-armed politics imported from Boston
will lead to an exodus from Houston. I believe this has already started with
some truly major leadership losses in the clinical areas.
The most potent political statement people can make is to
vote with their feet. I don’t think Anderson has the politics right, thus the
glut at the podiatric polling place.
No matter how good the science is, the Moon Shot Program
evokes an historical image that simply is not paralleled by the reality of the
cancer problem in 2013. The Moon Shot of the 60’s WAS a political problem. The
cancer challenge is still a scientific one requiring the minimum of hype and
politics possible, and maximum of thinking Jim Watson style not IBM Watson
Likewise, President Obama’s political mess of a bill called
the ACA and the even greater political mess of its rollout undermines any good
that might come of health care reform.
Krauthammer is absolutely right. If you get the politics
wrong, even the best of intentions will lead to hell. Germany 1933, he says. I
think things are nowhere near that bad here, but the political dynamic is
paralleled. It’s time to clean up the mess in DC and the one on Holcombe.
Personally, I think, as do many Americans, that in DC it’s time to start over
with some new players.
This is probably also the case on Holcombe.