Two Stories
By
Leonard Zwelling
I love when the NY Times editorializes on the front page as
it did on December 3. In two above the fold articles about health care, the
paper first described in detail the outrageous system of hospital pricing. Right next
to this story is a piece about the continuing legal challenges to ObamaCare.
Frankly, in about 15 minutes of reading, you can understand everything that is
wrong with American health care, or at least most of it.
The
first article focuses on the soaring prices charged by hospitals for relatively
minor emergency care (suturing of lacerations). The bills are huge. Every item
and procedure wrings more and more money out of the patient who is often forced
to rush to the nearest emergency care facility whether in- or out-of network, and out of the patient’s insurer.
The “charge masters” that dictate pricing bear no relationship to actual costs,
making medicine somewhat unique when compared to most other business endeavors.
And best of all, the price paid for any given service varies from place to
place, payer to payer and state to state. Is this supposed to be a health care
system? If so, it’s failing. But we already knew that.
Back
at the ranch in article two, the enemies of the ACA continue to mount legal challenge after
legal challenge in the courts. This should come as no surprise in our
ultra-litigious society. It should also come as no surprise when the law being
challenged was supported by no member of the opposition party and, let’s face
it, was a pretty stupid way to finance health insurance for those without it. It took
the Supreme Court to determine that it really was a tax after all, not simply
an order to buy what you may not want. It was also a decree that determines the
contents of what you have to buy that you may not want (first, you have to buy
a car; then you have to buy it with air conditioning and an XM radio). Thus, it
should come as a shock to no one that the courts are viewed as the last resort
for those who object to such mischief on the part of legislators.
So
how do we get out of this?
First,
what the heck are we trying to do?
The
Democrats wanted to create a way to gain insurance for the 15% of Americans
without it while not increasing taxes. This is, of course, impossible. So
instead of using a progressive tax-based redistribution of the money needed for
the premiums–coming from those who have the most to give—the Democrats reverted
to a forced purchase (the individual mandate) on the 15% without government- or
employer-supplied coverage, putatively giving subsidies to the most needy. This
will all be done with the ease of amazon.com. Hmmmm….
We
shall see how that all works out. If the Congress wanted to get everyone
insured, they should have just created a new tax and plowed the money into the
appropriate insurance vehicles. This could look like Medicare for all, but at
least it could not be challenged in court—unless the money bill originated in
the Senate not the House as all financial legislation must according to the
Constitution. As the second NY Times article indicated, this non-tax tax may
have done just that in originating in the Senate. (Remember the House passed
the Senate version of the bill. Welcome to PelosiCare).
If
we were trying to create a new public good, we should have so stated. We are
all taxed to pay for the military, the police, FEMA the FDA, etc. We may not
like it, but the constitutionality of Congress’s right to tax is not challenged in court too often.
Instead
of starting with a picture of where we wanted to go, we started with a
misreading of an election result as a mandate that led the Democrats to ignore the very people needed to
get this done, the Republicans, who approached this with a single word: NO! We
should have known then that the folks in the White House were not going to be
able to manage the implementation of a law whose purpose they could not even describe.
On
the subject of the indescribable, there’s cancer. Like the goals of the health
care reform legislation, the goals of the onco-industrial complex are rather
heterogeneous. The goal of cancer research, while stated as being a cure, is
really about a series of intermediate steps, incremental improvements and a
whole lot of hard thinking and discovery between our current knowledge state
and the one in which cancer is relegated to the status of small pox. The cancer
community should be no more ready to commit to a single attack plan than the
Republicans were ready to commit to a convoluted way to fund health insurance through
legislation that never was really about lowering medical costs as a drag on the
GDP or defining and improving true medical quality.
Here
are the two pieces from Tuesday’s Times. See what you think. If you think, then
you are doing more than most of the folks described in the stories.
