Health Care Reform
Well, it is presidential election time again (2008), and every candidate has to have a health care plan. Perhaps the best assessment of all the candidate's plans is a quote from that famous philosopher, Bugs Bunny: “What a bunch of maroons!”.
We seem pretty sure that Americans pay more for health care than anyone else in the world, and that the cost of health care keeps rising faster than inflation, but the available facts on exactly where all these health care dollars wind up could fit in a small thimble with plenty of room left over.
We also know (from previous experience as well as common logic) that the folks benefiting from those health care dollars don't intend to just give up swilling from that money river without a fight. With billions at stake, a big chunk of those billions will find their way into fighting tooth and nail to prevent any serious reforms which might jeopardize access to that river.
These simple facts render any and all health care plans ridiculous. Proposing a specific plan in the face of a total absence of intelligence is moronic. It is exactly like going into battle with no information at all about the size, distribution, or capabilities of your enemy, and real reform will be a battle. You can't have that much money at stake without provoking a major battle if you try to take a big chunk back.
If there were a serious plan out there, it wouldn't be a detailed plan for specific legislation, it would be a strategy outlining how America can do battle with out of control health care costs and come out on top with cheaper, better, and more universally available health care.
It might look something like this:
Step 1: Gather intelligence
We have to start by finding out where all the health care dollars go. If it takes legislation to force open financial records, that's what it takes. If it takes congressional investigations and subpoenas, then that's what it takes.
Naturally, the opposition will recognize they need to fight this right off the bat. We'll need to play every card in the deck. The national security card (increasing costs are a threat to national security and the economy). The if you aren't part of the problem, you have nothing to hide card. The if you are opposed to just finding the facts, you must be an unpatriotic traitor card. The bully pulpit has to be used to push this practically 24 hours a day, 7 days a week. Unrelenting bad publicity for uncooperative health care executives needs to be the order of the day. If we need to bring in Karl Rove and the swift boaters, then bring 'em in, perhaps they can do something beneficial for a change.
Success at this first step is essential. Not only can't we form an intelligent plan without the facts, but the opposition is sure to trot out the FUD strategy (fear, uncertainty, and doubt), and the existence of actual facts can go a long way to combat the uncertainty and doubt part.
The fear part is simpler. The opposition can try and generate fear of the unknown reforms, but there are too many known things to fear in the existing system: One serious illness will wipe out your savings. You can't quit that dead end job because you need the health insurance that comes with it. The second guessers at the insurance company will refuse to pay for vital treatment. You'll have to choose between food or medicine. The list goes on and on...
Step 2: Prioritize
Let's be optimistic, and say that after a death struggle with the health care industry, we finally have detailed facts about where all the dollars wind up. At this point, forming a plan gets much simpler.
For every item in the list of list of things that consume health care dollars, we need to ask: “How much does this expense actually benefit a real patient?” Anesthesia during surgery? That's pretty beneficial. Drug company junkets for doctors to con them into prescribing new expensive drugs that don't work any better than old reliable ones? Not so beneficial.
We can now make a big chart with direct patient benefit on one axis and total health care dollars on the other and plot all the points representing different things we are sinking our dollars into.
In one corner of that graph will be the points that are big on the expense axis and small on the patient benefit axis. Those items are the ones you want to target. Once you actually know what they are, then putting the effort into a plan to fix them can make sense.
Step 3 through Infinity: Iterate
You've implemented a plan to address the worst offenders. Something else is probably the worst offender now. You need to start over again. Gather data, see where the money is going under the new plan. Make sure the new plan actually had some benefit. Find the new worst offenders. Tackle them with the next plan.
Keep on doing this forever. In the words of Mad-Eye Moody, “CONSTANT VIGILANCE!”. Turn your back on such a large money river for a moment, someone will find a way to divert some their way.
I hope I've demonstrated the pointless stupidity of the typical politician's focus group generated feel-good health care plan. Please steal these ideas. Send them to the candidates. Send them to your congressman. Embarrass the candidates by asking them how they plan to implement cost savings in the face of relentless opposition from the folks profiting from the excess costs. Maybe we won't get real health care, maybe we'll get something even better: exposure of the utter useless frauds both the republicans and democrats have become.
My name is Tom Horsley, and I not only approved this message, I wrote it :-).