The Paradox of Health Care Costs

Health care reform is the big political issue at the moment. Some say that President Obama has lost momentum in the campaign for reform to his critics, who have been able to shift the focus away from the debate about policy to a focus on the disruptive town hall meetings many members of congress have experienced this month.

In an attempt to regain momentum Obama has been forced to demonize something about the status quo. His villain of choice is the insurance industry. Big health care insurers are now the reason health care doesn't work in America.

This is all bullshit on both sides. First of all, the critics of the President's ideas for reform have resorted to ridiculous rhetoric and outright falsehoods about what the Obama administration is trying to do. Recent comparisons by Limbaugh and Palin of the Obama reforms to Nazism are, of course, fundamentally why we elected Obama to begin with. The politics of fear. They are liars and perhaps just plain stupid. They discredit their case by taking extreme positions that have no basis in reality. But, of course, this is the American way. It has happened before. Our politicans and pundits have a long history of resorting to theatrics in controversial issues. So, it doesn't surprise me. Let's just dumb everything down and scare everybody into confusion and opposition. That's our wonderful democracy in action (or maybe that should read "inaction").

Secondly, the President himself and his Democratic Party supporters have utterly failed to either craft a piece of legislation that deals with the real problem of health care in this country or to direct their focus in a holistic fashion at a very complex problem. They too want to dumb everything down and blame the whole mess not on physicians or pharmaceutical companies or even the tragically unhealthy habits of - god forbid - the American citizenry, but primarily on the way insurance works in this country.

You idiots.

Until someone actually starts to have a debate about how are we going to manage to costs of health care we don't have a real debate about the real problem. The problem isn't that people are uninsured. The 40-something million uninsured number is probably inflated. The real number is probably far less. The real problem with the whole mess is that Obama wants to create another government entitlement without any aspect of the proposed legislation directed at controlling the costs of providing adequate health care for all.

Until you people stop with the Nazi scare tactics and the insurance company witch-hunt you aren't going to get a real debate nor a real solution. All you are going to get is politics as usual (what about that "change" idea you hit upon in the campaign Obama?). Those opposed are going to use the politics of fear to their advantage. Those in support of the policy are going to find a bad guy that must be taken down. The debate will be about everything BUT cost.

The fact is the President really doesn't have a substantive plan on the table. There are just all these ideas that various numbers of senators and congressmen agree on. Mostly they are divided. The Blue Dog Democrats heroically ask what is all this going to cost and how are we going to pay for it?

The President says "savings" (and probably a tax increase on wealthier Americans because of this and other government programs.) Horseshit. You want me to support the largest new entitlement program in recent history, one to rival Medicaid and Medicare in its implications and reach and you say government will pay for it all by creating "savings" and an increase in taxes based upon wealth. When has government "efficiency" ever brought about true savings?

David Brooks and Mark Shields summarized the situation pretty well tonight. According to Brooks the fundamental problem Obama has right now is that: "...he's really good at talking about why we need change. He's really good at talking about what change would look like if we had a good system. He's not so good at talking about what the plan is."

The "White Elephant" here is that if people live longer, healthier lives health care is going to cost more. Period. The great burden that obesity and smoking supposedly place on our society turns out to be a myth. Fat people and smokers don't cost as much long-term as thin people and non-smokers - because the people with bad health habits don't live as long.

This is a fine example of the simple fact that it is the routine nature of American health care today that makes it so expensive. The weight of the costs for regular health maintenance for a national population and a violent, emergency room culture means that, even as bad as being fat and smoking are in terms of what they financially cost our society, that stuff is still not as expensive as living longer. The maintenance of living longer is our primary health cost.

I'm not sure how that blatant fact works in a democracy? We have to be smarter about how much we allow the maintenance of our routine selves to cost our society. So, yes, this means some rationing of care, fewer tests, labs, specialized opinions, statistically ineffective returns-on-investment for measurable protocols.

Which brings us to an even more complex issue, the one that sends Sarah Palin into orbit.

End of Life is an expense no matter what your faith. Studies show that 25 percent of the Medicare budget is spent on people during their final year of life — with 40 percent of that spent in the final month. To simply not put that on the table for some kind of discussion because it offends some body's religious sensibilities is unethical and bad budgeting. Keeping the heart beating no matter what (with no other signs of human life other than a body lying in a bed) costs this nation tens of billions every year.

That might sound cold. I'm sorry. It is an irrefutable fact. End of Life issues must be brought under control or at least budgeted for in some sane manner. Unfortunately, End of Life has pretty much been taken off the table. So maybe Palin and Limbaugh accomplished something. They have ensured that the full spectrum of health cost issues are NOT debated.

The paradox of health care is that much of the cost is actually driven by healthy people living longer, taking drugs to help them live longer, doctors ordering tests to help them live longer, and healthy people costing a fortune when they finally near death, especially in the last four weeks of an otherwise healthy life.

If we can't somehow talk about this budgetary fact without engaging in name-calling, if we can't see that the American people themselves are as much to blame for skyrocketing health costs as any other factor, then we truly are lost in a muddled mess that may prove to be yet another monetary black hole (along with Medicaid and Medicare) the more the government gets involved.

But, neither side is willing to enter into that kind of debate. Because it means the voters are partly to blame. And the last politican to focus a problem on the American people didn't last very long.