Real healthcare reform

Friday, July 17, 2009

By Dr. Ronald Hoffman

[AUTHOR'S NOTE: I first published this blog 4 ? years ago. With the current brouhaha over the roll-out of the Affordable Care Act, I think readers will find it especially prescient. So far, my predictions are standing the test of time. Here it is, presented in its entirety, unedited.]

Amidst all the hoopla over healthcare "reform," we are missing the true point: No real turnaround in our head-long rush toward disaster can be achieved without a fundamental change in our orientation toward medicine.

It's avidly debated whether we should have a government healthcare plan or simply a beefed-up private market with subsidies. Everybody seems hot to automate our medical record-keeping system to introduce "efficiency." And we're urged to establish vast bureaucracies to make sure doctors practice medicine cost-effectively, not just to rack up dollars with expensive and unnecessary procedures.

But we're missing the point: Whatever the outcome of the current political jockeying, we're due for a major cram-down of lowered quality care, more limited choice, and outright rationing. Whether it's the government or the insurance companies that will be sticking it to us, the result will be the same. The era of unlimited testing, unrestrained drug prescribing, and surgical entitlement will end.

In America, swallowing the premise of Michael Moore in "Sicko," we curse the cruel, profit-mad insurance executives, hewing to their bottom-lines at the expense of our well-being.

In England, Canada, and elsewhere wherever the socialized medicine we're auditioning for has taken hold, it's the heartless, faceless government bean-counters who get the blame for shoddy care. Pick your poison, friends, it's coming!

Nearly two billion dollars have already been appropriated as part of the economic stimulus plan to establish CER's--Comparative Effectiveness Research councils within the National Institutes of Health. My take: Might CER stand for "Could Entail Rationing"?

You see, Obama and the Democrat reformers are just trying to make a virtue out of necessity: our health care system, just like our over-leveraged consumer economy, is unsustainable. We just can't have hot and cold running health care for every man, woman, child, and guest worker in this country.

Maybe it could've worked in the 60's when there were fewer drugs and surgical options, they were vastly less expensive, and the average American was lucky to reach 70. But now, with wondrous treatments that have created a legion of Americans dependent on expensive life support, it won't work. And it's only going to get more and more expensive as medical research pushes the boundaries of what we can do.

I thought, with a sense of relief, that after our 2008 financial collapse, ambitious and extravagant plans for revamping our health care system would be at least temporarily sidelined or down-sized. I thought wrong. Amazingly, counter-intuitively, Obama and his congressional allies have harnessed the crisis to argue that we can't afford NOT to initiate the largest entitlement since the Great Society.

Sure there'll be an economic stimulus associated with health care reform--and special interests are lining up to be its beneficiaries. Silicon Valley, General Electric, Washington fixers, generic drug makers, and select public hospitals and clinics all stand to reap fat sinecures if the legislation is passed. The overall economy will suffer as the costs get passed along to the "rich" and they rein in investment and discretionary spending.

Trouble is, how do you SAVE money when you add millions of Americans to our overburdened health rolls? If the policy wonks said, "Look, it's time to provide health equality as a matter of social justice," fine, but don't try to sell it as a cost-saving measure. Even without ambitious new coverage schemes, Medicare, our premier public health care program, is headed for imminent bankruptcy by 2017. Why not just address the formidable task of saving Medicare?

Doctors aren't happy, and somewhere it's been forgotten that they are the backbone of the American medical system. They are being asked to make more sacrifices, to treat the under-served, to accept lower Medicare and insurance reimbursement, to buy unwieldy and expensive computer systems, to spend more of their time submitting stats for data mining, and to adhere to onerous "guidelines" that restrict their freedom to exercise their medical judgment.

At the same time, they see that the other professional class, the lawyers, won't be asked to share in the down-sizing. The Democratic party is in the thrall of the trial bar, and so reasonable tort reform is off the table. And so every kid who falls off a jungle gym will still require an MRI, and doctors will unnecessarily prescribe powerful drugs and perform bypass surgeries "just in case."

The AMA and Big-Pharma, traditional opponents of healthcare reform, have conveniently been bought off with promises that government subsidies for more patients mean more income for them.

If this sounds like an anti-Obama rant, or an exercise in partisan politics, consider that I am a long-time equal-opportunity critic of the American medical system, period. The "cram-down" is coming regardless of which conventional political party prevails. So I believe the only hope is a populist revolution against over-the-top and unnecessary medical intervention. With the advent of out-of-control "Jurassic Park Medicine", the survival advantage will go to the self-reliant.

As public disillusionment with high-tech medicine grows, more people will turn to enlightened self-care. Sure there are instances where medical wizardry is great--I'll forever be grateful for the skilled mending of my broken hip, an injury which a generation ago would have left me limping for the rest of my life like Chester in "Gunsmoke".

True preventive medicine won't be achieved just by funding the system so we can put everyone on Lipitor, Plavix and Fosamax. The coming revolution will be grassroots in nature, and not initiated by government. It will be fostered by thoughtful and properly skeptical citizens tired of permitting their bodies to become dependent on government largesse. It will be guided by a growing cadre of complementary health care practitioners--mostly working outside the system--who understand healing better than Washington statisticians.

And so, in the end, passage of health care reform won't be the answer. It's just a sideshow distraction from the big picture of fundamental failure of our current Western medical paradigm. By over-investing in that flawed model, we risk hastening its demise. Hopefully, we'll wake up before the health, vitality, morale, and economic security of America are irrevocably lost.