Tuesday, February 19, 2008

Any hack can string together sentences...

A Republican sent me this “policy analysis” and asked; “so, tell me what is wrong with this?”

I wrote a really long reply via e-mail on my “smart phone” and then the e-mail crashed. It was a very dispiriting moment, but I will soldier on and try to recreate the mojo that I had while punching out that e-mail while holding my napping daughter.

Let’s go back to the orginal question, so, tell me what is wrong with this? My reply is, I don’t even know where to begin. OK, yes I do. First off, I think that we need to review what constitutes a public policy analysis. Rule number one when analyzing a particular policy, in this case health coverage policy, the analyst must be free of preconceived notion and allow the data to direct the outcome.

Lin Zinser and Paul Hsieh certainly have a preconceived notion and they don’t even try to hide it. Everything they say is absolutely true. So what’s wrong? Well, while they use fact to make their case, Zinser and Hsieh do so by using only half the story. The analysts methodically leave out key details that conflict with their outcome. It could be possible when conducting an analysis, with the incredible amounts of health policy data, that the analysis is innocently incomplete. Not in this particular case. Zinser and Hsieh actually tell half the story and omit key variables. As such, this analysis is half true. It is also half false. Thus it is not particularly interesting.

This analysis attacks “universal health insurance” as a policy program. This is almost idiotically off base. Universal health insurance is not a program, it is a goal. To achieve universal coverage there are many different approaches that could be pursued. Zinser and Hsieh call universal health insurance “socialized medicine.” This is what conservatives do when they can’t attack something on its merits. They try to create fear, in this case they go back into the vault to try to wake up the dormant fear of communism that is hibernating in the hearts of Americans. It rings hollow. What they are actually attacking is a national health system like they have in Canada, the United Kingdom, or Japan, to name a few.

The “analysts” rightly point out that the current system is broken. They also rightly point out that it is not a free market approach. But make no mistake about it, a free market approach will not move towards significantly expanding health coverage. This betrays the fact that the authors are not interested in moving towards universal coverage.

Zinser and Hsieh say that the current system is crippling American businesses. They are right, but the business community (led by the giants, GM and GE) fought hard in the 1950s to block an organized labor proposal to move towards some form of national health insurance. They were afraid of handing too much power and influence to the [communist] unions. Are you sensing a theme here?

Simply shifting the financial burden from employers to employees will not expand coverage. Working men and women have enough stress making ends meet. What would make us believe that they could or should become health care consumers that are well enough informed to be discerning. Health technology, as the authors point out, has become incredibly complex. People ought to be able to rely on their doctors to steer them towards the most cost effective care alternative. This is a system known as managed care. Managed care failed because people chose alternative plans (like PPOs) which offered them the opportunity to bypass the primary care physician and see a specialist, even in cases that could have been handled by PCPs at a lower cost.

Managed care only works when it is the only option. That is why care in the United Kingdom is half the cost for the same health outcomes. In Scandinavia, if you are rich, you can still bypass the system and go to private clinics, but most people choose not to. Care is prioritized and managed care is truly managed. Here that is called rationing by critics. But in actuality it is allowing doctors to determine severity of cases and triage based on priorities. A quadruple bypass surgery for an 80 year old is not as important as when the patient is 50. This may seem cruel, but it cannot really be refuted. Is the national health system approach perfect? No, it is not. At times people do have to wait for important tests and procedures.

But let’s be honest; the ship sailed on a national health system in the United States a long time ago. There are too many entrenched interests and too much money in the current system to do away with it all. I won’t even dare to dream. The eventual solution will likely be some sort of public-private partnership.

This could be a great debate topic in this year of politics. The solution could be crafted by uniting the liberal goal of equality and inclusiveness and conservative goal of individual responsibility.

But unfortunately only one side has showed up to the debate and won by debate. John McCain’s health policy platform focuses on controlling costs and increasing competition without getting specific. This is like nibbling around the edge without taking a bite out of the apple. Controlling costs and creating competition are certainly topics that need to be addressed, but they alone will not fix our system.

The authors of this “analysis” want a level playing field and free market solutions. That would be nice, but the playing field is not level. Free market solutions are not the best approach to ensuring that the least of us catch a break. This “analysis” is like watching the first half of the Godfather but then skipping the second half.

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