The entire premise of the discussions and debate on Capitol Hill misses the key point on the question of changing the health care system. Legislators have debated four points:
a) How to pay for the package
b) How to reduce its cost
c) Whether or not to have a government-run insurance company
d) What mandate to impose on employers to cover their workers
But none of these points copes with the more basic question of where the extra doctors to cover these now uninsured people are going to come from. You cannot cover the 50 million new people Obama seeks to cover without more doctors and nurses. But the administration and even the Blue Dogs in the House have proposed nothing to add to the supply of medical services even as they plan vastly to increase the demand by covering new people.
By focusing on false issues — or at least tangential ones — the politicians can play the Washington game of compromising on these questions while failing to address the central flaw in the legislation.
The projected Senate "compromise" being discussed in the Senate Finance Committee would eliminate the employer mandate and the public insurance option. But it would still extend coverage dramatically without making provision for more medical personnel. The Blue Dog compromise in the House would replace a public option with co-op insurance companies organized by states and would limit the employer mandate, but would have the same blind spot: too few doctors and nurses to cover the new patients.
Both bills would continue to vest the administration with the power to cut Medicare and the mandate to do so. Congress' only check on the evisceration of the program would be its ability to veto proposed cuts within a limited period of time, as now applies to military-base closure.
Experience has showed that Congress is just as happy to sit back and let the closings or cuts take place without acting to stop them.
And by failing to provide for more doctors or medical schools or nurses, both bills will force widespread rationing of medical care. And that rationing is going to mean lower-quality medical care for us all, especially for the elderly.
A doctor in Massachusetts — where Romney passed a plan similar to Obama's, recently told us that she now has to read 60 mammograms a day in the time she used to spend on 45. Less time, she said, means less accuracy in reading the complex data and more mistakes. "It keeps me up at night," she told us, "that I might make a mistake, I am so rushed."
And, for the elderly, it means less and less medical care. A Federal Health Board will sit in judgment of medical procedures and protocols and will decide what guidelines all providers must use in giving patients certain types of care or withholding them.
For example, the drug Avastin is widely used in the United States to treat advanced colon cancer. But it costs $50,000 a year. So the Canadian health system will not permit its use. As a result, 41 percent of colon cancer patients in Canada die each year as opposed to 32 percent in the United States. The average eight-month wait for colonoscopies in Canada also contributes to the problem. Colon cancer rates are 25 percent higher north of the border than in the United States, where colonoscopies are readily available.
Neither the House nor the Senate will act on these bills until September. Congressmen and senators will be home during August to test public opinion. It is up to us to give them an earful!
