critical condition

If you want an example of something that's emblematic of what's broken in America, try health care.

Sure, our Republican colleagues will mouth the exact same tired language about "the excellence of our hospitals" and those dreaded "trial lawyers."  Truth is, however, for twenty five years the United States, under Republican leadership and the hand of big business, has indulged in an experiment with allowing "market forces" to drive our health care system.

That experiment has failed.

We pay more for drugs, basic care, and insurance than ever before.  Due to an unchecked increase in the cost of catastrophic care and a change in bankruptcy laws, we are all more at risk of financial devastation when facing a serious illness.  Many of us are less healthy.  And all of us navigate a labyrinth of byzantine, hyper-duplicated and redundant bureaucratic formulas that consistenly favor profit over people.  Nothing exemplifies this better than the sight of millions of senior Americans struggling to read the fine print of the insanely complex new "Medicare Drug Plan."

Let's face it, health care is broken in America.2004 saw the publication of Critical Condition: How Health Care in America became Big Business and Bad Medicine by famed investigative journalists, Donald Barlett and James B. Steele.  The book is now available in paperback and can be read in an afternoon or a plane ride.  I highly recommend it.

Barlett and Steele lay it out:

Over the last few decades, American health care has radically changed.  A system that was largely not-for-profit has become a field where the profit motive and market forces affect every decision. [snip]

Much of the turmoil is a direct result of a national policy to run health care like a business, a misguided notion promoted by Washington over the last two decades that the free market and for-profit health care would restrain costs and bring high-quality care to all.  On both counts, the experiment has failed miserably. In the meantime, tens of billions of dollars--money that could have gone into patient care--has been drained from consumers and corporate subscribers and transferred to investors, executives, and others who have a stake in perpetuating this myth.

The result is a chaotic system that has shifted its focus from saving lives to saving dollars, one that discourages preventive medicine and rewards overtesting and overmedicating; a system that allows insurers to reject those most likely to require medical attention and keep only the healthiest; a system where six times as many people die from medical mistakes as from HIV/AIDS; a system that forces doctors to spend as much time negotiating with insurers over referrals and fees as they do treating patients.

Barlett and Steele don't mince words.   When you're sick, you're not a "customer"...you're not a "shopper"...you're a patient.  It's obvious.  When one of us gets cancer or has a car accident...it's not like we're wheeling a cart down the aisles of a grocery store comparing prices.  But that's exactly how the Republicans would like to have us imagine it.  (And when we do compare prices we realize, as the authors expose, that hospitals--even non-profit, "charitable" hospitals--price gouge uninsured Americans and send the inflated bills to collection agencies.)

Health care isn't like other "businesses" where it's perfectly expected and acceptable to make more money by selling more of your product.  When talking about our health, that's insane.  We want fewer diabetics and lung cancer patients.  We want healthier babies and children who grow up with good habits of diet and excercise.  As a society, we want our citizens to be healthy, to need less, not more,  intervention from the health care system.  That was the logic behind the initial governmental investment in "non profit" HMO's in the 1970s.  (It's also the logic behind most other countries vastly less expensive health care systems; countries we compete with in the world marketplace.)

Non-profit HMO's were invested in keeping all their patients healthy.  If you were in your 30s, and had a reasonable expectation of good health, you still knew that your HMO would cover you in the event of an accident or a chronic illness...and would cover the health care of your children from pre-natal check ups to doctor's visits for a cold or a broken bone.  If you were in your 50s you knew that your HMO was invested in proper diagnostics and preventive care...to keep you healthy, to intervene early, and to guide you into your senior years, and the medicare system, as a healthy senior citizen.

We've turned that on it's head.  Our government bought into the idea of for-profit HMOs and for-profit medicine...and that happened at exactly the point where conservative ideologues got their hands on U.S. government: during "the Reagan revolution."

Take this 1979 quote from David Stockman, who went on to become Ronald Reagan's budget director:

The secret is to liberate health consumers from the policy-induced stupor that has reduced them to passive, indirect payors when by nature they are accomplished, resourceful shoppers.  The activation of 150 million adult health care shoppers would dramatically transform the medical marketplace...

The conservative kool-aid was flowing even then.  That quote might sound good to some, if you don't stop to think about what a 'medical marketplace' means.  According to Barlett and Steele:

In 1983 alone, five formerly not-for-profit HMO's with hundreds of thousands of enrollees converted to publicly owned corporations. [snip]

The move to for-profit health care companies was a profound transformation that would affect milllions of Americans.  It was rationalized, explained, and justified for one reason--as the only way to control costs.  "The object will be to slow the explosive rise in the nation's medical bill." Business Week reported, "and set in motion free market forces that will reduce the waste, inefficiencies, and misuse of health services that have eluded the corrective thrust of government regulations."  For-profit HMOs were the "Johnny-on-the-spot answer to the health care cost problem," said a Piper, Jaffray and Hopwood analyst in 1984. [snip]

At the time, in 1984, health care costs represented 10.5 percent of gross domestic product.  Twenty years into the experiment to "slow the explosive rise in the nation's medical bill," health care costs at the end of 2003 exceeded 15 percent of GDP.  They are sill rising.  The last time so many on Wall Street and in government were so wrong was 1929--but this time many would  make a great deal of money.

For those interested in what a "cost savings"...rrr, increase...of 4.5% of U.S. GDP represents:  it's about 500 Billion dollars...annually.

For-profit medicine, as relentlessly exposed in Critical Condition, has meant big business scamming patients, scamming investors and scamming the government.  Ask yourself, when you look at the health of your fellow Americans, and the vast numbers of uninsured...where do you think that $500 Billion a year goes?  From where I stand, it sure doesn't go to making average Americans more healthy or more secure.

In fact, the obvious fraud and waste involved in for-profit medicine changed the meaning of HMOs to such an extent that it likely scared voters from supporting any attempt to reform health care away from the failed for-profit system, even though that reform is in all of our best interest.  Average Americans who do have health care see first hand the waste, fraud and corruption in the system; but instead of reforming it, in voting for a Republican-controlled Congress we've voted to let the market fix itself!  Ironically, Republican policies and voter manipulation have had the effect of luring voters to vote for 'more of the same' instead of asking themselves why the system's broken in the first place.  That has to change.  

Truth is, some people have been getting VERY rich for a VERY long time with business as usual.  The only way to change that is to make the case that the Republican experiment in for-profit health care has failed. The experiment has failed our patients, our children, our doctors, and, in the end, it failed even our big companies.  For profit medicine has failed our country.

For the scare mongers who preach conservative "market based" values, I have one question.  Would you let market forces raise your child?  Of course not. Just as we have core values we want for our children, we have certain standards and core values that we should expect for health care in this country.  Access to affordable health care that has all of our best interests at heart with an emphasis on preventive and healthy lifestyle choices should be one of those values.

When we had a basically "not for profit" health care system in this country, it was not perfect...what is?...but one core thing held true: the system was invested in our health,  not in making money off our sickness.

We've come a long ways from that moment.  As Barlett and Steele point out, health care in the U.S. is like a lottery.  If you're one of the lucky, you're alright.  If you're not.  You're screwed.

But anyone looking at their neighbors and family knows that it's not that simple.  It's connected.  When GM shuts those factories, in part due to the huge costs of for-profit health care, they will be gone for good.  When our neighbors lose everything over a family health crisis, it's not good for anyone.  The entire United States suffers when we let kids fall victim to an epidemic of childhood obesity due to crappy corporate food and a health care system that isn't doing it's job:  to help keep us healthy.

Like in so many things, the Republicans have had their chance. Their ideas have failed. It's everyday Americans who have paid the price.

[Update: Badger Blues joins the call for reform.]

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