don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

There was joyous pandemonium among Democrats as midnight approached on Saturday, November 7 in the U.S. House of Representatives. The Democrats, with "bi-partisan support of one Republican (an anti-abortion zealot who was paid off with an amendment that would greatly restrict a woman's reproductive rights), finally passed a health care bill. It was, as noted, a happy time for Democrats. If anything like the House Bill gets past the Senate and is signed into law by the president, partial coverage will be extended to 36 million more Americans and basic medical care will be somewhat more affordable for 96 percent of the population. The House bill, unfortunately, will "allow" the government to sell insurance but only in competition with private companies.

Unfortunately, this bill is too little, too late at too great a cost for too little benefit. Permit me to summarize why I think we need a 100 percent public option.

But first, let me tell you why I thought of Soren Kierkegaard (1813-1855) at the same time the Democrats were celebrating. Kierkegaard, the "merchant of melancholy," famously viewed happiness as but "a hiding place for despair." In my opinion, despair will emerge soon enough from hiding and beset Democrats. It will also threaten REAL wellness enthusiasts who value quality of life and REAL reform of our disgraceful medical system.

My own despair (quickly overcome, by the way, should you be inclined to worry about me) was occasioned by the failure of our Congress to enact reform legislation that will effectively control costs AND grant access to all. While these are the two objectives of the Administration and the Democratic majority, I prefer a system that rewards personal responsibility to stay well—a system that promotes reason, exuberance and liberty—REAL wellness. But, the latter is so far from being detectable by the radar of reform watchers that the omission never surprises, only disappoints.

Let me summarize why I favor not just a partial public option, a weak version of which is included in the House-passed bill, but a 100 percent single payer plan. (Yes, go ahead and call it "socialized medicine" if you wish. Add it to socialized national defense, socialized postal service, socialized national parks and all the rest.) I urge this strategy for Democrats knowing that it will cost the President and the Party support of their one Republican ally and the continued absence of love from Sarah Palin, Rush Limbaugh, Sean Hannity, Anne Coulter, Michelle Bachman, Glen Beck and other great Americans, or far-Right wing nuts, depending on your mindset along the fair-minded/lunatic fringe continuum. It is time to go for the gold—single-payer, government-provided health care guaranteed for all.

Of course, some of us already have socialized medicine, including Congress, citizens over 65 and veterans. Let's provide the same benefit to the rest of the population.

Here is a short summary of pertinent facts about the current system and why REAL reform is needed.

Consider, first of all, that the new bill would add about a trillion dollars to current spending, a spending frenzy that already consumes more than twice as much per capita as occurs in other developed countries.

Why are costs so high and still rising? Ask yourself this question: If we spent TWO or THREE trillion more on health care, would we become twice or three times as healthy? No—money is not the crucial variable—that is and will remain the dysfunctional nature of our system, which this bill does not change. Capitalism, as Michael Moore and others have shown, is the basic problem, best exemplified by the worst element of medical capitalism—the health insurance industry. That's where most of the money is going, $2.5 trillion to be precise.

No fewer than two-thirds of Americans rely on private insurers and entrepreneurial providers. Health care is a market commodity. It is distributed according to the ability to pay, even though half of the money comes from federal and state governments.

These private insurance companies set prices and benefits and they pay the doctors and other providers of actual medical care. Their profits are dependent upon NOT selling policies to sick people and limiting services to policyholders who do get sick.

Does this not sound like an insane system for all but the insurance companies and their investors? These companies are known to skim at least 15 to 25 percent off the top of all premiums taken in. Taxpayers are indirectly paying for insurance company profits and overhead. Doctors and others, the people who actually provide medical care, have to compete for what's left. Of course, they have their own high billing and collecting expenses that further reduce the pool of funds for actual caring services. Adding all these overhead business costs (executive salaries, marketing and so on) represents 30 percent of the US medical bill. Thirty percent of about six trillion dollars! (Source: Marcia Angell, "Health Reform: Throwing Good Money After the Bad," Huffington Post, August 24, 2009.)

Ms. Angell estimated we would save $400 billion if our overhead spending amounted to the same percentage of our medical system spending as Canada's. (Warning: Be advised that mention of the word "Canada" in a medical context will invite animated comparisons with Lenin, Trotsky, Stalin, Pol Pot, Saddam Hussein and Ghenghis Klan from the likes of Palin, Limbaugh, Hannity, Coulter, Bachman, Beck and company.) So it goes. 

Medical care is also delivered, for the most part, in investor-owned health facilities. The incentive here is to provide more services than needed for the well insured and less for those unable to pay top rates.

Other dysfunctional aspects of our current system that begs for top to bottom reforms include the following factors: 

• Most doctors are paid on a fee-for-service, piecework basis. Again, bad incentives in that.
  
  
• Specialists draw the highest fees and the more frequent and expensive the testing, (e.g., cardiac angiography, MRI's), the more they make. Estimates are that unnecessary testing accounts for hundreds of billions of wasted dollars annually.
  
  
• There are fewer primary care doctors in our system than in comparable societies.
  
  
• The cost control targets advanced by the president and Democratic reformers, while all desirable, will make only a modest difference in cost relative to the amount of waste in the private, for profit and "non-profit" systems. This reality applies to electronic records, disease management, preventive care and comparative effectiveness studies. 

Basically, the two most massive sources of waste in our system are the diversion of funds needed for medical care to:

1. profits and overhead, and
   
   
2. exorbitantly priced, medically unnecessary tests and procedures. 

The House bill leaves untouched the profit-driven, wasteful, inflationary system. The distorted incentives are essentially unchanged. All the House bill does is pour more money into a system that is based on maximizing private profits, not increasing health while saving unnecessary costs.

To borrow a phrase from the musical South Pacific, the bill passed by the House seems to be but a "divisionary tactic" to take the public's mind off REAL reform—which would be a single payer, not a half-baked public option.

Did I mention that health outcomes are far better in other nations with single payer government systems? I should have, but that's a topic for another day.

Be well. Hard as it is, try to look on the bright side, despite what Soren Kierkegaard had to say about despair in hiding. When the effects of this pitiful reform package are better recognized, despair will have no place to hide, so perk up now before it's too late.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of adaptations and challenges. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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