"Those whom the gods destroy, they first make mad." — Euripides
Are death panels going to euthanize grandma? Why is the government touching my Medicare? Would Stephen Hawking survive Britain's National Health Service? These have been the burning questions driving the health care debate in the United States this summer. The concerns of millions of un- or underinsured, the ability of health insurers to rescind policies, the primary care shortage, or even the 17 percent of our GDP that health care currently consumes have all been relegated to the sidelines. Protestors storm town hall meetings and shout down members of Congress, talking heads on cable declare the impending and simultaneous arrivals of socialism and fascism, and misinformation spreads like wildfire. Interest groups pour millions of dollars into lobbying, while agreeing to superficial cuts in the name of cooperation.
This is the madness of health care reform. From the era of Harry Truman to Bill Clinton, and now President Barack Obama, opponents of reform have employed fear, half-truths and bribery to avoid the real issues and have introduced fallacious myths by using the intrinsic complexity of the topic to distort public opinion. Special interests have run vast advertisement campaigns, e-mail chains have proliferated and many Americans have found themselves without credible sources of information in the media to counter the dishonesty.
The majority of Americans know that there are problems with the overall health care system, but are satisfied with their own health insurance. Many have no first-hand experience with the system until they are ill. As a result various groups feel that change is unnecessary. Young adults do not want to spend money on policies that they seldom use, workers fear losing employer coverage, and senior citizens dread the thought of cuts to Medicare. Meanwhile, the constituencies that comprise the underinsured and uninsured are poorly organized and politically disenfranchised. Health providers, insurance companies and drug manufacturers, on the other hand, are well organized and have the resources to ensure that their bottom line is unaffected by reform. And everyone wonders: Why do we need reform?
That reformers and politicians cannot clearly answer this question underlies the crux of the current problems with reform. What reformers should be doing is emphasizing two key issues: increased insurance regulation and cost control. Yet the conversation has shifted away from these points.
Politicians often attack the health insurance companies because they make for easy targets. But when it comes to passing actual regulatory reform, the fiery rhetoric suddenly disappears. Our current laws allow health insurers to cherry-pick consumers and arbitrarily cancel policies. Insurers can and do rescind policies of individuals who have forgotten to mention conditions like acne. And, as recent Congressional hearings demonstrate, insurance companies are clearly uninterested in self-regulation. Policies are poorly worded and confusing. Companies either deny coverage or charge high premiums on the individual market to customers with pre-existing conditions. No standard benefits package exists and policy prices vary greatly by region. But because so much of Congress is indebted to insurers for campaign funding, regulatory reform is ignored.
And then there's the question of bending the cost curve. Here we see significant concerns, also largely ignored in the discussions. Atul Gawande and researchers at the Dartmouth Atlas of Health Care argue that increased costs come largely from provider-driven overuse. Most economists agree that programs like Medicare are unsustainable. The government is forbidden by law from negotiating drug prices for Medicare. The American public is largely unaware or uninterested in many of these concerns and the current administration and reformers have not pushed these topics into the open. Instead, the arena is filled with scare-mongers who talk about death panels and rationing. That we already ration care based upon individual ability to pay and fall behind on standards of care despite spending twice as much as other nations is lost in the debate.
In short, as long as Americans continue to demand expensive new treatments and aggressive end-of-life care at any cost, physicians will order more tests and procedures. Regional discrepancies, the increasing prevalence of obesity and inefficient use of procedures and tests will continue to exacerbate the cost crisis. But we as a society tend to ignore all of this and so has the health care debate. There are no frank discussions of evidence-based medical practice, hospice care and end-of-life counseling or the growing obesity epidemic, to name just a few factors, in the public debate. Politicians have not mustered the courage to face these difficult questions.
So, then, where do we stand? Well, special interests have shifted the conversation away from costs and regulation and allowed a host of strange myths and inaccuracies to permeate the airwaves. Instead of talking about end-of-life counseling, we are discussing death panels and our government's desire to kill grandparents. There are some organizations like Families USA that have tried to lay out clear reasons for reform and others like Media Matters that fight back against the lies, but these groups are in the minority and not followed by most of the public. The madness of the political system seems to be winning.
We should hope for effective reform, but realize that the way things stand right now means that change will likely be incremental. But we as members of the Tufts community owe it to ourselves and the community to remain active and informed. Will we overcome the madness? Can we pass viable reform and prevent the collapse of the health care system? Or have we been driven mad by our own self-interest? Only time will tell. And we wait.
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Michael Shusterman is a senior majoring in biology and history. He is co-Editor-in-Chief of TuftScope: The Interdisciplinary Journal of Health, Ethics & Policy. TuftScope provides commentary on health issues at tuftscope.blogspot.com.
