Tuesday, September 21, 2010

The Kaiser Family Foundation takes up the cause of Obamacare. Once again, finance and bureaucracy triumph over medicine and healing.

The Kaiser Family Foundation has released a new animated video, narrated by Cokie Roberts, touting--they would say “explaining” but I maintain that “touting” is a more accurate verb--Obamacare.

Let me begin my review of this new video by saying I am all in favor of using new tools to communicate dense policy information.    We should be using videos and texts and tweets and anything else we can think of to better communicate policy.   If we do, there’s every reason to believe that policy literacy will rise--as the Pew Foundation noted recently, consumption of news is actually rising, as people now find their news on new platforms, such as PDA’s.  So the KFF deserves credit for pushing the envelope of imagination. 

However, it’s just as easy to put a distortion, or worse, into the new media as it is into the old media.   And that’s what we see early on in the nine-minute KFF video, at about the :40 mark, when narrator Roberts says,  “Polls show about three out of ten of us say health care reform will make us better off, a similar number say worse off, and a similar number again say it won't make much difference at all. Some of us don't know what to think. I guess you could say we’re kinda split on this one.”   Well now, that’s a pretty optimistic take on public opinion, in keeping with the strongly pro-Obamacare tone of the whole video.  

Indeed, that “one-third, one-third, one-third” conclusion, which makes everything seem so reasonable and balanced, is starkly at odds with the conclusion of, say, the Gallup Poll, which finds that by a 56:39  spread more Americans disapprove of Obamacare than approve.   I should say that the KFF is a big outfit, and a great resource for healthcare information that might please, at one time or another, all sides in the  debate, and so no doubt there’s a poll that somehow supports Roberts’ assertion.  

Yet as lots of anecdotal information tells us--most notably, the special-election victory of Scott Brown to replace the late Edward M. Kennedy in the US Senate--the preponderance of evidence suggests that Americans are much more anti-Obamacare than pro-Obamacare.   And yet none of that is included in the video.   Thus so the KFF video gets off on the wrong foot, using an assertion that is at best misleading.   
Next, Roberts’ narration takes up the issues that the Obamacare legislation purports to deal with, starting with the cost of healthcare:  

Let’s begin with the problems in our current health care system. Problem number one is, what problem number one usually is, money.  Most people agree that health insurance policies are too expensive. For a family, the average premium is almost $14,000 dollars a year...and growing. Premiums have doubled over the last nine years, ballooning way faster than inflation!  Plus, our population is aging, meaning more people with more health problems. So, health care costs are the fastest growing part of the federal budget.

In the minds of the KFF video creators, that’s an open-and-shut matter of fact: The biggest single issue in healthcare is the cost of care.   

But is that really the case?  When you go to the doctor, do you talk to the doctor about finance?   No.   You talk to the doctor about your health--what hurts, what’s not working, what might even kill you.    For their part, doctors go to medical school to learn the art of healing, not the art of financing.   At best, healthcare finance is a means to an end--the end is better health.   

Moreover, if we wanted to be churlish, we could note that so far at least, there’s no indication that Obamacare has had any success in restraining the growth of healthcare costs.  Indeed, Dr. Arnold Relman, emeritus professor at Harvard Medical School and also the former editor of the New England Journal of Medicine, Relman wrote recently in The New York Review of Books about the Obamacare bill, there was nothing in the design that will ever curb costsIt has also been promoted by its sponsors as a measure to control costs, but it is not.” but it’s only been six months, maybe that will change--although, again, it’s not at all clear that controlling costs is the right goal to start off with.  

But as noted here in the past at SMS, over the past 40 or so years, doctors and medical scientists have been dethroned from their place at the pinnacle of our healthcare system, replaced by a combination of public- and private-sector financiers.  And these financiers have persuaded Washington DC, at least, that the real issues in healthcare are financial.  In other words, financiers have sold the political elite on a vision of healthcare that is not unlike the financial vision of everything else in the country.  Everything is a financial issue, and if you hire the right bean-counter, backed up, of course, by a Wall Street “quant,” then every problem can be solved. Or if the problem can’t be solved, well, at least the financiers make money.  This “financialization” of everything is a problem everywhere, but it has deformed healthcare policy, to the point where healthcare experts, such as those at KFF, tell us that the issue is medicine is not medicine, but finance.  Perhaps the KFF’s roots, amid Kaiser Permanente, the big managed-care conglomerate are starting to show.  Such a pro-financialist bias might be perfectly understandable, but that doesn’t make the bias more accurate.  

But let’s not ignore the bureaucrats, and their role.  As narrator Roberts tells us, the other problem of healthcare that needs to be solved is the problem of access to health insurance:  

The second problem is that the system is full of holes. Like the fact that people buying insurance on their own can be turned down for having a pre-existing health condition. Small businesses may be charged extra if some of the workers are sick, making insurance unaffordable.  And some insurance policies have a lifetime limit on benefits. After that, you’re out of luck.  That means some of the people least likely to have coverage are the ones who need it most.

To be sure, access to health insurance is a problem, but is it really the second biggest problem in healthcare today?  In America right now, some 85 percent of the population has health insurance.  Meanwhile, more than 600,000 people die every year of heart disease, nearly that many die of cancer,  and rapidly rising diseases such as Alzheimer’s have no cure, no treatment, even.   Surely those death rates, and all the other medical problems that Americans face, deserve some higher priority.  

And so once again, we see the increasing influence of non-doctors, in this case, social-science-oriented policymakers and the bureaucracy.    If financiers have demoted doctors, so have social scientists.   As a result, we have a healthcare system dominated by financiers--including for-profit hospital executives, who seem to spend more time worrying about investor relations and their own bonuses than they do about patients and wellness--and bureaucrats.  And so it shouldn’t be surprising, then, that we are told that cost and access are the number one and number two issues facing healthcare.

So what’s number three on the KFF list?  Actually, there is no number three.   Echoing, once again, the arguments of Obamacare, the KFF video stops at those two issues: cost and access.   The goal of healthcare, according to the Obama/KFF mindmeld, is to hold down the cost and ensure universal access.   We can imagine a company that saw itself as providing a cheap product to all customers.  Never mind whether or not the product was good, the goal is that it is cheap, and that everyone could get it.   Such a company, of course, would not likely stay in business for long, but as we know, the government, as well as richly endowed private foundations, have their own ways of doing things.  

For any discussion of research and cures, well, you’ll have to go somewhere else, other than this video.   Those two words, “research” and “cures,” literally do not appear in the video, just as they have fallen out of the discussion in Washington.    And none of us--not even the financiers and bureaucrats--are better off for it.    


  1. “doctors and medical scientists have been dethroned from their place at the pinnacle of our healthcare system, replaced by ... public- and private-sector financiers.”

    “... financiers have persuaded Washington DC ... the real issues in healthcare are financial.”

    “ ... we have a healthcare system dominated by financiers”

    “we are told that cost and access are the number one and number two issues facing healthcare.”

    OK, everybody it’s time to smell the coffee! The financiers are also called ATTORNEYS.

    Wanna ‘hold down the cost and ensure universal access’?
    Let the uninsured go to doctors.
    Let the doctors send these bills to the IRS.
    Let the IRS give the doctors, say, a 30% tax credit.
    Any excess tax credits can be used to buy medical equipment. Non-Profits can do the same.

    So that doctors can truly practice medicine without worry about an attorney screwing them, then the first order of health care change is TORT Reform.

    It is not an easy subject that you are writing on Jim because they lie and distort to distract the likes of us, -you, me and J. Q. Public from the real issue, TORT REFORM.

  2. Nice post. Agree that tort reform is critical. This will save tens of billions of dollars (by anyone's estimate), protect patients from the risk and expense of unnecessary defensive medicine and relieve physicians of legal abuse. For some balance on this issue from the trenches, see www.MDWhistleblower.blogspot.com under Legal Quality.

  3. Jim:
    The financial people are messing up the government’s medical plan over in Ireland for Dentists. And they are not even lawyers like they are here! See
    The Irish Times - Tuesday, September 21, 2010

    “Why I'm closing my practice”

    “NEWS FOCUS: Draconian cutbacks in state-sponsored dental schemes (aka Plans) have led to a severe drop in the number of patients. Dentist Paul O'Dwyer tells his story ....... Then came the clouds. Last year, An Bord Snip Nua recommended that the PRSI (aka aka Plan) be downgraded. Efforts by the dental profession and considered opinion from health experts were ignored. An independent economist’s study showed that the PRSI scheme gave a three-to-one saving in real terms – in other words €3 saved for every €1 spent. But that too fell on deaf ears.”
    So here we have an opportunity to look into the future of our government health care plan. Open wide now; it’s only gonna hurt a little bit!
    After roses die, all we have left are their thorns! Obama Care are you listening?