Think of this as Volume 14, Number 9 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.
That's the difference between the American system (or any proposal from any party to change it) and the systems in place everywhere else in the world.
There are many ways to say “no,” and in America we do it with dollars. We say “no” when the money runs out.
If you're in the middle class, if you can't afford the health care premiums you're offered, the system says “no” to you in every respect. If you're poor, however, or old, or you work for the government, or you have a generous employer, or you're rich, or you're a kid, or you once served your country, however, we say “yes” to you on just about everything.
This is the system Republicans are defending. The middle class is squeezed and screwed, more people fall into this widening crack every year. We know the ultimate Republican goal, because they state it plainly. They want those other groups (save the rich) falling into the same hole. Health care is not a right, they say, but a privilege, something that you have to earn. No one should give it to you.
That's a consistent message but it's one that even Republican constituencies don't swallow in practice. The party's greatest gains in the last year, according to all opinion polls, are among those 65 and older. Medicare recipients. “Keep the government's hands off my Medicare,” these people shout.
It's sort of funny.
But the system Democrats are offering right now is little better. Everyone gets a pony. Savings will appear by magic. If everyone gets into the pool, we can afford to cover everyone. We'll just do some adjustments around the edges.
It's a lie.
Back during the 1990s we thought there was a way to say “no.” It was called managed care. HMO companies like Humana grabbed big hunks of market share by promising to control costs. They lost. Hospitals shifted costs onto other people, fought them at every turn, beat them in court, made it more worthwhile to give in than fight. Humana is now laying off tons of people and calling itself a “health insurer.”
Where will the authority to say no come from?
The best place for it to come from is science, from data. The health IT revolution now underway is designed to collect that data. Get everyone's health records online and we can do a database sort to see what treatments are most cost-effective. Not just which are effective, but which deliver the best bang for the buck -- in every case.
This is called “comparative effectiveness.” And it was the first thing tossed aside when the debate over health reform began. “You're gonna kill grandma,” cried the right, and liberals caved.
Here's the truth. Grandma is going to die some day. Get over it. So are you. So am I. Health care is not about immortality, it's about living as long as you can, as well as you can. It's about managing wellness, trying to cure sickness, giving you all the good days God may permit to you.