Llewellyn King: A reality check for some Dems on fixing America's awful health-care 'system'

The Democrats on the left of the party, exemplified by Elizabeth Warren, Bernie Sanders and Kamala Harris, are running away with the health-care debate.

The problem for those who, like myself, want to see health care extended and rationalized is that the real goals of reform have been abandoned for “universal health care” as an ideological and political goal; add a political prejudice against corporations and the idea of the most health care for all of the people gets lost, as it did in the debates.

There should be only two goals in health-care reform: bring down the cost and see that everyone is covered.

We in the United States have the costliest medicine on earth. We also have the spottiest and most risible coverage. We spend over 18 percent of our gross domestic product on health care, nearly twice the cost of health care in other advanced countries like Britain, France, Germany and Holland. That is a huge cost, making us a less-competitive country. It comes not from medicine but rather from inefficient management.

We are a nation which venerates its business culture, but in health care, as it stands, we are protecting inefficiency as though it were a system. There are better ways, short of upending the whole structure, as Warren, Sanders and Harris would like to do, of fixing the system.

Serious reform is seriously needed.

Children’s National Hospital , in Washington, D.C., for example, I am told, employs 150 people just to deal with the insurance companies, negotiating payments, securing permission for procedures and protesting disallowances. Presumably, there are as many people in the insurance companies on the other side of these transactions. None of this huge personnel deployment is delivering health care or serving medicine. They are engaged in health care’s equivalent of a souk -- bargaining care for money. It should change because it is enormously wasteful, let alone because it fails in its mission: delivering care to the sick.

Remember the old military saw: We had to destroy the town to save it.

In full bay at the Democratic debates in Detroit, Warren, Sanders and Harris were in competition both to junk all private health insurance and to trash the companies that provide it.

I have spent three decades studying health-care delivery. While I am an unalloyed admirer of the National Health System (NHS) in the United Kingdom, it is not for the United States. Not now.

I know the NHS: It has treated my family well since its inception and, briefly, myself. But I do not think we can trash what we have here root and branch and install a duplicate NHS. We have too much that would have to be changed; too large a new bureaucracy would have to be created.

I am in favor, though, of the government as a payer of last resort for those who cannot get coverage and those for whom treatment is too expensive for the insurer.

We need to regulate medicine and to take the uncertainty out of it. That uncertainty extends from patients who never know when they will be sideswiped by an out-of-network procedure and routine providers, to the hospitals which need to know what they will be paid. Coverage should be guaranteed, not negotiated.

I used to own a newsletter publishing and conference company in Washington. I provided health insurance, which cost me in well-being as well as dollars. The costs went up relentlessly and coverage was problematic. My top aide came down with a rare cancer. The treatment was fine, all paid for, but the post- treatment painkillers were not allowed. I tried to persuade the insurer -- after all, we were a 20-strong group. They would not be moved. So my aide, who is French, had her sister send the medications from France, where she could get them for free as a citizen.

If we can get the horror of negotiation out of the system, care would be better, and costs would fall.

I am told that the future might be based on what already is working well with Kaiser Permanente, an integrated managed care consortium that insures, provides doctors and hospitals in the package.

It is worth a look -- before we start shelling the system to save it.

Llewellyn King is executive producer and host of White House Chronicle, on PBS. His email is llewellynking1@gmail.com and he’s based in Rhode Island and Washington, D.C.

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Complication and opaqueness breed corruption

  Respond by rwhitcomb51@gmail.com

 “In its majestic equality, the law forbids rich and poor alike to sleep under bridges, beg in the streets and steal loaves of bread.’’

--  Anatole France

Ambrose Bierce famously defined politics as the "strife of interests masquerading as a contest of principles. The conduct of public affairs for private advantage.’’ There are people of principle in politics, but Bierce’s statement is a pretty good generalization.  The Founding Fathers would have generally agreed with it.

The Supreme Court’s  recent McCutcheon ruling, in which it struck down overall limits on campaign contributions by individual donors, is much less important than many have made it out to be. Yes, it’s true that yet more money will flow into the campaign cycle. And, yes, America’s oligarchs will continue to accumulate power, aided by the general public’s civic disengagement.

But money flows around campaign-finance laws as water flows around rocks in a river. I doubt if any limits have all that much effect. After all, look at the record since Watergate-era reform laws went into effect. There are so many monetary methods by which rich folks can influence politicians to help maintain or expand donors’ wealth and power. And as government has gotten bigger, there’s more and more reason to buy influence in it.

A couple of things, however, could level the playing field a little. One would be tougher (not more) laws mandating transparency in campaign gifts. If more voters could find out who’s giving what to whom, they’d be better able to make evidence-based decisions on Election Day. Back when I was a newspaper editor, I tried to find out who was funding an op-ed writer and/or the “public interest’’ group he/she was writing for and then note it at the bottom of their essays. Much of the time they turned out to be pushing an economic self-interest -- e.g., the climate-change deniers were paid by oil and coal companies, those fighting medical-malpractice reform were funded by trial lawyers’ associations. But all too often I gave up trying to find out. Deadlines!

Indeed, news organizations (most are understaffed) rarely try to discover the paymaster behind opinion pieces. And it can be very difficult to find out, though such organizations as Guide Star, FollowTheMoney.org and the Sunlight Foundation can sometimes help cut through the smoke from the smoke machines of economic royalists.

Another thing that could help reduce the prostitution in Washington is vastly simplifying the tax code, which has been endlessly complicated to please economic interest groups and do social engineering. The more complicated – and the perception it can be complicated even more – the tax code, the more donors are drawn to bribe members of Congress to manipulate it to the donors’ advantage.

Enacting a modified flat-tax system would dramatically reduce campaign corruption and free up vast amounts of time now spent to game the impenetrable code that Congress and the White House have given us over the decades. (Don’t blame the IRS – they’re just following orders.)

Likewise with other laws: The more complicated they’re made, the more campaign donors bribe elected officials to manipulate them and the regulations to enforce them. Complication favors corruption.

Finally, the majority of the public could, for a change, vote. Before that, they could study the issues, and find out who’s paying whom. But they probably won’t bother.

xxx

Let’s laud Rep. Tim Murphy (R.-Pa.), a clinical psychologist, for pushing what would probably be the biggest improvement ever in the federal government’s support for programs to address mental illness. It’s a complex measure but two elements stand out. One would put federal support behind court-ordered treatment of certain severely ill people (bi-polar disorder and schizophrenia victims particularly come to mind). Most states allow, in varying degrees, this sort of mandatory treatment, which is often the only thing that works.

The other thing is easing the disastrous federal law of 1996 that has made it almost impossible in many cases for family and other caregivers of mentally ill people to get actionable medical information on these sick people – and thus can make it almost impossible to treat them. Of course, this bleeds into the rest of the health-care system: Think of how many more overtly physical illnesses stem from mental illness.

xxx

How wonderful  finally to be able to walk around outside without four layers of clothing, to see a few more patches of green grass, more crocuses and even daffodils every morning, albeit on south-facing slopes. As the writer Bill Bryson noted, New England’s beauty is undermined by the difficulty of strolling in it for several months of the year.  I say that an old person for whom harsh weather becomes more inconvenient every year. Still, if winter weather slows the arrival of the Ebola virus, I’ll take it. Colder places are generally healthier places.

Robert Whitcomb is a New England-based writer, editor and business consultant.