View Full Version : Obama: Bringing a Bazooka to a Knife Fight

08-19-2009, 02:33 PM
OK, the analogy of "fixing a watch with a hammer" is better, so sue me!

i highlighted a couple sections that were very apropos in light of this new liberal trend at ripping down our current quality of care.


Why health-care reform is so scary By Steve Chapman
Chicago Tribune

Published on Wednesday, Aug 19, 2009
CHICAGO: A hammer is a marvelous tool, but only for the right job. If you took an expensive watch to a repairman and he pulled out a hammer, you would be extremely nervous, if not aghast. Maybe he could find a way to do some good with that implement, but you would be more focused on the damage he could cause.

A similar scenario is playing out in the public anxiety over health-care reform. Plenty of people think the existing system is in need of repair. But when they hear about expensive plans that require a more powerful and intrusive federal government, they fear that what is best in our approach to medicine may get smashed in the process.

What is best in our approach is the exceptional quality it provides. Americans grasp that: A 2006 poll found that 89 percent were happy with the medical care they get. But President Obama and his allies in Congress don't seem to realize how good we have it.
He says though the United States spends more per person on medical care than any other nation, ''the quality of our care is often lower, and we aren't any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do.''

That's one of the favorite rationales for a government-led overhaul. But it gives about as realistic a picture of American medicine as an episode of Scrubs.

It's true that the United States spends more on health care than anyone else, and it's true that we rank below a lot of other advanced countries in life expectancy. The juxtaposition of the two facts, however, doesn't prove we are wasting our money or doing the wrong things.

It only proves that lots of things affect mortality besides medical treatment. Heath Ledger didn't die at age 28 because the American health-care system failed him.

One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

In their 2006 book, The Business of Health, economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.
That discovery indicates our health-care system is doing a poor job of preventing shootouts and drunken driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases.

Some of those foreign systems are great, as long as you don't get sick. Samuel Preston and Jessica Ho of the Population Studies Center at the University of Pennsylvania examined survival rates for lung, breast, prostate, colon and rectum cancers in 18 countries and found that Americans fared best.

The U.S. also excelled on other measures, such as surviving heart attacks for more than a year. Why? Because our doctors and patients don't take no for an answer. The researchers attribute the results to ''wider screening and more aggressive treatment.'' Another factor is that we get quicker access to new cancer drugs than anyone else.

Critics say all those great medicines and therapies are cold comfort to Americans who lack insurance — which by any standard is our greatest shortcoming. People without coverage are more likely to do without needed treatment or preventive care and more likely to die from disease or accidents.

But they have it better than you might think. Some 62 percent of uninsured Americans are satisfied with their medical care. That is probably because they get a lot of uncompensated treatment from the most advanced, ambitious and capable medical system in the world.

In Britain, by contrast, having guaranteed access to care doesn't mean you'll actually get it. Twenty percent of British cancer patients who might be cured become incurable while awaiting the treatment they need.

The challenge in this country is to extend coverage to the uninsured without degrading quality for everyone. With a little caution and humility, the president and Congress can find ways to achieve that goal. But first, they need to put down the hammer.

Chapman is Chicago Tribune columnist. He blogs daily at newsblogs.chicagotribune.com/steve—chapman.

08-20-2009, 08:18 AM
And some more common sense from a Dr. with some real and workable solutions:


By David Ignatius
Washington Post

Published on Thursday, Aug 20, 2009

WASHINGTON: Reading the transcripts of President Obama's ''town hall meetings'' this month on heath-care reform is painful. He's preaching the right gospel, but the parishioners are getting restless. The harder he tries to sell his program, the louder and angrier the debate gets — and the more the general public tunes out the politicians.

It reminds me of the polarizing Iraq debate of several years ago. Forgive the analogy between war and health care, but maybe Obama needs the medical equivalent of a Gen. David Petraeus — that is, a professional who can break through the political chaff and describe a strategy for reform that can unite the country.

I have a nomination for the medical commander role, and it won't surprise anyone who follows this issue: Dr. Denis Cortese, the chief executive of the Mayo Clinic. He's already doing what the nation needs — that is, providing high-quality health care at relatively low cost. Every time I listen to Cortese explain what's wrong with the system, I have the same reaction: Let him and other smart health professionals lead us out of the political morass.

Talking to Cortese this week, I heard two themes that cut to the heart of the current debate. First, he thinks Obama has made a mistake in moving toward the narrower goal of ''health insurance reform'' when what the country truly needs is health system reform.

Imposing a mandate for universal insurance will only make things worse if we don't change the process so that it becomes more efficient and less costly. The system we have now is gradually bankrupting the country; expanding that system without changing the internal dynamics is folly.

Second, Cortese argues that reformers should stop obsessing over whether there's a ''public option'' in the plan. Yes, we need a yardstick for measuring costs and effectiveness. But we should start by fixing the public options we already have.

Cortese counts six existing public options that should be laboratories for reform:

• Medicare, with its 45 million patients and a fee-for-service structure that all but guarantees bad medicine;

• Medicaid, with an additional 34 million beneficiaries;

• Military medicine, through which government doctors deliver state-of-the-art care;

• The Department of Veterans Affairs, which has improved performance at its hospitals by embracing new technology;

• The ''Tricare'' insurance plan for military retirees;

• The Federal Employees Health Benefits Program.

Adding a new public option for insurance, as congressional reformers are demanding, would be useful. But it's not necessary now, and it is creating a poisonous debate that's undermining the more important reforms — which are in the delivery system, not insurance.

If liberals really want to show they are serious, they should begin with our existing single-payer behemoths, Medicare and Medicaid. Cortese argues that the White House should mandate that, within three years, these programs will shift from the current fee-for-service approach to a system that pays for value — that is, for delivering low-cost, high-quality care.

If doctors performed unnecessary tests that ballooned costs, their compensation would be reduced. And doctors would be compensated by regional formulas, to encourage them to work cooperatively in local networks where they could all make more money by practicing better medicine.

What difference would such Medicare reform make? Take a look at estimates prepared by the Dartmouth Institute for Health Policy and Clinical Practice (which developed the national ''health atlas'' that was the basis for the widely read New Yorker article by Dr. Atul Gawande).

At current spending rates, Medicare will run a $660 billion deficit by 2023. But by cutting the annual growth in per-capita spending from the current national average of 3.5 percent to 2.4 percent (the rate in San Francisco, for example), Medicare could save $1.42 trillion and post a big surplus.

This ''pay for value'' approach would amount to a cultural revolution in American health care. It would take our bloated system and make it both cheaper and better. The adjustments wouldn't be easy, and the medical profession would balk unless respected doctors such as Cortese led the way.

Obama has been campaigning furiously in this crazy summer of bogus debates about ''death panels,'' but he's losing traction. Reformers aren't helping by drawing a false line in the sand over a ''public option'' when we already have one, in Medicare, that provides a laboratory for systemic change. I hope that Obama understands that his health plan is in mortal danger — and that it's time to call for the doctor.

Ignatius is a Washington Post columnist. He can be e-mailed at davidignatius@washpost.com.