The Price of Health Reform

By John A. Farrell, Thomas Jefferson Street blog

I am generally late in embracing a television show. At home we tend to stick to movies and sports, until a friend whose taste we respect raves about something—Deadwood, The Wire—that we absolutely gotta see, and then I get addicted and start renting or buying the DVDs. So it is with House, M.D. which hooked us this fall.

Dr. Gregory House (played by the skilled Hugh Laurie) is a genius whose team of specialists are called upon, each week, to solve a baffling medical mystery. Like all television geniuses, House is a lovable curmudgeon, addicted to sarcasm, who provides most of the entertainment. He and his doctors toss around enough medical mumbo-jumbo as they discuss exotic viruses and order up MRIs, labwork and other hi-tech tests, to keep things interesting until the 47th minute of each hour-long episode, when the killer bug or syndrome is finally brought to ground. Oh yeah, and the fetching hospital administrator wears low cut blouses.

I bring this up because the great unanswered mystery in House is the very same query that dominates the current debate on healthcare. Every time I watch the show the political junkie in me shouts: "Who is paying for all those tests?" If you want an explanation for what is happening this week on Capitol Hill—watch House. Forget the conservative and liberal conspiracy theories about creeping socialism or the greedy insurance industry. What we are all really talking about is, "Who is paying for all those tests?"

As so many grateful middle-class Americans discover, the U.S. healthcare system is filled with House-like finales, where patients thank the doctors for using the latest advances in medical science to save their lives from some absolutely awful life-threatening illnesses—and the cost is never mentioned.

But somebody has to pay for all the miracle machines and procedures and drugs and lab tests. Meanwhile, waste is rewarded and, in too many cases, there is no happy ending. We need to cowboy up: We have managed to assemble a healthcare system that costs far more than that of other advanced nations, while not doing as good a job.

In the mid-20th century, with the enactment of Medicare and Medicaid and the increased availability of healthcare insurance, Americans rejected the notion that only wealthy heart or cancer patients get to be cured. But we dominated the world economy then. Now we ain't doin' so good. Competition from overseas has wiped out whole industries. Income and wealth aren't spread as equitably. Companies need to shave costs. And so, in healthcare, we have created an unwieldy machine with immense blessings, huge gaps and a soaring price tag.

Don't kid yourself. The current clash is no socialist or insurance industry plot. This is the fourth time—the Clintons in 1993, Newt Gingrich in 1997, George W. Bush and the Republican Congress in 2003 and now Barack Obama and a Democratic Congress in 2009—in the last two decades that a president and/or Congress have launched major initiatives to address this problem. If this latest try at "reform" doesn't work, you can bet your health that another president and Congress, under crisis conditions, will need to return to it again.

The Democrats, being big-hearted goofs, God bless 'em, are accepting the mandate they received last year and trying to insure more people, and save families from losing their homes or savings from catastrophic illness, by making health insurance a requirment—like auto insurance. They have enlisted the support of a lot of very influential and very worried stakeholders in the system who hope that, with government-supervised standardization, we can maintain our existing levels of care and research and somehow not go broke.

Universal insurance, protection from bankruptcy, and continued advances in medical science, then, are what the Democrats are offering for "reform" legislation that will end up costing us—you and me and our doctors and hospitals and the healthcare industry—hundreds of billions of dollars in benefits and higher taxes and premiums in the years to come. That is the tradeoff the Dems propose. You may like their approach or not. But don't delude yourself. There is no easy way out.

I remember, when I was a kid, how kindly Dr. Bennett would make a house call, appear at my bedside with his leather bag, take my temperature and urge me to be "brave as an Indian" as he gave me a shot. My folks probably paid him $15 in cash, and the government in Washington played no role in the transaction. But there were no mammograms or CAT scans then, and all he could do when my mother got sick was watch her die of breast cancer.

Gregory House has replaced Marcus Welby. We are doing a little better at staving off death. But someone has to pay the bill for the months and years we buy. Time to be brave as an Indian.

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