Senate Majority Leader of Harry Reid, D-Nev., center, accompanied by Senate Democrats, speaks during a health care news conference on Capitol Hill in Washington, Wednesday, Dec. 23, 2009. From left are, Senate Banking Committee Chairman Sen. Christopher Dodd, D-Conn,, Senate Health, Education, Labor and Pensions Committee Chairman Sen. Tom Harkin, D-Iowa, Sen. Patty Murray, D-Wash., Sen. Debbie Stabenow, D-Mich., Reid, Senate Finance Committee Chairman Sen. Max Baucus, D-Mont., Sen. Barbara Mikulski, D-Md., Senate Majority Whip Richard Durbin of Ill., Sen. Arlen Specter, D-Pa.
(AP Photo/Manuel Balce Ceneta)
Details of the health reform bill likely to pass the Senate on Christmas Eve have been difficult to divine. Most media and political interests have highlighted only those few provisions that support their particular points of view out of hundreds of items in the two-thousand page document.
A step forward:
Generally, despite some giveaways to specific senators in exchange for their votes, the proposal takes a giant step forward toward solution of a crisis worse than anything greedy bankers visited on us during last year’s holiday season. The biggest difference is that last year’s financial crisis was able to be manipulated by government in the short term. A health care meltdown would be much worse and unmanageable by its very nature.
The consequences of doing nothing:
In 2009, America spent $2.55 trillion on health care or between double and triple what anyone else pays for the same services. It would be reasonable to expect that this outrageous expenditure would buy us the best health care in the world. When stacked up against similar nations, America ranks 17th overall. The United States trails dramatically in almost every health metric.
It has been difficult for the public to know who to believe and on what subject. Elements of the bill have been exaggerated by both political sides for maximum effect. In particular, Republicans want to know what the rush to passage has been all about. Voters deserve an answer.
Attempt to terrify:
There has been a deliberate attempt to frighten voters by those who oppose change. Rather than seek an accommodation with the administration, a well known professional organization vowed “to exhaust the association’s treasury, if need be, to prevent passage of the … health insurance scheme.” They made a special assessment of all their individual members to build up a “political war chest” and hired a high-powered public relations firm to conduct its campaign.
The year all this happened was 1949. Harry Truman had just been re-elected. The organization in opposition to what they called "socialized medicine" was the American Medical Association. They assessed each member physician to join in the opposition and even printed negative brochures liberally sprinkled around doctor's offices.
Nothing has changed very much since 1949 except some of the players. Republicans remain in opposition. The AMA now agrees that reform is necessary. The insurance, pharmaceutical, hospital, and medical device lobbies have replaced them in opposition.
Reasons for action:
Growth of the economy since 2000 has averaged only 2.8 percent per year. Growth of health care expense has averaged 7.5 percent per annum over the same period. Relatively simple math tells us that health expense will overwhelm everything else in a relatively short period of time.
Personnel shortages:
Even worse, there are 730 thousand licensed physicians in the United States currently or about 2/3 of what is normal in similar countries. Of these, 250 thousand are now aged 55 or older. Even with increases in the class sizes of the 146 U.S. medical schools, America can’t replace the number of doctors who will retire in the next ten years.
And we will need even more physicians than that because in 2020, there will be 340 million Americans compared to only 300 million today. Similar shortages exist in other specific clinical specialties like nursing, various medical technicians, and you name it. America does not have the capacity or the teachers to train the people it needs.
It takes 15 years to train a doctor after high school. They currently graduate with an education debt of up to $250 thousand. America is out of time to get the job done even if we begin today.
Politically possible now:
America needs to act NOW because the super majority in Congress and the Presidency makes it possible to do so. To wait even until next year makes it more politically difficult to act because of mid-term elections. The minority party has proven that it will not act by its historical opposition for over a half century. Nothing they have put forward holds up to scrutiny. Why should we trust them now?
Minority suggestions fly in face of long held positions:
Most luke-warm minoriity recommendations run directly into constitutional questions of state's rights which up until now have been held inviolate by each of them. Torts, for example, have always been litigated on the state level. Interstate sales of health insurance as suggested would trample state licensing and requirements on insurance providers. These folks don't want to help. They just want to get in the way.
Making fast food in slow motion:
Following health care reform through both houses of Congress and the European Union has been a learning experience and not necessarily a positive one. The way in which America passes its laws has been aptly likened to the making of sausage. Please believe this if you believe nothing else. No one wants to know what is really inside a hot dog or a bratwurst.
Administration tactical positions:
In 1993, President and Mrs. Clinton presented a finished product of a health care reform plan to the Congress for consideration. After a year of study, the Clinton finished proposal did not even make it out of committee.
This time around, President Obama laid out general principles and told the Congress to work out the details. It has been messy and not the best possible result. It is, however, a result. Whatever is wrong can be fixed via the incremental approach favored by the minority
The polls:
Pay no more attention to the polls taken by media and political outlets about health care than you would pay to the little man behind the curtain in the “Wizard of Oz.” What you see reflected is a growing and deserved frustration with the process of making all those hotdogs.
Once the smoke clears, the result will gain in public support. Americans won’t believe there was ever a time when access to health care was not a right. Today, America is the only advanced country where health care is not a right.
What is really in those 2000 pages?
The bill that will go into the conference committee following the holiday has nine main titles or subdivisions. The next few columns will be devoted to explaining what is provided in each section.
Al Portner is a former daily newspaper editor and publisher in seven states and author of the forthcoming “Mark Twain and the Tale of Grant’s Memoir.” He can be reached at alanportner@theassignmentdesk.net.
For more info:
Primary physician shortage complicates reform
Doctor shortage may be mitigated by PAs and NPs
Status Quo will bankrupt country by mid century
Why is American health care so expensive?
America's health care challenge
More nurses needed
How America compares with the rest of the world
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