Saturday, August 22, 2009

Treating the Symptom and Not the Cause

Bill Moyers interviewed Marcia Angell, one of the most insightful observers of the medical scene, and what comes out is an indictment against the current bills in Congress. A little excerpt from the interview follows:

MARCIA ANGELL: He [Obama] was right in his press conference, when he talked about cost as the central issue. And he said, if we don't control cost, not only will the health system continue to disintegrate, but it'll drag the whole economy down with it. What he has essentially advocated is throwing more money into the current system. He's treating the symptom and he's not treating the underlying cause of our problem. Our problem is that we spend two and a half times as much per person on health care as other advanced countries, the average of other advanced countries. And we don't get our money's worth. So, now he says, okay, this is a terribly inefficient, wasteful system. Let's throw some money into it.
BILL MOYERS: Into the same system?
MARCIA ANGELL: Into the same system. That's his problem. The other problem, in the press conference, was that he was trying to mobilize public support for a bill, and we don't know what that bill is.
TRUDY LIEBERMAN: I want to get to that point, because he's been vague right from the very beginning on this point. We have not known exactly what the Obama health plan has been. Even though the headline writers, and the press has been talking about his health care overhaul for months. And so, I like to step back and say, "Well, what exactly is he talking about? What exactly does he mean?" And he has not been clear on that.
BILL MOYERS: You said he's been AWOL, A-W-O-L--
BILL MOYERS: --on details.
TRUDY LIEBERMAN: He has been out to lunch on this. And I think that's a deliberate strategy on the part of the White House.
TRUDY LIEBERMAN: What they had done is learn from what they call the Clinton mistakes in '93-'94. And what happened then is that Hillary came out with this big 1 thousand-page bill, although we have now another 1 thousand-page bill. And let the special interest groups sort of pick it apart. This time, they decided not to do that. That they would be deliberately vague about this. And stay as vague as they could be until push came to shove. And so basically, it's my belief that this whole discussion about health care reform is flying over the heads of the American people. They know about reform, but they don't know-- they know the words reform, but they don't know what they mean at all.
BILL MOYERS: I had the same reaction you did to that press conference. And I woke up Thursday morning after the press conference, to the headline of "The New York Times" that read, "President Seeks Public Support On Health Care." And in the margin of the Times I said, "Does the public know what is in this health care--"
MARCIA ANGELL: He doesn't know. Nobody knows.
BILL MOYERS: Well, somebody has to know. They keep talking about it.
MARCIA ANGELL: Well, he says, let Congress do it. In their wisdom, they'll come out with something, and I will give you a few feel-good principles. And then we'll wait and see what happens. Because he doesn't want his fingerprints on it if it fails.
TRUDY LIEBERMAN: I feel the American people need to know what is in that bill. And what's in the bill is an individual mandate that is going to require all Americans with a few exceptions, to carry health insurance. And that means if you do not get insurance from Medicare or Medicaid or your employer. You're going to have to go out and buy health insurance. And that is a lot of money for most people because most of them would buy it now if they could afford it. About 85 percent of the uninsured require subsidies, because they can't afford it. And I think this is going to come up as a big surprise to people to realize they're going to have to buy insurance from private insurance companies or face a tax penalty.
MARCIA ANGELL: Well, that goes to the cause of the problem. We are the only advanced country in the world that has chosen to leave health care to the tender mercies of a panoply of for-profit businesses, whose purpose is to maximize income and not to provide health. And that's exactly what they do.
BILL MOYERS: The President, as you were saying a moment ago, is saying to everybody who's not covered, we're going to mandate that you exercise that right. We're going to mandate that you buy some form--
MARCIA ANGELL: We're going to deliver the private insurance companies a captive market. That's right. And they love that.
BILL MOYERS: Say that again.
MARCIA ANGELL: They love that.
BILL MOYERS: The-- his policy does what? His program?
MARCIA ANGELL: Delivers to the private insurance industry a captive market.
BILL MOYERS: By the mandate.
MARCIA ANGELL: By the mandate.
BILL MOYERS: It says "Marcia Angell, you've got to--"
MARCIA ANGELL: For whatever price they want to charge. Right. And so, this will increase costs. And let me tell you what he's running into, and he'd like to be able to pull a rabbit out of the hat, but he won't be able to. If you leave this profit-oriented system in place, you can't both control costs and increase coverage. You inevitably, if you try to increase coverage, increase costs. The only answer, the only answer, and he said it at the beginning of his press conference, is a single payer system. In his first sentence, he said, that is the only way to cover everyone.
BILL MOYERS: But he's also said, if we were starting the system from scratch, we could have single payer. But we're not starting this system from scratch.
MARCIA ANGELL: You know, you don't pour more money into a failing system. You convert.

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