A Reader Responds
I published an opinion piece about health system reform in the Salt Lake Tribune on July 11, 2009 (read it here).
One reader (RFKay) responded like this:
Yes, Joe. The whole system is dysfunctional. And it makes me sick that
President Obama has to compromise, to support "what works" to get Republican
(and Democratic) votes to pass health care reform. Health care should not be
profit-driven & market-based like so many free market fundamentalists in
Utah fervently believe. Covering the uninsured is the principal MORAL &
ETHICAL problem that health care reform needs to address. No matter the quality
of Utah's health care, it still leaves hundreds of thousands without access to
affordable care. Hence the absolute necessity of a public option that makes
health care for ALL a reality. Why does it have to be argued in Washington? The
whole system is dysfunctional, remember? That's what the smirking Utah
legislator on your website's video doesn't care about: the common good. There is
no social conscience in a business plan, no effort to promote "the general
welfare," except that of shareholders. We should be, as another writer on your
website wrote [my paraphrase], free of the burden of worry that our current
[market-based] health care system imposes, we could all be truly free to pursue
happiness for ourselves, our families, our communities, our nation. We've got a
president who can connect all the dots. I hope your PAC, Joe, is truly about
reform - not just health industry shills, and has been talking with the White
House and our Congressional delegation.
First, thanks for taking the time to participate in this vital community conversation. It's obvious that RFKay considers health system reform to be of utmost importance. I applaud all willing to work towards a better health system. I can name many people who share this commitment. But far more are not informed and remain aloof. To them, I restate why this issue is (or should be) foremost on the domestic agenda: Health system reform is necessary to preserve the American way of life. Health care costs are expensive, but the opportunity costs of our current health care system are threatening our tax base, our education system, and our economy.
Now to RFKay's particular concerns:
1) The whole system is dysfunctional: This was originally my statement intended to counter Pres. Obama's premise that in health system reform, we should build on what works. I contend that nothing is working. RFKay has offered a different meaning, more along the line of reasoning that health care is nationally dysfunctional so we need a national solution. It is unclear whether RFKay agrees with me that Obama's premise (building on what works) is incorrect, though it is clear that RFKay invests faith in Pres. Obama's approach to health system reform, a particularly finds a national approach appealing. As for me, I'll stick with my original meaning. To begin with, there is no national health system in any functional sense. People seek health care on a local or, with necessary referral, regional basis. Yes, those with means can go to the Mayo Clinic (or equivalent), but that is a vanishingly small part of health care. State lines often, though not universally, define health system referral patterns. And some states are large enough to have more than one regional health system. Utahns are fortunate to have a health system which is essentially region leading for the Western Intermountain area. But we have ourselves to thank. Over the years we have built this system penny by penny, tax by tax. It is far less expensive to operate than is the case elsewhere in the country, though there is nothing particularly laudable about being less expensive than the most egregiously expensive health care in the entire world. And we have the same inefficiency and quality problems found elsewhere in the US, needing reform. Improvements here can make a difference here. Entirely different improvements are needed elsewhere in the nation. To nationalize is to average all health care regions together and lose these distinctions as well as the improvements that the people of Utah have earned. What Massachusetts passed for health system reform will not necessarily fit our circumstances. We should not pretend otherwise.
2) "It makes me sick that Pres. Obama has to compromise": Here RFKay has asserted that Pres. Obama has actually proposed an ideal for health system reform which he has not been able to defend in Congress because of detractors on both sides of the political aisle. That, in fact, is not true. Pres. Obama has clearly left the articulation of what health reform will be to Congress. He has been clear about only one thing: that nothing, not even campaign assertions, is off the table. He has indicated a willingness to tax health benefits even though he castigated John McCain for proposing such. He has been for a public option and then agreed that perhaps other approaches would work. Unlike the Clintons, who actually published a book about their health system reform proposal, Obama has no actual proposal. Unlike Obama, the Utah Healthcare Initiative actually has a proposal (see the outline by clicking the "executive summary" on the website, URL below).
3) "Health care should not be profit driven and market based": I agree, as I have articulated so many times on this blog. Health care is not a commodity efficiently distributed by a market. Please peruse the nearly 250 entries on this blog to review the extensive reasons why that is the case.
4) "Covering the uninsured is the principle moral and ethical problem that health care reform needs to address": I believe that it is equally morally imperative that we assure, through health system reform, that our patients are safe and served by a system that does well what is known to work while avoiding the delivery of inappropriate care. In fact, universal financing for health care, RFKay's moral imperative, is financially unachievable on a sustainable basis without the quality improvement that I have asserted has equal ethical standing.
5) A public option makes health care for all a reality: Not necessarily true. This blog has numerous entries detailing the various arguments for and against the public option. I refer the reader to these various entries and the documents to which they are linked. To summarize, it is not at all clear how the public option would function or whether it would be affordable for all. Regional differences in cost (see item #1 above) make national public option function particularly tricky. One thing is eminently clear, however. The public option does not remarkably increase efficiency in our health system and it does not automatically improve quality. Without these reforms, it is simply true that with our without a public option, our health system is not economically sustainable.
6) "I hope your PAC is not just an industry shill": I have spent 20 years advocating for comprehensive, sustainable health system reform. I have appeared giving testimony before three state legislatures. I have spoken with dozens of elected officials in private, including 4 of Utah's current 5 members of Congress. I have twice been nominated as a candidate for the Utah legislature and run campaigns principally featuring health system reform. I have served on numerous public panels in Utah and many other states discussing health system reform. I have briefed dozens of other candidates on this issue. And I have spoken to thousands of individual citizens. This has been my avocation and life's work, for which I have never received remuneration. My health system reform advocacy has been costly to me and my family both in time and treasure. The Utah Healthcare Initiative accepts political donations in order to pursue health system reform which holds the interest of the patient foremost above any other concern.
7) "The smirking Utah legislator": RFKay has a low opinion, both of Utah's legislators and apparently of Congress, believing them to be uninterested in health system reform. My opinion about the possibility of a 'legislated' solution to health system problems, whether state or national, has been amply outlined on this blog. I don't have a uniformly bad opinion about our elected political leaders. In fact, I am persuaded that some are sincere and hard working. However, the 'sausage-making' process of legislation, I find, is not suited to major problem solving, but rather to incremental changes. Sustainable health system reform will not be accomplished in increments and we do not have the decade or so of time to slip stepwise into a better place. I urge summary health system reform by ballot initiative because health system reform is necessary now to preserve the American way of life.
Please contact me if there are any questions.
Join me in advocating for what will actually change the plight of the patient.
Dr. Joe Jarvis