The Truth in Healthcare Act.
The pretty July days are upon us and there are so many ways to enjoy them. But Mr. McConnell has decided we need to have one last go at a healthcare bill, so it’s back to pain and misery instead.
The first Senate healthcare bill was conceived in secret, like some dark convening of the Death Eaters in a Harry Potter movie. McConnell’s new one is coming at us in the full glare of the spotlight. We all get to watch the spectacle of the Senate Majority Leader tossing out fistfuls of blood money as he tries to buy the votes of the last principled Republican holdouts.
Nobody thinks this is a good idea. When I see the pinched looks on the faces of McConnell & Co I’m reminded of that old Greek fellow who was condemned to spend eternity rolling the same boulder up a hill while eagles pecked at his flesh.
It doesn’t need to be so painful. There is an easy way out of the mess the party now in full control of the U.S. government has created for itself.
All they need to do is tell the truth.
I know, for a politician the idea of telling the truth is about as appealing as drinking hemlock. Trust me. It works. There is pain at first. But it’s a ripping off the Band-Aid sort of pain. Then the truth is out. Everyone feels much better. We can all move on. Why do you think we Catholics have been dragging ourselves to confession for two thousand years?
So in the interest of turning all those Republican frowns into smiles, here are five truths to inspire a fresh start for healthcare for the U.S.
Truth Number One: the past seven years of promising to repeal Obamacare was political windbaggery, strategically impressive, but with zero substance behind it.
There was never a bright policy idea, no sense of what American healthcare would look like post-repeal. It was all empty words. Everybody knows that. Why not admit it and move beyond the conceit that the Republicans somehow owe the nation a bill, even if it’s a terrible bill, solely because they’ve been talking about it so long. This is a hard truth for Republicans to swallow and we can all feel their pain. But they’re professionals, and will know how do it in a statesmanlike way. It will make everything that comes next so much easier.
Truth Number Two: Obamacare has flaws, and has been further damaged by seven years of relentless political assault.
There are things that need fixing. Sooner would be better than later. The adults in the room know what needs to be done. They could patch up the existing law in a week or two and Congress will still enjoy some lovely days off in August. The rest of us will continue to benefit from a law that’s doing some solid good in the country. And we’d all have some breathing room to discuss as a nation whether there might actually be some better way to get the job of delivering healthcare done.
Truth Number Three: healthcare accounts for one-sixth of the U.S. Economy.
You read this in every news item about the healthcare debate. So yeah, it’s expensive. There are massively big numbers involved. Any sense that we’re going to find a way to do this on the cheap is an empty political promise. It’s more productive to talk about what we get for the money. In today’s news: an item about the first ever treatment that genetically alters a patient’s own cells to fight fatal cancers in children. A miracle with a $300,000 price tag. And worth every penny if it’s your kid in need of said miracle. Right?
Here’s some back-of-the-envelope math. One-sixth of a $27,000 yearly salary is about $4,500. That effectively prices you out of the healthcare market if you still plan to feed your kids. One-sixth of a million dollar salary is $166,000. That will buy decent healthcare for you and a lot of other families, and still leave plenty to pile onto the golden hoard in your bank vault. You see how truth helps us look at things in an interesting way?
Truth Number Four: sooner or later we’re all going to die.
Most of us would like to opt for later. Doing everything we can to eek out a final few months of life is a big part of what’s making healthcare so expensive. About half of America’s $3.4 trillion annual healthcare bill gets spent on just 5% of patients. Throwing those people out of the insurance market isn’t going to change that. Putting a cap on Medicaid isn’t going to change that. Selling Ted Cruz’s cheap junk insurance plans to young, healthy people isn’t going to change that. One thing that can help is an honest conversation between doctor and patient about the point at which a life is meaningfully ending, even if the machines are still working to move fluids through the body. For that conversation to happen the patient needs to be in the system. Not freshly thrown out of it by the Senate bill.
Truth Number Five: the free market doesn’t work very well for healthcare.
There are a lot of reasons for this. The most basic is that for the healthcare market to function like other markets we’d have to be willing to stand by and watch a lot of people die. So it’s not surprising Americans get nervous when they hear House Speaker Paul Ryan say things like, “We’re going to have a free market and you buy what you want to buy.” People who aren’t Republican Members of Congress understand that thinking your life is over because you can’t afford the latest iPhone is different from thinking your life is over because you can’t afford to see a doctor about the lump growing in your neck.
It gets more frightening when politicians start throwing around free-market terms like “disruption” and “creative destruction,” or when Senator Mike Lee says he’s going to tear out the system that helps so many people pay for their doctor visits “root and branch.” We have families to feed and mortgages to pay and work to attend to and, hopefully, a few beautiful summer afternoons left to spend sitting under a tree with a good mystery. We don’t want to worry about our access to the miracles of modern medicine being creatively disrupted.
Ted Kolderie, who has spent a lifetime thinking about system redesign, has a new book out titled Thinking Out the How. He offers some sage advice for those who honestly want to make the delivery of healthcare more innovative. “The transition to the different must be gradual. And voluntary. The existing system will remain in place, improving, while the innovative appears.” He calls this the “split-screen strategy” for reform. He also says there is a 10-year pattern to big social changes like this. The Republicans have been working to repeal Obamacare for seven years. If they get serious about reform and start to involve ideas from the Democrats and the healthcare community, we should expect a good result by the end of the current presidential term rather than at its beginning.
These are by no means the only truths about healthcare. If you have others you think worthy of inclusion hit Reply and add them to the list. But these are the kind of truths Mr. Jefferson would have described as “Self Evident.” They’d form a solid core to an effort to honestly improve the delivery of healthcare in the U.S. One that maintains the access that an unvarnished free market would take away, while encouraging creative ideas and incentives so whole thing doesn’t turn into two-sixths of the economy. That’s what we really need to be talking about as a nation.
We could even name it The Truth in Healthcare Act, and Mr. Trump can finally tweet that he has “A beautiful new HealthCare bill fully approved and ready to go!” For once he would be telling the truth.
As always, I appreciate what your your green hearts do to help get this out into the world.