Sunday, November 15, 2009

The healthcare dance

isconsin Political Fix
not just another blog
November 15, 2009

By Bill Kraus

Two great political adages are at play in the prolonged, complicated, contentious attempt to put together a new health care system for this country.

The first is that no one should have to witness sausage or legislation being made.

The second is that when major, complicated legislation is in the making (which you shouldn’t have to witness) the important thing is to get Mathilda on the dance floor.

Turf wars are what the health care bill is about, and it is a virtual golf course.

For openers, health care spending is 17 percent of our gross national product. This means that people and companies who are in the health care business are getting paid that 17 percent. That is the status quo that is being protected by insurance companies that do the paperwork, doctors and their helpers who do the mostly fee-for-service healing, hospitals that house the ailing, drug and device manufacturers that provide the stuff of which medical miracles are composed, administrators and managers who orchestrate this melange, and a collection of bystanders and outsiders whose interests are improved or threatened by the health care system and practices.

My own views on this collection of sausage makers:

1.) Insurers don’t belong at the table.
2.) Fee-for-service incentives rarely if ever lead to less of either.
3.) Physical facilities need to be kept full.
4.) Drug companies produce and promote the things they invent and sell; the cost of the former is irreducible; the cost of the latter is arguable.

The outsiders are too numerous to list but a small sample is that the ideologues led by groups as diverse as the Catholic Bishops, the anti-immigrationists, and the free marketeers are weighing in on medical practice policy in ways and with demands that mostly make change almost impossible.

With the lobbying costs running in the neighborhood of $4 million a day (an amount that is added to the “cost” of health care) and with the job protecting legislators being threatened or seduced by money and votes, it is impossible to produce anything approaching an ideal sausage out of the box.

Which gets us to Mathilda.

If anything is to happen, it is going to have to be imperfect, even a half measure.

The judgment that will have to be made is whether what does come out of the box is better than the status quo ante.

It is hard to believe that it will not improve on a health care system that costs twice as much as what is available in every other first-world nation and that delivers results that are no better than average and in many categories very much worse.

So let’s take what we can get, and, over time, improve on and expand the inevitably flawed sausage that is being assembled.

We couldn’t do worse. We can get a small or even a significant step in the direction of lower costs and better results, and once on that path we can do better and better and better. We will probably never get the kind of perfection the purists insist on. As for me, I’ll settle for, at long last, getting Mathilda on the dance floor.

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