Hoary platitudes on health care


AN ESPECIALLY pathetic event took place in the House of Representatives last week. A man labored mightily only to give birth to a mouse.

President Bush had promised that he would lay out a bold vision for health care in his State of the Union address. But what we BTC got was mousy, not bold.

The president had assured the voters of New Hampshire that he understood what it meant to lose one's job and thus lose one's health insurance; he had told the people of Pennsylvania that he got their message about the importance of health care access when they sent Dick Thornburgh packing.

If you listened closely during the speech, however, you might have thought the problem facing the nation was not inadequate access to health care but that your sink needed to have a washer replaced. The president's message was one of trickle down. Tinker a bit with the tax rates, jigger around a bit with the means to purchase insurance, keep competition lively, and things will be fine in what the president thinks is a system providing "the best quality health care in the world." He does not seem to have a clue.

The American health care system is dying. The bill this year will be $750 billion for a "system" -- using that word very, very loosely -- that fails to cover one-seventh of the population. Other countries don't spend anywhere near that much, and yet they cover everybody.

Our doctors and nurses are awash in a sea of red tape. Professional judgment is fast becoming the dodo bird of health care, driven into extinction by huge overhead and insurance costs. The chances are good that your doctor cannot order a test or direct you to a hospital without consulting a telephone hot line for a few minutes of bureaucratic flummoxing.

Hospital administrators cannot figure out how to keep their beds full. At the same time, emergency rooms in the inner cities are overflowing with poverty-level patients. In many cities and towns, patients recover from operations in the hospital corridors.

Many rural Americans cannot find a family practitioner without traveling across three counties. American children are being told there is no money for them to get transplants, vaccinations or prenatal care, while waterfalls of money are poured into high-technology care for the permanently comatose and terminally ill.

The unemployed and those without private insurance put off regular visits to the doctor and dentist while the nation frets about the rights of rich women to have their breasts enlarged for purely cosmetic purposes.

All of these signs of a system in its death throes are appearing in an environment in which people have no idea whether the treatment they receive will be effective, in which no information is systematically collected about services' outcomes and in which payers have no idea why the prices they pay are as high as they are.

The president must have a generous sense of what counts as quality to rhapsodize about our gasping and wheezing health care system.

Health care in America needs structural change, not tinkering. Simply putting money into the hands of the poor or giving tax rebates to the middle class will not reverse the system's downward spiral.

The president has offered nothing but a trickle of tired reforms riding a wave of hoary platitudes. It won't wash. Apparently Americans must look elsewhere for leaders willing to dish out the strong medicine that is necessary.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota and is a columnist for the St. Paul Pioneer Press.

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