A recent online commentary from Ezekiel Emanuel in the New York Times Opinion Pages (“What We Give Up for Health Care” at opinionator.blogs.nytimes.com/2012/01/21/what-we-give-up-for-health-care) is a bit of a rant on how “liberals,” in their drive to get universal health care coverage, miss the point that a health care system that is too expensive makes “coverage” all but irrelevant. I wasn’t particularly persuaded by Mr. Emanuel’s slanted opinion; and based on the vast majority of the hundreds of comments to this rant, I was not alone. What I did find very interesting was the degree to which so many respondents expressed frustration and anger with a system that seemed to them to do so little general good for so much money. Every participant in our health care system, from patient to provider to insurer to politician, was fingered (almost literally) as THE major contributor to the failure of health care in the U.S.
Explore This IssueACEP News: Vol 31 – No 03 – March 2012
I also found it interesting that no matter how this criticism was leveled, it inevitably came across as a political statement, from the left, from the right, from the center, from Socialists and Libertarians and even Anarchists. This left me with the question: in a presidential election year, is it possible to have an opinion about health care that isn’t political?
One of the recurrent themes that come up in the comments to Emanuel’s piece is the role of profits in the cost of health care in the U.S. Liberals mostly suggested that the profit motive undermines our health care system; conservatives rallied around commercial health care insurers and venture capital as health care’s saviors. When it comes to Medicaid, I have argued in The Fickle Finger [blog] that there is just not enough meat on the bone to support good care, reasonable reimbursement, AND profits for investors. I guess that would make me a liberal, but I am not entirely opposed to for-profit enterprises on the commercial side of health care. Sometimes, the profit motive encourages inventive solutions to difficult problems, and at other times, it is just expressed as greed and manipulation. In health care, when providers have “skin in the game” (HMOs, for example), this can result in good care for less cost, or it can result in unconscionable indifference to suffering. Kaiser is very good at cost-effective care, but the group has also had its share of stumbles.
I am not sure we will ever get to the answers to the many problems in America’s health care morass if we continue to make this about the politics of health care. In politics, there are always winners and losers. What we need are improvements in the system that make winners of us all. The only way I know to do this is through science. I don’t mean scientific advances: not all advances in health care science are either affordable or even desirable. I mean using the scientific method to make distinctions between effective health care systems and ineffective health care systems, between good care delivery and not so good care delivery. It amazes me how little we have invested in doing good solid research on cost-effective care. We spend billions on trying to distinguish between a drug that is very good and one that is just a bit better, and not nearly enough on finding which drug is good enough, or simply, when enough is enough. Oh, and by the way, when I mean “good science,” I am not talking about studies supported by foundations funded by someone with an agenda. In 2012, there are more than enough agendas to choke a donkey, or an elephant, or both.