White House Chronicle

News Analysis With a Sense of Humor

A Plea to Start Again on the Whole Issue of Health Care

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The process now underway in Congress to repeal and replace the Affordable Care Act (Obamacare) reminds me of what would happen if you tried to thread a small darning needle with a strand of bulky yarn: It won’t go through the eye. The more you try to pull the strand through the eye, the less useful the yarn coming through it will be.

Therefore, isn’t it time to reconsider the whole proposition as though there were no Obamacare, no House version of its replacement, and no preconceived objective beyond affordable care for all?

Also, there should be no pre-established conditions, such as single-payer and multiple-payer; no pre-established goals, such as preserving particular insurance practices and expectations that employers will always be part of the deal; and no expectation that the health-care bill should also be a tax bill or a welfare bill.

Its simple goal should be to free people from fear of medical catastrophe and enable physicians and hospitals to care for the sick without commercial pressure.

I’ve come to the belief that big, new ideas are needed from my own experience as an employer-provider. For more than 30 years, as a small Washington publisher, I provided health insurance for my staff of 25. It was a nightmare that got worse as medicine got more expensive.

Of many strange situations, none was worse than the employee who developed nasopharyngeal cancer, a rare type of head and neck cancer. The insurance paid for chemotherapy and radiation, but refused to pay for expensive painkillers. These had to be brought in from France by a family member.

Maybe the most discouraging was a printing-press operator who wanted the premiums given to him, as he refused to see the point of insurance, although he was married with three small children. “We don’t use insurance,” he declared. “When the kids are sick we go to the emergency room and tell them we have no money.” When pressed, he said they did this because they didn’t want the bother of filling out forms.

If you think, as I do, that the system we have is less than perfect, one is immediately thought to be a believer in British-type national health insurance. Not necessarily so.

As a former citizen, I know something about Britain’s National Health Service and I think it is better than what is happening in the United States. I’ve received treatment in Britain under the system and members of my family in England are devoted to it. There is good treatment for major procedures. However for lesser ailments, there are long waiting lists. Bureaucracy is everywhere.

Worse, can you imagine a health-care system dependent on the budget cycle in Congress?

In Switzerland there is a totally private system, which looks like improved Obamacare. Everyone is obliged to buy insurance, just as everyone has to pay taxes. There are no limits on troublesome things like preexisting conditions. The government regulates the insurers. In a referendum, the Swiss rejected a switch to a single-payer system by 60-40 percent.

There also are mixed systems in Germany and Holland. The commonality is that everyone is covered and the governments regulate. That way, insurance pools are large and have the correct mix of old and young — otherwise the old will overwhelm any system.

Unless we devise a structure that caters to all, we will continue with overburdened emergency rooms, preposterous hospital charges and doctors who will pick and choose their patients.

No one on a gurney being wheeled down a hospital corridor should be thinking, “How will I pay for this?”

The chances are that when Congress has finished trying to thread the unthreadable needle, there will be a groundswell on the left for single-payer — better, possibly, but not a fit in the United States.

Meanwhile, there are too many pre-existing conditions in congressional thinking. We need a new prescription, a bigger needle and a finer thread.

Photo: CALDWELL, IDAHO – NOVEMBER 9 2016: at healthcare.gov getting ready to start an application. txking / Shutterstock.com

Obamacare’s Silent Constituency

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In the end, as so often, it all came down to one person. In this case Chief Justice John Roberts.  He sided with the liberals enough to save the basic provisions of the Affordable Care Act.

In the tumult the wailing and the sighing, the gentlest of gentle sighs, inaudible to all but those who know, comes from the permanently sick, just-alive people who suffer from the immune system disease known as Chronic Fatigue Syndrome, called Myalgic Encephalomyelitis in much of the world. This is a disease little understood and under-researched, which it is believed afflicts 1 million Americans.

It is a disease that has no mercy. It is almost without exception a life sentence, robbing the victim of normalcy. Its symptoms include total collapse after exertion, especially after exercise; sleep that does not refresh; periods of months or years of being bedridden with pain from bones “that feel as though they are exploding,” according one victim, Lynda Haight; and a mental fog that makes the simplest task, like paying bills, too difficult many days. Other symptoms include extreme sensitivity to light, noise and normal city and suburban noise.

To this community of the lost, this cohort of hopelessness, Obamacare is a blessing; a small blessing but one that may grow in time when a cure is found, or at least when a therapy which relieves the suffering is developed.

These are the very people — sick, voiceless and hidden in in plain view – who have been shunned by insurance companies.

Those patients who contracted the disease in childhood have never been able to get insurance. They are the quintessential preexisting condition demographic. No room at Hippocrates Inn for them, even if they can afford it. Others have been dropped when they reach lifetime limits embedded in many policies.

Sadly, most of the expenses of those living this zombie life spend money not on being cured but being tested and using off-label drugs (drugs that are used for a purpose other than that for which they have been certified) in an endless search for partial, temporary relief.

Marly Silverman, a patient activist and director of PANDORA, a coalition of Chronic Fatigue Syndrome groups, said that had the Supreme Court decided otherwise, patients with chronic disease would have been forced back to uninsurable limbo.

For now, the apparent saving of Obamacare is a mercy for all the lifetime diseases. But it has a particular meaning for CFS sufferers because there is no easy diagnosis of the disease, and the patients often look quite well. It is a cruel irony that many CFS patients do not show signs ofbeing sick, so they are accused of sloth and malingering when they are as sick as can be.

Which is where the power of one comes in.

Women tell stories about devoted husbands — maybe the most famous being author Laura Hillenbrand’s. Also there are loyal wives who take up the burden, as in the case of Courtney Miller of Nevada, who is crusading for recognition for the disease that afflicts her husband Robert.

In other cases, lovers and spouses have taken the exits, leaving the prostrate to the additional suffering of loneliness and often poverty. Some sufferers are among the homeless. There many cases of victims living in cars and getting scant recognition or help from either the SocialSecurity Administration or doctors who take Medicaid patients.

John Roberts has become an important person in some very sad lives. For now he is the “one.”— For the Hearst-New York Times Syndicate

Universal Health Care — It’s Addictive

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Opponents of President Obama's health care legislation were wise to attack it preemptively in the courts on constitutional grounds.

If they hadn't attacked now, they would've learned that universal health care systems – sometimes a hybrid of public and private and sometimes single-payer national systems – are wildly popular in other countries.

So popular that politicians can do no more than fiddle at the edges, as they have done in Britain recently and are about to do in France. No leader, not even that incontrovertible defender of private enterprise, Margaret Thatcher, dared or even thought, to privatize health care.

In the industrial democracies, from Canada to Japan, people complain about their health care systems and would defend them to the death. Once universal health care is introduced and people are relieved of the fear of illness, leading to financial ruin, it is unrepealable.

The opponents of Obamacare must know this, or they wouldn't have been so anxious to test it in court on the grounds of the constitutionality of the individual mandate. Kill it before people love it was an imperative.

Now it's widely believed, after three days of hearings, in which conservative justices sounded more like they were conducting a congressional hearing than a judicial one, that Obamacare will be thrown out before it has ever been sampled by the public, which wouldn't come until 2014. It's been a bit like the Chinese and democracy: Don't let them try it, they might like it.

So how is it the Republicans have been able to so demonize Obamacare? Partly, it's because the administration has done an appalling job of selling its own program. It's almost as though it's ashamed of its offspring because it isn't the child they really wanted: a simpler bill with a public option and such goodies as interstate insurance sales.

The administration is frequently bad at trumpeting its achievements. As health care reform is its defining domestic issue, the fact that Obama and his cabinet have not extolled the virtues of the bill amounts to a curious dereliction, a sin of omission.

Most people have been persuaded, if they know anything about the bill at all, that it's socialized medicine (it is not); that it will double expenditures on health care (it won't); that it's an enormous new dictatorial intrusion into individual liberty (it's not).

It's not a great bill, but a good start.

We in the United States spend about twice as much as other countries on health care – about 18 percent of our gross domestic product.

Why? Everyone knows there's excessive testing and waste. The quick answer is to defend against lawsuits. Another answer is that doctors have no incentive to save money and through their investments in testing companies, often they have an incentive to order up the tests.

Mostly, I suspect it's just indifference; the medical equivalent of not turning the lights off.

I don't like Obamacare because it only does half the job and I'm uneasy about the individual mandate. Just two cheers from me.

The uninsured should be assigned an insurer and the premium collected through the tax system. That way the insurers would compete for the most desirable prospects, young adults, and a real pool would operate.

Another question that isn't asked: As new technology usually brings down costs, why does this not apply in health care? Why are CAT scans and MRIs not getting cheaper, as they would if they were in a different framework?

Why not use the Republican idea of health vouchers as an incentive to keep patients from frivolous use of services – not as the substitute for insurance, but rather as an incentive mechanism. Pay them to stay healthy.

We suffer from a failure of imagination in health care.

There are good reasons to be ambivalent about Obamacare, but it's a start, a building block. Our medicine is without peer, but our concepts of care are quite sickly. – For the Hearst-New York Times Syndicate