Monday, January 10, 2011

How's This for a Healthcare Problem?

"Hundreds of residents had been seized by the disease within a few hours of one another, in many cases entire families, left to tend for themselves in dark, suffocating rooms."

Steven Johnson, from his book “The Ghost Map: The Story of London's Most Terrifying Epidemic - and How It Changed Science, Cities, and the Modern World”

Not much was understood about disease and how it spread in the early part of the nineteenth century. In London -- perhaps the most civilized of cities at that time -- the medical profession theorized that the black plague and cholera were spread through miasma, the foul smelling stench that emanated from factories and sewers. London’s population had more than quadrupled in the first half of the century and the city was unprepared for the impact of more than 2.4 million people.

A cholera epidemic in the 1840’s had killed thousands and led to the creation of the General Board of Health. Despite the Board’s efforts, an outbreak of Cholera threatened London again in 1854. Inside of a week, over 100 people died and many more were sick. Seventy-five percent of the residents of Soho fled the city leaving factories with a dearth of workers. There were calls to shut down the factories as they were thought to be the primary cause of the miasma.

Dr. John Snow did not believe in the miasma theory and he set about to prove that contaminated water was the cause. The science of epidemiology was in its infancy and it wasn’t as simple as peering at water samples under a microscope. Rather, Snow acted more detective than physician. He famously mapped the cases and triangulated on a public well – the Broad Street Well -- that had been contaminated by sewage.

The city government shut down the well. How? By removing the pump handle. Wouldn’t it be great if all such problems could be solved so easily?

The following year, the General Board of Health drafted a bill for consideration by Parliament. The Nuisances Removal and Diseases Prevention Act threatened to curtail or shut down factories by regulating the foul odors that emanated through the city. Its proponents continued to promote the theory that miasma caused disease. Businesses objected vehemently. In their view, the bill jeopardized their ability to continue to do business.

In other words, the bill was a “job killing” healthcare law. Dr. Snow testified on behalf of industry, reasoning that since factory workers were no more likely to die of the disease than other residents of the city the smell could not be its cause. The bill was defeated.

I guess some things never change.

Today, congressional Democrats, who believe that the government should engage in economic intervention, argue that we are the only industrialized country that does not provide universal healthcare to its citizens. As though that is a good reason to do anything!

Meanwhile the Republicans have labeled Obamacare as “government controlled healthcare” and have promised to “repeal and replace” it. Huh? Replace it with what? If you think that government controlled healthcare is bad, then just repeal it! They point to the US Constitution as the proper construct and who can argue with that. It’s an extraordinary document and no other country has been able to improve upon it in the last 230 years.

In my view, all of the political rhetoric is a distraction.

The Brits don’t even have a constitution. And, whether the foul stench of 1850’s London was causing disease or not, it was probably a good idea to get rid of it. It’s not there today so something must have happened in the last century and a half.

There’s no question healthcare needs reform. The rising costs threaten our economic security.

Fifty years ago, the AMA feared Medicare and decried it as “socialized medicine”. Over the last two generations the program, which is a bottomless pit of taxpayer money, has made many a doctor filthy rich. Meanwhile, roughly 40 million Americans have no coverage. Many, who can afford it, can’t get it because of pre-existing conditions or some other nonsense. (I’ve been there, personally.)

The problem with Obamacare is that it doesn’t address the core problem – cost. So, what should we do? Like most of you, I have opinions but lack expertise. However, I have read a number of studies including one by McKinsey and Co. which compares the embedded costs of our system to others in the industrialized world. McKinsey lays it down to three simple matters that need to be addressed: (1) the rapid growth of outpatient costs due to higher utilization, (2) higher pharmacy costs and (3) higher administrative costs (including malpractice claims). I won’t go into details. If you’re interested, you can read the study by clicking HERE.

Those who would argue for no change (let the market decide) are not coming to grips with reality. The current system is not free enterprise. And, anyone who doesn’t think it needs reform is simply nuts. The reason that government needs to be involved is that the industry is too fragmented. Unlike for example the auto industry, there is no dominant player who can drive standards and automation into the supply chain like GM did in the 80’s.

That said, the country simply cannot afford another entitlement program when the national debt threatens our financial security.

We will undoubtedly be treated to lots of posturing by politicians and blathering by pundits. Ignore it. It’s a distraction.

It really comes down to one question: WHO WILL LEAD?


  1. HealthCare .... Hey, why don't we do what the President did about the deficit, form a committee? But then, I guess that still doesn't answer the question, "WHO WILL LEAD?" We had a leader, but he died 4 Presidents ago. He said that Government run Healthcare was not about HC but it was about Government control. In my mind, he hit the nail right on the head.

    In your blog you stated: McKinsey lays it down to three simple matters that need to be addressed: (1) the rapid growth of outpatient costs due to higher utilization, (2) higher pharmacy costs and (3) higher administrative costs (including malpractice claims).

    Until those issues are addressed by anyone speaking about HC, then we are pissing into the wind. We have the best HC in the world. We have one of the worst systems of delivering and administering it.

    "WHO WILL LEAD?" ....... It's not the obama administration and I don't think it's the 112th Congress. Then it has to be the electorate in the 2012 elections. If "We The People" don't wise up and quit bringing self-serving people to the forefront, then we get what we get. It's not Leaders, but "Ideologues" with agendas. THEY WILL LEAD ...... just not where we want or need to go.

  2. You said, "Meanwhile the Republicans have labeled Obamacare as "government controlled healthcare" and have promised to "repeal and replace" it.  Huh?  Replace it with what?"

    I have asked many of my Republican friends exactly this question, and, to a man, they have no answer. They are hell bent on destroying Obamacare, but methinks it is mainly because a black guy has his name on it.
    When I suggest that Obamacare was modelled on Mitt Romney's plan, they look blankly at me, like deer caught in the headlights.'
    A staunchly Republican (Tea Party) pal suggested that culling the herd, by letting those die who couldn't or wouldn't buy health insurance, was the nation's best policy. I've always felt it a disadvantage to argue these sorts of topics when in someone else's home. The feeling was strengthened when he mentioned he had several weapons ready for when government collapsed. A little later I noticed his gun cabinet and curiously inquired if I could see his collection. He refused, and told me there were guns in there that he didn't want folks to know about; they weren't for killing deer!

    You quote England's Health System, and as I have experience of it, Australia's and Canada's, I can perhaps shed more light on the current state of affairs in the head of the Commonwealth's system.

    There are two tiers, The National Health, which will provide a basic service to everyone, where with less critical things you will stand in line, but you'll get reasonable service; this is paid for by a compulsory deduction from all employees wages. Then there's the additional Private Care System, where, if you afford it, you pay a premium which will push you to the front of the line with plush service. Not perfect, but everyone gets care and, unlike the USA, the poor get economical care, not in the expensive ER. I've heard of folks going to the ER because their kids have ticks and "What are you going to do about it!" They even phone for an ambulance, because they don't want to pay the taxi fare.

    So much has been said, mainly by Republicans, decrying the British National Health Service, but it is a smoke screen, and is completely ignorant of the facts.

    I was under the impression that Obamacare was designed to reduce the overall cost of health care, to cut the waste etc. etc. But who to believe? Where are the figures? What mathematicians have done these calculations. I want to see them! My math is ok. I can read a balance sheet, but where are they? It's not rocket science! Someone ought to be able to cut through the fat and show us the truth.

    Until then, no one will lead.