Monday, January 10, 2011
How's This for a Healthcare Problem?
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?