August 5, 2009
At a recent AARP Town Hall meeting President Obama shared a letter he received.
“I got a letter the other day from a woman,” said the President. “She said, ‘I don’t want government-run health care, I don’t want socialized medicine, and don’t touch my Medicare.’ And I wanted to say…that’s what Medicare is, it’s a government-run health care plan that people are very happy with.”
“Government-Run” is a phrase used for over a century to scare people away from health care reform. Yet about half of all dollars in our health care system come from a government source. Medicare – the health program for seniors, Medicaid – the health program for low-income families; Tri-Care the program for military families; the Veterans Administration – these are all “government run” programs.
‘Socialism’ is another scare tactic used for a century to keep Americans from solving problems with health care. Teddy Roosevelt in 1906 came close to adopting something similar to the German health insurance system initiated by Otto von Bismarck in the late nineteenth century. But fear of German military aggression stopped Roosevelt from promoting the German health plan. Roosevelt was accused of being a ‘socialist.”
Health care reform was a part of the 1912 presidential campaign and in 1915 model health reform was proposed but defeated. By the 1920s, the American Medical Association (AMA) had organized opposition to health care reform. Franklin Delano Roosevelt, Harry Truman and later Lyndon Johnson all met the wrath of the AMA and were accused of the evils of promoting ‘socialized medicine’ and ‘government – run’ health care.
President Johnson successfully navigated the health care mine field and created a compromise the AMA could support – a system known as Medicare and Medicaid. But when asked how he would control costs, he allegedly told his aide, “Don’t worry about cost. We will deal with that next year.” We are living with the consequences of not dealing with the hard questions of cost and quality.
The AMA was even active in organizing against Canadian efforts to create a provincial (state) based health care system. The story of Tommy Douglas, the architect of the Canadian system, provides insight into the tough fight to create what Canadian citizens now consider expected.
Critics of Canada point to bureaucrats directing doctors and to long waiting lines. But they ignore the insurance bureaucrats who decide whether to pay for a doctor ordered procedure and the millions of Americans waiting until life or limb are threatened, hoping they will recover without medical care because they simply cannot afford to see a doctor.
I spend many hours discussing health care concerns. Every fair, chicken dinner and festival I attend, the topic comes up. People are delaying care, paying way too much for poor coverage and concerned about costs eating up their business’ meager profits.
If there is one thing about which both sides agree it is health care costs too much. We pay twice as much as other countries and yet we aren’t healthier. We don’t need to spend more – we need to use what we spend wiser.
The answers are complex but doable.
Government ought not be the provider of health care but rather the referee in a system based on value not volume where we begin to pay for results, manage chronic disease, keep care coordinated and eliminate duplication, errors and inefficiency. We need to encourage doctors and hospitals to use electronic records and prescriptions. We need to know what treatments work best and reward success and best practices. We must build primary care, prevention and wellness as the foundation of our health care system.
This is not ‘government-run’ heath care. The sooner we get away from debating false choices – the sooner we get to a real discussion about health care reform. In the words of President Harry S. Truman, “We should resolve now that the health of the nation is a national concern; that financial barriers in the way of attaining health shall be removed; that the health of all its citizens deserves the help of all the nation.”