One useless person is a depressing sight. Two useless people are a law firm and three or more useless people constitute a congress. As we watch the Obama administration back away from “change you can believe in,” there is no place where it is greater illustrated than in the question of health care. He was smart enough to appoint a Nobel Prize-winning physicist to deal with energy issues. Why in the world would he pick mere politicians to deal with health care, which is the single largest business and expenditure in the United States? We’ve moved from Tom Daschle – who didn’t know how to pay his income taxes – to a governor from Kansas. What exactly does she bring to the table? I have no idea what makes this person able to comment on health care in the United States.
The principle task of anyone who leads the discussion on health care is that they must LEAD THE DISCUSSION ON HEALTH CARE! They have to talk about issues that are not comfortable or politically correct. Somebody has to be the stalking horse who will get out there and talk about the things we need to discuss. What are those issues? Number one: The shift in the dependency ratio. How many people are sitting in the wagon and how many people are pulling the wagon? The huge shift in this ratio means that this is an aging country and we are no longer going to be able to retire at 67 or 68. The number may have to go up to 72. We are no longer going to be able to supply certain services to everybody through insurance programs. The real question is, who has the courage to carry on the discussion about the limitations of health care. Nobody in Washington minds if you use the “F” word; nobody wants you using the “R” word. Rationing frightens the living daylights out of everyone in this country. If you think we’re held hostage by the National Rifle Association, think again. It’s the American Association of Retired Persons (AARP) that is going to closely monitor any real change in health care.
This is the only country of the 17 western democracies which cannot carry out an intelligent discussion on end-of-life issues. What emergency physician has not watched an 89-year-old with terminal Alzheimer’s brought in for the treatment of their pneumonia? What are we doing? Why have we decided that ministering to dying flesh is better than helping the young?
There is no reasonable way to spend your way out of this situation. The current stimulus package is probably a misnomer and a mistake. To think that we are not going to have pain and suffering while pulling ourselves back into line is a joke. And that pain is going to fall – to a great degree – upon how and what we give out as health care. You can’t avoid it. It’s the largest single expenditure in the United States government. The only way that is will be resolved will be through catastrophic inflation. There are two things everyone should do when they go home tonight. Number one, rethink how health care needs to be given. Number two, teach your children to bow politely to their Chinese masters. If the Chinese are no longer willing to fund the debt, we are, as a country, screwed.
The time for small, itsy bitsy band-aid solutions is over. Someone is going to have to lead. Someone is going to have to make real suggestions. Someone is going to have to ask why the Singaporeans are able to have better health stats for one-quarter the money. Someone will have to ask why the Germans can figure out what therapies they will and will not give for breast cancer and we can’t. This is a politically-driven agenda, not a scientifically-driven agenda. We are encountering forces that are so entrenched it’s beyond belief. To think that there will be respect commanded in the medical community by an ex-governor of Kansas is a joke. We need to bring people to the table who can talk about the history, the worldwide activity, and the future of what’s actually happening in health care. It is almost an affront to tax-paying citizens of the United States (and to our children who will inherit this mess) that we allow someone appointed to that job who, quite frankly, can’t articulate the real issues involved.
If not the governor from Kansas, and if not a former senator who can’t figure out how to pay his taxes, who should sit in the seat as secretary of Health and Human Services? There are plenty with health care policy experience and real ideas who ought to be leading this discussion. I don’t agree with everything Uwe Reinhardt from Princeton has to say, but I respect Uwe Reinhardt as a mind. This is a man who has devoted his life to health care policy. He is, by birth, a German. He understands hard decision-making. And Mr. Reinhardt represents only one of at least a dozen major figures who are well known in the United States, have at least reasonable respect from the American Medical Association, and could at least present a series of discussions which we could all relate to. God save me from this compulsive need to appoint people who can’t get honest jobs to positions where they’ll lead major discussions in this country.
Greg Henry, MD, is the founder and CEO of Medical Practice Risk Assessment, Inc. Dr. Henry is a past president of ACEP and directed an ED for 21 years.