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  Exhibit A: Why Oh Why is Health Care Reform so Hard to Do?

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« (Not So) Gray Hair | Main | EngAge... Baby »

October 5, 2007 |Permalink |Comments (2)

Exhibit A: Why Oh Why is Health Care Reform so Hard to Do?

Let's say that Congress decided to get behind some incremental changes in one part of our medical industrial economy. It could even get all optimistic and cool and call its package of proposals the “CHAMP Act.” The bill might, for example, improve coverage and benefits for children, extend Transitional Medical Assistance for people enrolled in “Welfare to Work” programs and, make it easier for elders to continue using community-based Adult Day Service Programs. Well that's exactly what it did and the AMA , AARP and National Association of Children's Hospitals have all applauded this legislation. Nice huh?

Oh, there is one more thing, CHAMP also...

“Takes into account recommendations from the non-partisan Medicare
Payment Advisory Commission, the bill refines payments for a variety of
institutional providers including skilled nursing facilities, rehabilitation
facilities, long-term care hospitals, cancer hospitals and rural and small urban
hospitals.”

It turns out that the nation's for-profit nursing home chains (and their defenders in Washington) are just not that into the cancellation of multi-billion dollar funding increases in their future revenues.

"The CHAMP Act, as it now stands in the House Ways and Means Committee, is highly detrimental to the long term care needs of 'America's Greatest Generation' as well as future generations - contrary to the claims being made by its proponents," stated Bruce Yarwood, President and CEO of AHCA.

So what does a big-time Washington lobbyist do?

How about running attack ads directed specifically at freshman Representatives who dared voted against the perceived interests of the nursing home industry? Here is the ad being run against Tim Walz in Minnesota's First Congressional District.

Congressman's Walz's is pushing back against the nursing home industry's fearmongering.

“For too long, these private insurance companies and big nursing home chains have reaped the benefits of Medicare overpayments, and when I voted for the CHAMP Act, I voted for legislation that will help the most vulnerable of our community: our low-income children and seniors.

The people of the First District don’t have to buy expensive and deceptive ads. They don’t have to hire expensive lobbyists. People in southern Minnesota can be confident that I have and will continue to cast votes that are in the interest of our children and seniors, no matter how many full page, color ads costing thousands of dollars the special interest groups can buy.”

Read the full text of his statement here.

So what's new? Congress withdraws promised increases in the nursing home industry's funding stream. The industry's lobby lashes out at the CHAMP Act's Congressional supporters (especially freshmen). Little changes. Another battle is won, lost or drawn.

It is easy to see that the American medical industry is huge and exceptionally powerful. Each component of that industry holds a laser focus on its own needs first and foremost. Each component has its own individual war chest that it can you to attack elected officials who refuse to do its bidding.

It is also easy to see that the public supports fundamental change in our health care system. Hundreds of millions of people can see and are appalled by the waste, the injustice and the failure to produce the quality health care outcomes enjoyed by citizens of other industrial nations. Despite the urgent need for reform, nothing happens.

It turns out that attack ad is asking the right question: “Why?”

A few years back, Jonathon Rauch wrote a brilliant book (Demosclerosis) that explained the paradox of popular support for change being stymied by gridlocked inaction.

Scott London captured the the crux of Rauch's argument nicely...

“In a stable, democratic society, pressure groups inevitably form to persuade government to redistribute resources their way... Taken one at a time, these benefits have practically no effect on society as a whole, so no countervailing group arises to stop the waste. But, taken as a whole, group demands gradually sap the effectiveness and flexibility of government to the point where no program can be cut and no subsidy eliminated without arousing vehement opposition from some group or another. As the number of interest- groups in a society increases, and as the benefits secured by groups accumulate, the economy rigidifies. By locking out competition and locking in subsidies, interest-groups capture resources that could be put to better use elsewhere.”

As a physician, I believe that this kind of insightful diagnosis is a starting point for action. I believe that our national health care policy is being held strangled by a powerful industrial complex. The only thing that can break its grip is a counter-force of educated citizens who can see past the spin, the self-serving distortion and the outright hypocrisy--- and are willing to stand together and fight.

When I was in medical school a fellow student started his third year (the most challenging phase of medical school) by posting a sign on his dorm room door. It read: “I must therefore I can.” Today I would amend that statement. “We must therefore we can.” In fact it's already happening. Take a look at VOTER Mel Strand's counter-attack on lobbyist-generated attack ads running in his hometown paper.

Comments ( 2)

One afternoon, I was in the backyard hanging the laundry when an old, tired-looking dog wandered into the yard. I could tell from his collar and well-fed belly that he had a home. But when I walked into the house, he followed me, sauntered down the hall and fell asleep in a corner. An hour later, he went to the door, and I let him out. The next day he was back. He resumed his position in the hallway and slept for an hour.
This continued for several weeks. Curious, I pinned a note to his collar: "Every afternoon your dog comes to my house for a nap. "
The next day he arrived with a different note pinned to his collar: "He lives in a home with ten children - he's trying to catch up on his sleep."

I cried from laughter
Sorry, if not left a message on Rules.

Posted by Melissik
May 2, 2008 2:35 AM

I read some of the posts and I think it is a great place! I can get boistrous with my lucid judgement Wanna very nice joke?)) What kind of tree has hands? A palm tree.

Posted by EZWilliam
November 11, 2008 9:26 PM

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