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Recent Newspaper & Online Columns by Kate Scannell MD

Congress at the helm of health care's sinking ship

By Dr. Kate Scannell, Syndicated columnist
First Published in print: 08/06/2011

THINKING OFTEN about health care, I am increasingly disheartened about the direction it's taking in this country. We seem to be sailing further away from a clear understanding about the goals of medical care, on an expensive junket with politics and commerce commanding the helm.

It feels that we are sinking a little, our ship also bogged down with the weight of the federal deficit and hefty health care costs. We anxiously hang on because it's the only ship in sight, but all of us know there aren't enough lifeboats to go around.

So the last thing our health care system needed was last week's tribal tantrums in Congress rocking the boat for political show. The harrowing rollick not only nauseated most of us passengers -- it also demonstrated that our political officers were inept and unsafe navigators of the financial crisis on which health care drifts.

Still, it is the same two-headed congressional body that could not talk its way out of a teacup last week that is expected to lead serious and imminent budgetary "discussions" about Medicare, Medicaid, and health care reform. As Popeye the Sailor Man said, "Shiver me timbers, and blow me down!" There simply isn't enough Antivert or Bonine on pharmacy shelves to steady everyone for that future spectacle.

I naively used to think of "health care" in terms of actual people -- health care professionals and patients, with enabling administrators in the background -- working toward the relief of illness and suffering, the promotion of everyone's well-being, the flourishing of communities.

But it's been a bracing life lesson to learn that, in reality, "health care" is as much generic body politic and impersonal public commerce. It is strongly influenced by ideological abstractions in the political arena that leave health care looking and distributing unevenly to real people, according to their financial standing, race, gender and age.

"Health care" is so intrinsically bound to market and commercial contingencies that its real-world meaning can only be determined in terms of access and someone's insurance status or ability to pay. "Health care" for a diabetic possessing insurance could mean a medication, active surveillance for kidney complications and blood sugar management; but for diabetics lacking insurance or adequate wealth, it could mean a slap on the back and good wishes, a prescription that can't be afforded, a follow-up appointment that won't be kept when its co-pay loses out to expenditures for food or rent.

Still suffering post-traumatic stress disorder after last week's congressional debacle, I doubt the capacity of the current political crew to make thoughtful, fair, evidence-based and coherent policy decisions affecting health care reform. I especially do not trust this particular Congress, wielding its blunt-toothed knife in the operating theater, to make necessary budget cuts in the least painful way.

Certainly, "health care" has never been divorced from politics, money and commercial lobbyists. But that doesn't mean that it must tolerate the relationship when it turns unacceptably abusive.

Currently, health care has become battered beyond recognition by political and commercial forces. Is it a for-profit market commodity like cereal? A luxury item that only some can afford? An article of trade varying in quality, reflected by the price tag? A "consumer service" negotiated with health care "providers"? A political concept shaped by government officials?

Whatever health care is, it is costing us dearly. In human terms, about 50 million Americans remain uninsured, primarily because of prohibitive premium costs -- 40 percent live below poverty level and more than 75 percent belong to working families. More than 60 percent of all personal bankruptcies in 2007 were medical bankruptcies, and the majority of those debtors were well educated homeowners with middle-class occupations. Physicians for a National Health Program estimate that 137,000 Americans died between 2000 through 2006 because they lacked health insurance.

Meanwhile, on a macroeconomic level, health care spending will consume fully 19.8 percent of our total economy by 2020, according to predictions last week from the Centers for Medicare and Medicaid Services. Our country faces financial bankruptcy if it can't find credible ways to tame skyrocketing health care costs -- and moral bankruptcy if its main strategy merely entails denying medical care, Medicare or insurance coverage to millions more Americans.

The real problem is the cost of medical care itself -- which is a unique and independent problem existing outside the Medicare program for the elderly and disabled, outside the Medicaid program for our poorest Americans. Escalating medical costs first and foremost drive the cost of these public programs. If a drug sells in the free market for $5,000, if a new imaging test prices at $3,000 per patient, if medication and hospitalization charges continue to rise relentlessly -- they do so within the domain of our profit-generating free market health care system, those expenses are just handed off to insurance programs like Medicare or MediCal.

Billions of dollars could be saved by promoting and utilizing nonprofit health care industries and services that, in a truly free market economy, ought to compete with profit-focused businesses. Millions could be saved by rooting out financial fraud and abuse in the entire health care industry, not merely the smaller Medicare sector. Millions could be saved through routine collective bargaining between our government and drug companies for less expensive pharmaceutical prices for federal health programs.

But no one in Congress is willing to tackle the problem of unregulated, unaffordable, ever-increasing health care costs and the powerful lobbying interests of the insurance, hospital, pharmaceutical, medical device and physician organizations who profit from the status quo. It is so much easier to cut costs by nudging the elderly, poor and disabled out of so-called entitlement programs. So much easier to pass health care costs on to small businesses and privately insured citizens as premium and co-pay increases.

Congress must prioritize a fundamental choice when it tackles federal deficit reduction later this year -- to either cut profit-generating health care costs through market reform, or cut off more Americans from medical care.

Still, until we agree on what "health care" is and what it ought to be, Congress cannot possibly make coherent public policies about it or rational decisions about what it's budgeting for. Until Congress can look at health care through a non-partisan lens, we will continue to suffer its clouded purview of medical science, and its vast blind spot in which many of us reside at great distances from health care's saving embrace.
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Kate Scannell is a Bay Area physician and syndicated columnist. She is the author of "Flood Stage" and "Death of the Good Doctor."
Copyright 2011, kate Scannell