Health Care

In the debate between Clinton and Obama on Tuesday evening in Ohio, Hillary got the first question and as a consequence the debate was steered by her into what became a tedious 16 minute colloquia on health care. I thought, for a moment, that I was watching C-Span.

I believe the candidates miss the point on the health care debate. I don’t know anyone who cares about the details of the candidate’s plans. I just tune out. Clearly, in the next administration, much attention will be given to the health issue by the Congress. The next President will propose a plan. Hearings will be held. A bill of some variety will pass and it will be distinctly imperfect.

When the candidates talk about health care, no one mentions the most important element in the discussion. That is personal responsibility. The key to good health is taking care of yourself. When I was a young man I read that the wise person learned to become their own physician/healer by the time they were 30. It is true. A vast amount of the cost of health care in America is a consequence of poor personal choices. Whether the result of obesity, cigarettes, alcohol, or a sedentary life style, self imposed ill health is very expensive. Any plan which does not include incentives for being well and taking care of yourself is, in my view, flawed.

Another aspect of the cost of health care, is the extraordinary cost associated with the last six months of life. In this country we will spend hundreds of thousands of dollars to squeeze out a few more days or weeks of sub-human life.

Add to this some fundamental structural inhibitors to quality health care. The system, over the past generation has become increasingly stove-piped in nature. There are experts for everything. It is rare, today, to find the wise general practitioner, who knows and treats the whole person. In recent experience with the medical establishment I have been perplexed at how difficult it was to identify the capital of the ship. Experts dart in and out. Who is coordinating the treatment of the person?

I am convinced that a fair amount of disease exists only because we define it as disease. The more disease we define, the more money available to create new experts to research the cure for yet more disease. And, then strangely enough, more disease is defined. It is a process that has nothing to do with a healthy life. Ivan Illich, the Jesuit social theorist, wrote a great book in the early 1970's entitled Medical Nemesis. It chronicled, now almost 40 years ago, the contrarian belief that the more money you spend on health care, the sicker you are. Unfortunately, no wide ranging social theorists walk the halls of Congress.

A thoughtful dialogue on these and other issues is difficult in Washington, DC where the conventional wisdom looks for the easy band aid solution. And, there is huge momentum behind maintaining the dysfunctional status quo. Most noteworthy is the disgusting Pharmaceutical bill passed in the dead of the night a few years ago. Pushed by Billy Tauzin, Congressman from Louisiana, it prohibited the Federal Government from negotiating prices with the pharmaceutical companies. With its passage, Tauzin left Congress and is now paid $2 Million a year as head of the Pharmaceutical lobbying group in Washington, DC. He belongs in jail.