My prescription for what ails us all

Kerr-plunk!

Oh great. I just dropped my Axe antiperspirant into the toilet. Well, this is a great way to start the day.

I’m sure all of us have dropped things into our toilets that didn’t technically belong there. The sound of the splash is quite unique. It has an unusually musical tone. It must be the echo chamber effect from the shape of the bowl and the depth of the water. You just don’t get that kind of noise when you throw your cell phone into a pond.

But I heard that musical splash a second time today when I logged-on to the Associated Press to check the morning headlines.

White House appears ready to drop ‘public option.’

Kerr-plunk! Health care reform just got dropped into the toilet.

Well, I’ve said numerous times that I’m not smart enough to fix health care, but it is becoming apparent that I’m smarter than a lot of the folks in congress; so today I’m introducing the LifeAfterDx Health Care Repair Plan.

So here is my prescription to “fix” American health care: first I need five guys with machine guns and a wall.

Sorry, that was out of line. Leave it to the chronically ill to have the blackest senses of humor. But being chronically ill also shapes my thoughts about our health system. I view America’s health care system as being diabetic. It has a chronic, progressive disease that cannot be cured. It gets worse every day. Left untreated the complications will be unimaginable both in terms of human life and in terms of cold hard cash.

But like diabetes, absent a cure, a good treatment is the next best thing. So how do we “treat” our sick health care system?

Starting from the foundation let me say that in my heart I believe that profit has no place in health insurance. But I am no fool. There is entrenched power and money in this fight that cannot be defeated. And maybe it shouldn’t be. I really don’t like the idea of legislating an industry out of existence; even a vile and distasteful one. It doesn’t feel right. It doesn’t feel American. We are a capitalist democracy.

Health insurance for profit should never have been allowed to exist, but it does, and here we are. They are part of the reform process, whether we like it or not, and the sooner we all accept it, and take the thumb tacks off the chair we left for them at the table, the better.

I think we should start our treatment of the sick health care system by giving every American New-and-Improved Medicare. My idea is that the government provides a basic foundation for all citizens. The private insurance companies can then focus on supplemental plans in a competitive market place.

The New-and-Improved Medicare for everyone would use a single payor model. It would be heavy on preventative care, something we simply do not invest in right now. We only spend 2% of our health dollars on prevention. That must change. All of you with diabetes know that preventing complications is preferable to treating them.

So we’d pay for annual physicals, and dental cleanings, and eye glasses, and mammograms, and medications that are standard of care for all the common illness our people suffer.

To encourage people to use the plan I’d offer tax incentives for reaching healthy targets. In Japan they fine people who are overweight, using the logic that such people will cost the health system more. I don’t think sticks work well with the American character; but we do respond well to carrots.

So good BMI, good cholesterol, good blood pressure. Thank you. By keeping yourself healthy you are saving us money. Please knock a thousand bucks off of your taxes this year.

Oops! Not quite to goal on that cholesterol? Here, we’re going to give you the tools and meds you need to fix that, so that next year you can knock a thousand bucks off of your taxes.

We wouldn’t force anyone to take care of themselves. And we’ll treat your self-inflicted gunshot wounds because it is the right thing to do. But if you make an effort, we’ll reward you.

This “universal” Medicare would not be a Cadillac plan. It would be bare-bones, basic. But it would help shape a healthier society. Now if the government has invested heavily in preventative care, the population should be healthier, and thus not need to use their supplemental insurance as much or as often. This (assuming the insurance companies where honest and all of that) would lower the cost of the bells-and-whistles insurance add-on plans.

I’d leave Pharma pretty much alone, as I recognize that without a profit motive there is no incentive to develop new treatments. However, I would leverage the national buying power into serious discounts like Wal-Mart does on everything it sells. I would also ban direct-to-consumer advertising. I don’t think you should “ask your Doctor” about any medication. I think you should tell your Doctor where it hurts and let him or her figure out what’s wrong and how to treat you.

I’m not sure about the Ken and Barbies and the samples. That situation has improved. And of course I want them to give my Tiger book to every medical office in the country so I have a bias, damn it. But medically . . . no. We should not allow direct marketing to doctors either. Nor should we allow sampling. (Second hypocrite alert: samples keep some of my patients alive until we can arrange permanent supply.) But like the realities we must face with private insurance, sampling and marketing to medical professionals realistically needs to be left in place.

But to balance this, we should establish a national internet clearing house run by the FDA that lists new meds in a universal format with all relevant information.

Hypertension? Your doc goes to the web site and gets a list of meds, new and old, with the latest scientific data on effectives and side effects; with each med presented in the exact same format. I’ve seen some horrendous distortion of scientific fact in materials brought in by drug reps. Statistics don’t lie. But you can use them to lie if you pick and choose your numbers selectively.

In short my prescription looks like this:

Everyone gets a free, basic plan that is heavy on prevention.

Everyone who pays taxes can get a break for reaching and maintaining healthy targets.

Private insurance will be limited to supplemental plans in a free market place.

Pharma could not advertise direct to consumers.

A national medication facts data base would be established for health care providers.

OK, sounds good, you say. But how do we pay for it? Well, long range it will actually pay for itself. Right now we spend billions treating really serious stuff than could have been prevented. Unfortunately, our society has lost all ability to plan for the long term. All of our corporations, institutions, and even our citizens can only think of short-term gain. Rome wasn’t built in a day. This will take time to fix. We’ll have to not only pay for preventative care for those not yet sick, we still need to pay to fix those who were denied preventative care over the last twenty years.

Like putting pennies into a piggy bank, I think we should pay for the plan from dozens, maybe hundreds, of sources.

If the basic plan is free, then companies do not need to provide health insurance to their employees. There is a pool of money there. Yes it would be some sort of tax, but it would actually save companies money and remove one of those scary every-year-it-costs-more balance sheet items.

We could tax unhealthy foods like we do cigarettes.

We could tax the supplemental plans.

We could have a bake sale.

But I think the simplest and fairest approach is a national sales tax on all goods. We already have the apparatus in place for collecting sales taxes levied by cities, counties, and states. A national sales tax is fair in that those who make more tend to spend more. It is an indirect way to get the wealthier to pay more without socking them with a higher percentage.

(As a side note, I do believe in “tax brackets.” Ten percent is harder to give when you make $10,000 per year than when you make $100,000 per year. I think the more you make the more you should contribute, but that is a fight best left for another day.)

On the current efforts at “reform,” I’m going to be first to admit failure. It has degraded into nothing more than forcing all citizen to buy products from the folks who helped create this mess. To buy products that increase in price at double-digit annual rates. The current “reform” is a prescription for disaster. We are asking the foxes to watch over the hen house.

This congress will not give our sick system the treatment it needs. This congress will tell it to take two aspirin and call back in the morning. They will create a bill that amounts to nothing and declare a victory. Many supporters of reform will get on board, resigned, thinking that something is better than nothing. They will fool themselves by saying, “let’s get something started and we’ll fix it later.”

I disagree. I accept that there is no cure, but I will not tolerate a band-aid. Give our system a robust treatment it needs to keep it healthy even though it is chronically ill. If we accept the band-aid congress will never act further.

Our health care system is in the emergency room. Maybe it needs to be in ICU before the fat cats will take the illness seriously.

President Obama: flush this bill when it reaches your desk. We can . . . we must do better.