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How To Improve Our Health Delivery System Without Destroying It
The Advocate
By Herb Denenberg, The Advocate
There’s only one thing worse than the planned universal health insurance system that will surely be proposed during the next few years. The damage it will cause is bad enough, as it will destroy the best health system in the world, and that is so despite all of its defects. But even worse than the damage is that it will be irreversible.
So the grand planners of a new system ought to take a more incremental approach. The risks and uncertainties of the introduction of a gigantic national system simply aren’t worth taking. So I would suggest the alternative of fixing one subsystem and then gradually working forward from system to system.
This enables the planners to test one variable at a time, providing more certainty than if all changes occur at once. This incremental approach also allows you to judge the quality of your thinking. If you try something and it bombs, then you know you not only have to go back to the drawing board with your plans, but you may also have to re-evaluate your methods and your personnel.
This idea came to me while reading the book of one of the nation’s leading experts on geriatric medicine. Dr. Robert N. Butler is president of the International Longevity Center, and in 1975, he became the founder of the National Institute on Aging of the National Institutes of Health. In 1982, he founded the first department of geriatrics in a U.S. medical school at the Mount Sinai Medical Center. That’s what his book’s dust jacket says, but I was even more impressed by the fact that he is in his 80s, and is still going strong and has not retired.
Dr. Butler writes that we are now spending only 1 percent of our health care dollar on prevention. That has to be foolhardy, as it is universally agreed that it is easier and more economical to prevent disease than to treat it or cure it. The cost consequences of failing to practice prevention are perhaps the leading factors in the skyrocketing cost of health care. I’ve always been impressed by Campbell & Campbell’s book, The China Study, which found that a properly designed diet would virtually eliminate most of the most deadly and expensive chronic diseases of our time such as heart disease, hypertension, stroke, diabetes and more. We understand what has to be done in diet, in exercise, in stress control, and a few other basics. In fact, the great Jewish physician Maimonides long ago wrote that almost all people will die as a result of their lifestyle.
So a program of prevention can be added to the present system, delivering huge potential saving in money, and delivering huge potential additional years of good health.
This incremental approach has another advantage. We can actually afford it. We can’t afford universal health insurance, which would only put us further into deficits, debt and economic stagnation. Still another advantage is we can do it step by step, in a sequence that can be carefully tailored to our resources, our administrative capability, and our priorities at the moment.
We can’t say the same for universal health insurance. In fact, its advocates always make the argument that we need the massive fix to bring about what we need. Barack Obama, for example, in his Iowa City speech on the subject, says the first thing his plan does is to provide coverage to all Americans. If you know something about health care delivery system structuring and reforming and if you are familiar with its history, you can read President Obama’s proposals and know he is in Disney Land or perhaps again smoking pot. Here is what he claims he will do:
“Barack Obama will make health insurance affordable and accessible to all.
“Obama will lower health care costs. The Obama plan will lower health care costs by $2,500 for a typical family by investing in health information technology, prevention and care coordination.
“Obama and (Joe) Biden will require coverage of preventive service, including cancer screenings and will increase state and local preparedness for terrorist attacks and natural disasters.”
Think about that. Everybody gets coverage. Everybody gets more coverage than they get now. That has to create a huge increase in demand. That should drive prices up, if the economic system works, as it should. But everybody who pays now will pay less, and everybody who doesn’t pay now will get great coverage (the same as that now provided all congressmen. Ain’t that grand.)
Recall that we still haven’t figured out how to pay for Medicare and Medicaid. Every cost estimate for programs such as Medicare has almost always proven to be gross underestimates.
There’s a whole series of miracles operating here. Everybody gets top quality care at reduced prices, and medical care is made affordable and accessible. In fact, as Dick Morris has pointed out in his book, Fleeced, the Obama proposals during the campaign even called for coverage of illegal aliens. But apparently money is no object.
We can’t afford Mr. Obama’s plan. As one sage observer noted, if you think medical care is expensive now, wait until you see what happens when it is free. We not only can’t afford it, but we also don’t know how to do it. I’ve been following this debate for over 60 years, starting when high school debaters were going at national health insurance.
I had occasion to teach many courses related to health care and social insurance at the Wharton School of the University of Pennsylvania. I was closely involved in health care regulation and reform as Pennsylvania Insurance Commissioner for over three years. And I can tell you reforms are always one hundred times more complicated than they seem. And I can tell you the less reformers and advocates know about health care, the more grandiose are their proposals … and the more unsound they are.
When I hear Mr. Obama speak and propose on universal health insurance, I recall one of the most fundamental pieces of consumer advice: If it sounds too good to be true, it probably is too good to be true. Everybody covered, everybody gets more coverage, and everybody pays less.
Take a look at universal health insurance or other such schemes with heavy government involvement and you find low quality care, you find shortages, you find patients waiting in long lines for long times, you find rationing in one form or another, and you find a broken system and an expensive system.
Government doesn’t make anything more efficient or cheaper. When it is heavily involved it just adds the bureaucracy, the paper work, the inefficiency, and the excessive costs of government. Do you want U.S. Postal Service-style of health delivery?
So brace yourself for the battle over universal health insurance, and remember how reckless, how arrogant, how socialistic, how dishonest the first major legislative act of the Obama administration was. The 1,000-plus-page, 5-pound, 8-inch-high legislative monstrosity and abomination called the stimulus bill was passed without anyone voting for it having read it. Never before, have so many done so little thinking about so much. If you sign a trillion dollar contract (with interest payments) without reading it, you are an idiot … among other unkind designations.
Do you really want these people designing your health care delivery system? Do you really want Rep. Nancy “San Francisco Values” Pelosi deciding about your doctors and hospitals? Remember, she wrote the original stimulus bill. Unlike other presidents, who have historically drafted their signature legislation in the White House, President Obama delegated the task to the wild leftists that hold forth in the House of Representatives. Remember all those congressmen advocating the stimulus bill without even reading it? Don’t trust them next time around.
I come back to one of my constant themes. Before you tear down the Empire State Building with plans to replace it with a better structure, demonstrate that you can paint the first floor. Show your competence in small but important matters, before you start tearing something down. And above all, don’t fix it, if it ain’t broken. And if it is broken, fix what is broken, rather than tearing down the whole system.
For starters, I’d recommend taking a look at some of the proposals of Dr. Butler for bringing prevention to our system. Mr. Obama stresses the importance of prevention in his plan. Consider some of Dr. Butler’s proposals in the area of the public education designed to teach life-saving life styles — diet, exercise, stress control, etc. And you’ll see there is every promise of improving health care for all and of avoiding harm to a good system.
Here are some of Dr. Butler’s many ideas for what he calls “a prescription for longevity and quality of life.”
He first focuses on public health measures. He would make Medicare strongly focus on prevention. He says the annual physical doesn’t make sense during most of life, but is sound after age sixty. Ideally, we should have a system that gives doctors time (and compensation) for counseling patients on life style changes. And ideally, at all ages there should be health promotion and disease prevention, along with treatment.
He stresses the need for more attention to adult immunization, which is one of the great prevention measures of science and history. He writes that 70 percent of tetanus infections occur in people over 50. So that shot is a high priority for older people as well as others.
He writes Hepatitis A and B, pneumococcal pneumonia and the flu vaccine should be routine. He also recommends the vaccine against shingles and human papillomavirus (to prevent cervical cancer). He believes there is some misconception involving the belief that vaccinations are just for children.
He is aware of the critical role of nutrition in health and longevity. Part of our health problems arises from government and the influence of pressure groups on it. For example, he notes that the Department of Agriculture subsidizes and promotes sugar and cheese, but offers little or no assistance to fruit and vegetable growers. So it has the healthy diet exactly wrong. Why don’t the politicians take care of that little detail before dismantling our whole health care delivery system?
The government rhetoric on obesity is also wrong, emphasizing exercise and personal responsibility, which he says are “messages the food industry favors” rather than the message of less consumption.
The master key to good health, or certainly one of the master keys, is exercise. Yet our schools don’t provide that in their programs. Dr. Butler says third-graders exercise nowhere near the 30 to 60 minutes a day children should get. They log an average of only 25 minutes a week. How about the great master planners fixing that before they take on the whole health care delivery system.
We also know the risk markers for heart disease due to the great Framingham Heart Study. One is high cholesterol, which is another great area for public health targeting. Another is high blood pressure, where we’ve barely scratched the surface in attempts to educate the public on this disease. And the same for diabetes, another risk factor.
The public health and prevention opportunities go on and on. They include environmental and occupational hazards. But they hold almost miraculous opportunities for saving life and money. And they are a much better bet, with more bang for the buck, than plunging into the unknown and irreversible domain of universal health care.
Again, Americans should demand that any reformer demonstrate competence in one area before destroying and rebuilding the entire health delivery structure. Start with one or more aspects of public health and prevention and go from there.
While you’re preparing to fight universal health insurance, you better prepare yourself to fight a flood of other loony left legislation from establishing the Fairness Doctrine (which should be called the Censorship Doctrine) and the Card-Check Law (which should be called the anti-American law to abolish the secret ballot in union elections).
If there was ever a time when eternal vigilance is the price of freedom, it will be now and about another four years. God bless America. God save America. We are going to need Him, too.
Herb Denenberg is a former Pennsylvania Insurance Commissioner, Pennsylvania Public Utility Commissioner, and professor at the Wharton School. He is a longtime Philadelphia journalist and consumer advocate. He is also a member of the Institute of Medicine of the National Academy of the Sciences. His column appears daily in The Bulletin. You can reach him at advocate@thebulletin.us.
So the grand planners of a new system ought to take a more incremental approach. The risks and uncertainties of the introduction of a gigantic national system simply aren’t worth taking. So I would suggest the alternative of fixing one subsystem and then gradually working forward from system to system.
This enables the planners to test one variable at a time, providing more certainty than if all changes occur at once. This incremental approach also allows you to judge the quality of your thinking. If you try something and it bombs, then you know you not only have to go back to the drawing board with your plans, but you may also have to re-evaluate your methods and your personnel.
This idea came to me while reading the book of one of the nation’s leading experts on geriatric medicine. Dr. Robert N. Butler is president of the International Longevity Center, and in 1975, he became the founder of the National Institute on Aging of the National Institutes of Health. In 1982, he founded the first department of geriatrics in a U.S. medical school at the Mount Sinai Medical Center. That’s what his book’s dust jacket says, but I was even more impressed by the fact that he is in his 80s, and is still going strong and has not retired.
Dr. Butler writes that we are now spending only 1 percent of our health care dollar on prevention. That has to be foolhardy, as it is universally agreed that it is easier and more economical to prevent disease than to treat it or cure it. The cost consequences of failing to practice prevention are perhaps the leading factors in the skyrocketing cost of health care. I’ve always been impressed by Campbell & Campbell’s book, The China Study, which found that a properly designed diet would virtually eliminate most of the most deadly and expensive chronic diseases of our time such as heart disease, hypertension, stroke, diabetes and more. We understand what has to be done in diet, in exercise, in stress control, and a few other basics. In fact, the great Jewish physician Maimonides long ago wrote that almost all people will die as a result of their lifestyle.
So a program of prevention can be added to the present system, delivering huge potential saving in money, and delivering huge potential additional years of good health.
This incremental approach has another advantage. We can actually afford it. We can’t afford universal health insurance, which would only put us further into deficits, debt and economic stagnation. Still another advantage is we can do it step by step, in a sequence that can be carefully tailored to our resources, our administrative capability, and our priorities at the moment.
We can’t say the same for universal health insurance. In fact, its advocates always make the argument that we need the massive fix to bring about what we need. Barack Obama, for example, in his Iowa City speech on the subject, says the first thing his plan does is to provide coverage to all Americans. If you know something about health care delivery system structuring and reforming and if you are familiar with its history, you can read President Obama’s proposals and know he is in Disney Land or perhaps again smoking pot. Here is what he claims he will do:
“Barack Obama will make health insurance affordable and accessible to all.
“Obama will lower health care costs. The Obama plan will lower health care costs by $2,500 for a typical family by investing in health information technology, prevention and care coordination.
“Obama and (Joe) Biden will require coverage of preventive service, including cancer screenings and will increase state and local preparedness for terrorist attacks and natural disasters.”
Think about that. Everybody gets coverage. Everybody gets more coverage than they get now. That has to create a huge increase in demand. That should drive prices up, if the economic system works, as it should. But everybody who pays now will pay less, and everybody who doesn’t pay now will get great coverage (the same as that now provided all congressmen. Ain’t that grand.)
Recall that we still haven’t figured out how to pay for Medicare and Medicaid. Every cost estimate for programs such as Medicare has almost always proven to be gross underestimates.
There’s a whole series of miracles operating here. Everybody gets top quality care at reduced prices, and medical care is made affordable and accessible. In fact, as Dick Morris has pointed out in his book, Fleeced, the Obama proposals during the campaign even called for coverage of illegal aliens. But apparently money is no object.
We can’t afford Mr. Obama’s plan. As one sage observer noted, if you think medical care is expensive now, wait until you see what happens when it is free. We not only can’t afford it, but we also don’t know how to do it. I’ve been following this debate for over 60 years, starting when high school debaters were going at national health insurance.
I had occasion to teach many courses related to health care and social insurance at the Wharton School of the University of Pennsylvania. I was closely involved in health care regulation and reform as Pennsylvania Insurance Commissioner for over three years. And I can tell you reforms are always one hundred times more complicated than they seem. And I can tell you the less reformers and advocates know about health care, the more grandiose are their proposals … and the more unsound they are.
When I hear Mr. Obama speak and propose on universal health insurance, I recall one of the most fundamental pieces of consumer advice: If it sounds too good to be true, it probably is too good to be true. Everybody covered, everybody gets more coverage, and everybody pays less.
Take a look at universal health insurance or other such schemes with heavy government involvement and you find low quality care, you find shortages, you find patients waiting in long lines for long times, you find rationing in one form or another, and you find a broken system and an expensive system.
Government doesn’t make anything more efficient or cheaper. When it is heavily involved it just adds the bureaucracy, the paper work, the inefficiency, and the excessive costs of government. Do you want U.S. Postal Service-style of health delivery?
So brace yourself for the battle over universal health insurance, and remember how reckless, how arrogant, how socialistic, how dishonest the first major legislative act of the Obama administration was. The 1,000-plus-page, 5-pound, 8-inch-high legislative monstrosity and abomination called the stimulus bill was passed without anyone voting for it having read it. Never before, have so many done so little thinking about so much. If you sign a trillion dollar contract (with interest payments) without reading it, you are an idiot … among other unkind designations.
Do you really want these people designing your health care delivery system? Do you really want Rep. Nancy “San Francisco Values” Pelosi deciding about your doctors and hospitals? Remember, she wrote the original stimulus bill. Unlike other presidents, who have historically drafted their signature legislation in the White House, President Obama delegated the task to the wild leftists that hold forth in the House of Representatives. Remember all those congressmen advocating the stimulus bill without even reading it? Don’t trust them next time around.
I come back to one of my constant themes. Before you tear down the Empire State Building with plans to replace it with a better structure, demonstrate that you can paint the first floor. Show your competence in small but important matters, before you start tearing something down. And above all, don’t fix it, if it ain’t broken. And if it is broken, fix what is broken, rather than tearing down the whole system.
For starters, I’d recommend taking a look at some of the proposals of Dr. Butler for bringing prevention to our system. Mr. Obama stresses the importance of prevention in his plan. Consider some of Dr. Butler’s proposals in the area of the public education designed to teach life-saving life styles — diet, exercise, stress control, etc. And you’ll see there is every promise of improving health care for all and of avoiding harm to a good system.
Here are some of Dr. Butler’s many ideas for what he calls “a prescription for longevity and quality of life.”
He first focuses on public health measures. He would make Medicare strongly focus on prevention. He says the annual physical doesn’t make sense during most of life, but is sound after age sixty. Ideally, we should have a system that gives doctors time (and compensation) for counseling patients on life style changes. And ideally, at all ages there should be health promotion and disease prevention, along with treatment.
He stresses the need for more attention to adult immunization, which is one of the great prevention measures of science and history. He writes that 70 percent of tetanus infections occur in people over 50. So that shot is a high priority for older people as well as others.
He writes Hepatitis A and B, pneumococcal pneumonia and the flu vaccine should be routine. He also recommends the vaccine against shingles and human papillomavirus (to prevent cervical cancer). He believes there is some misconception involving the belief that vaccinations are just for children.
He is aware of the critical role of nutrition in health and longevity. Part of our health problems arises from government and the influence of pressure groups on it. For example, he notes that the Department of Agriculture subsidizes and promotes sugar and cheese, but offers little or no assistance to fruit and vegetable growers. So it has the healthy diet exactly wrong. Why don’t the politicians take care of that little detail before dismantling our whole health care delivery system?
The government rhetoric on obesity is also wrong, emphasizing exercise and personal responsibility, which he says are “messages the food industry favors” rather than the message of less consumption.
The master key to good health, or certainly one of the master keys, is exercise. Yet our schools don’t provide that in their programs. Dr. Butler says third-graders exercise nowhere near the 30 to 60 minutes a day children should get. They log an average of only 25 minutes a week. How about the great master planners fixing that before they take on the whole health care delivery system.
We also know the risk markers for heart disease due to the great Framingham Heart Study. One is high cholesterol, which is another great area for public health targeting. Another is high blood pressure, where we’ve barely scratched the surface in attempts to educate the public on this disease. And the same for diabetes, another risk factor.
The public health and prevention opportunities go on and on. They include environmental and occupational hazards. But they hold almost miraculous opportunities for saving life and money. And they are a much better bet, with more bang for the buck, than plunging into the unknown and irreversible domain of universal health care.
Again, Americans should demand that any reformer demonstrate competence in one area before destroying and rebuilding the entire health delivery structure. Start with one or more aspects of public health and prevention and go from there.
While you’re preparing to fight universal health insurance, you better prepare yourself to fight a flood of other loony left legislation from establishing the Fairness Doctrine (which should be called the Censorship Doctrine) and the Card-Check Law (which should be called the anti-American law to abolish the secret ballot in union elections).
If there was ever a time when eternal vigilance is the price of freedom, it will be now and about another four years. God bless America. God save America. We are going to need Him, too.
Herb Denenberg is a former Pennsylvania Insurance Commissioner, Pennsylvania Public Utility Commissioner, and professor at the Wharton School. He is a longtime Philadelphia journalist and consumer advocate. He is also a member of the Institute of Medicine of the National Academy of the Sciences. His column appears daily in The Bulletin. You can reach him at advocate@thebulletin.us.
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