Two Canaries in a Political Minefield

Written by: Healthcare Advisor's Blog on Apr 13, 2009 9:29 AM EDT

Authors:

Michael Pine, M.D., M.B.A., President, Michael Pine and Associates, Inc.

Stephen Gorin, Ph.D., MSW, Professor, Plymouth State University

The great American debate about health care reform is dominated by three voices. One voice advocates government-sponsored, single payer universal health insurance. Another advocates mandated private health insurance based on free market principles. The third seeks a mutually acceptable compromise that will serve as the first step in a transition to affordable, high-quality health care for all.

In the larger debate about the future of America, there are only two voices. The first, embodied in Dr. Cutler’s introductory blog a month ago: "This Time is Different." The second, embodied in the words of a great American folk hero: "It's like deja vu all over again."

Barack Obama was right when he said that Ronald Reagan was the last transformational American President. At that time, the critical issue was energy. Faced with a clear choice, America chose what Jimmy Carter described as "the path that leads to fragmentation and self-interest . . . [a path] of constant conflict between narrow interests ending in chaos and immobility." So we gave lip service to energy independence but steadily increased our dependence on imported oil. Oil companies were entitled to their profits, executives were entitled to their retention bonuses, and Americans were entitled to unlimited amounts of cheap energy. When faced with the need to sacrifice and compromise for the common good, the right’s response often was a simplistic "drill, baby, drill."

In many ways, the history of American health care reform parallels the discouraging history of American energy independence. Over the past century, the American health care industry has spawned an ever-increasing number of special interests that will do whatever it takes to protect their turf, whether it's playing fast and free in the open market, currying favor with legislators and regulators, or using fear tactics to block efforts to overcome fragmentation and narrow self-interest. It's not hard to find villains to blame for our health care crisis, and blaming others is something we've learned to do very, very well. It's much easier than making difficult decisions about how to preserve individual choice while conserving scarce resources needed to serve the common good.

Like life and liberty, health care may be a right to which all are entitled, but does this right entitle us to insist that society pay for costly, inappropriate care? Including all-expenses-paid MRIs in all-expenses-paid emergency rooms as part of the routine care of sprained ankles may generate peace of mind for patients and additional revenue for emergency rooms and their staffs and suppliers, but this type of profligate but not uncommon behavior is unsustainable, even for the richest and most powerful nation on earth. Unfortunately, when faced with the need to sacrifice and compromise to create a politically acceptable system that provides coordinated cost-effective health care for all Americans, some on the left respond simplistically with "single payer or bust."

Out-of-control health care spending lies at the root of what some have called an "entitlement crisis." This is misleading, however. The problem isn't Medicare (which in some instances is more efficient than our private health care system) or Social Security but accelerating health care costs, which according to Peter Orszag, the Director of the Office of Management and Budget, are a "driving force in our long-term fiscal gap." If we fail to bring health care costs under control, they will overwhelm us, "reducing workers' take-home pay" and "crowding out" spending by state governments on "other priorities" (http://tiny.cc/AlNvg).

America has been wringing its collective hands about energy independence and health care reform for decades but has done very little about either. Instead, we've squandered our economic capital on disposable consumer goods in the belief that we can continue indefinitely eating our cake and having it too. It's gotten so bad we don't seem to be able to distinguish between borrowing to enjoy today and borrowing to invest in our future.

The Obama campaign was one of the best start-up companies in American history. But President Obama is not only a first-rate entrepreneur. He, unlike most of the financial wizards getting large retention bonuses, also is a first-rate corporate CEO. Like any good CEO, he is looking for the best return on investment for Corporation America. Being well versed in history, he knows that a healthy, well-educated workforce is as essential to America's success in the coming century as it was in the last. And like every great CEO, he knows that what happens on the ground is even more important than what happens in the boardroom.

President Obama can only lead. We, the American people, must make real change happen.

We are entering a crucial fourth phase of our nation's history. First, we built and preserved a nation. Then we became an economic and military superpower. And then, over the past three decades, we gutted our industrial base and hollowed our government in a display of profligacy that transformed us into a debtor nation with a deteriorating infrastructure and a negative balance of trade. Now we are left with a brutal choice. Either we continue to squabble among ourselves and spend what is left of our greatness until all that remains for the next generation is to grieve about what we have lost. Or we step back, return to our fundamental values of hard work and fair play, invest wisely in what really matters, and rededicate ourselves to the task of building our more perfect union.

Energy and health care are two critical canaries in our political minefield. If we continue to do what we've been doing since the Reagan revolution, we will continue to suffer financial meltdowns and military quagmires. In that case, the Obama presidency will mirror the Clinton presidency as an interlude in our inexorable decline. Only if we recognize that the canaries are on life-support, give up our knee-jerk all-or-nothing solutions to difficult-to-solve problems, and come together as a nation can we overcome the challenges we face and make good on the promises of the American dream.

David Cutler's new beginning or Yogi Berra's deja vu all over again, the choice is ours.

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