14 11 2010

Our “Truth in Strange Places” Award this month goes to Tennessee Governor Phil Bredesen.  Long-time listeners and readers will recall that I have referred to our governor as a vampire, because he has profited so handsomely from the suffering of others.  The American health care system seems designed to make poor people out of sick people, which smells like bloodsucking to me.

So, I was startled when I found myself reading an interview with Governor Bredesen about his new book on health care, and nodding along in agreement, as he said

There are problems in the way we use insurance, but the insurance companies themselves aren’t the core problem. If we want to blame somebody, let’s look at other medical providers, like the pharmaceutical industry. In the book I use the example of [drug maker] Merck, where profits last year were equal to the earnings of all the companies in the Fortune 500 health insurance and managed-care category combined.

Well, okay, I actually rolled my eyes at the first part of that and started nodding when he outed Merck’s excessive profits.  Bredesen made his money in the insurance biz, so he’s not going to accept the blame, and I suppose in a way he’s right.  While for-profit insurance companies are primarily concerned with making a profit for stockholders and only secondarily with providing adequate benefits to policyholders, it’s immaterial to them whether medical costs are inflated or not, as long as their income is sufficient to cover those costs.  As for-profit companies, they will do whatever they have to do to stay in the black, including denying life-saving procedures.  (As more than one wag has pointed out, “America already has ‘death panels’–they’re called ‘insurance companies’.”)

So, while he’s telling the truth about Merck here, it’s also a form of passing the buck.  Sure, Merck’s (very) gross profit contributes to the excessive cost of medical care, but so did the estimated $100 million dollar fortune Bredesen amassed while running HealthAmerica.  Remember, that hundred mil is just a part of the difference between what average Joes like you and me paid in for our insurance coverage and what Bredesen’s company paid out.  You can also think of that fortune as blood sucked from the bodies of the poor and sick by a vampire….yeah, I know, Halloween is over, but ’tis still the season….

Just for the record, Merck’s estimated profit for 2010 is in the range of $26 billion dollars, so I suppose the Guv thinks his personal hundred mil is chump change…”Hey, I’m not the bloodthirstiest vampire in the crypt!”

Tell it to the people who lost their Tenncare coverage, Phil.  See if they think you’re poor like them.  See if they think you’re not just as much a part of the problem as Merck.

More on Tenncare later.   What Phil had to say about Obama’s “health care reform” was a lot more on track:

….we put a structure in place in the 1930s—an insurance-based, employer-based system—and it’s outgrown its usefulness. It’s obsolete. We’re sitting here in America with frequently inferior care which is more expensive than anywhere else in the world. You’re not going to fix that by simply adding more people to the rolls or singling out particular enemies.

….The core problem is this: if you leave health care as an open-ended entitlement, where the people providing services get to define how much service is provided and how much to charge for it, you will never contain costs. The history of the last fifty years of health care is uniform in that regard. So let’s try to find a different way of doing it, one that disengages from the insurance model. That model is inefficient and it creates all sorts of bad incentives, ones where the incentive of any doctor or provider is to do more and charge more.

What Phil recommends is the “Mayo Clinic model,” which divorces physicians’ income from the number of patients they see and the number of tests and procedures they order, thus freeing doctors to spend more time with each patient.  One study found that this simple step cuts health care costs by over 50% for some groups of patients.

And, by the way, here’s what an official Mayo Clinic spokesperson had to say about the health care plan that Obama and the Democrats passed:

“The proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite,”

Back to Phil…here’s what he said about those notorious TennCare cuts:

The TennCare experience was very painful. It was somewhat politically painful for me—I had people sitting in my office twenty-four/seven for six months. But it was extraordinarily painful for the people who lost their health insurance because of it. What we were forced to do in the end was make reductions with a broadax rather than a scalpel. And it was very painful for the people who got lost in the cracks in that. The sense in the book that the system we have is not serving the needs of some of the people who most need it comes very strongly from that experience.

The other thing that comes from my experience with TennCare is that if we indeed consider some level of health care a basic right, let’s divorce it from being charity handed out by politicians and organize ourselves deliberately and fairly and without anybody having to grovel to get it. I’d love to go back to more of what Harry Truman’s vision was, which is that there is some underlying level where everyone’s treated the same. We’ve really gotten close to that with Medicare, and there’s no reason we can’t do it with the rest of the system.

So he’s coming mighty close to endorsing the “Medicare for all” paradigm in the book he wrote, even saying:

To pay for it, let’s give people vouchers that can only be spent on health care. That’s essentially what Social Security is, just reworked for medical care. Of course, it’s different in the sense that if someone isn’t a part of the Social Security system, you’re willing to not write them a check—whereas if they’re not part of the medical system you’re not willing to let them die in the street. But if you disburse a limited amount of money and say it can only be spent on health care, then you’re limiting the maximum amount of money that comes into the market, which creates some competition and value. Then, third, you create quality auditing systems to monitor what is being provided. What the book is about is how to do all this in a fair and responsible way.

I have to confess here that I haven’t yet read Phil’s book, entitled Fresh Medicine, so I’m not in a position to comment on what he considers “a fair and responsible way,” but what I perceive here is that, from his strongly capitalist, free market perspective, he’s trying to design universal access to health care without mandating that everybody has to buy private insurance, which, he seems to agree, is not the most cost-effective way to make Americans both healthier and less financially vulnerable in the event of a catastrophic health problem.  And sure, I’m in love with the idea of a national health service that  incorporates holistic practices, but if somebody’s got a way to improve the skewed system we’re currently stuck with that will actually get through our legislative process, there are compromises I could live with.

I’ve saved the best for last:

I don’t want to be a Cassandra, but we’re in a difficult financial situation in this country, and we’re going to have to deal with entitlements very soon. So let’s start addressing the issue now, particularly as related to health care, and not wait until China stops buying our bonds. Let’s start getting things set up so that when the whole issue comes to a head, we’ll be ready.

Got that?

Let’s not wait until China stops buying our bonds.

That thrilled me to the core.  It let me know that I am not just a lunatic fringe, nutjob doomer for thinking the US is approaching the end of our financial choke-chain leash, and the Chinese could just decide to snap it tight around our throats any time.  Our own governor, a conservative guy whom I have excoriated on numerous occasions,  sees it that way.  You can hardly get a more independent confirmation than that.  And,  with Obama and the US bankers making threatening noises about Chinese currency manipulation, it is clear that we are on the brink of a financial war, a war the US is almost certain to lose.  When that poop comes through the air intake, affordable health care is going to be among the least of our worries.

So, Phil–you may be a vampire, but you’re a lot more clear-headed than I had suspected.  Thanks for your, yes, Cassandran pronouncements–hey, I believe you.  But then, I’m a Cassandra too.

music:  Material:  “Words of Advice for Young People”



3 responses

7 12 2010

[…] have decided to quit financing the American way of life and world domination.  As I commented last month, even mainstream, middle-of-the road politicians like our Governor, Phil Bredesen, recognize this, […]

8 12 2010
David K. Cundiff, MD

Re:”…if somebody’s got a way to improve the skewed system we’re currently stuck with that will actually get through our legislative process, there are compromises I could live with.”

Dear Brother Martin,

Please consider this way to improve our skewed system:


David K. Cundiff, MD

8 12 2010

Thanks for posting a link to your article–I’ve read it, and I appreciate your vision.

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