The Right Way to Reform Healthcare
James P. Pinkertonr
Maria Shriver and Sandra Day O'Connor show the way, pushing to cure Alzheimer's
By now it is obvious that the Establishment was snookered on Obamacare.
But what will happen next on healthcare? Right now, the Establishment seems clueless, and yet fortunately, insurgent Establishmentarians, led by Maria Shriver and Sandra Day O'Connor, are breaking with elite orthodoxy, offering a better healthcare solution.
Since the current healthcare approach is a costly fiscal and medical failure, Shriver and O'Connor are offering a new direction. Their argument: It's cheaper, as well as more compassionate, to cure a disease as opposed to treating it and insuring for it. In short, they are offering hope for healthcare based on hard science, not on political promises, nor evanescent charisma.
Yet what, exactly, did the bulk of the Establishment, and the Democrats, get wrong these past two years? Here's what: They fell for the theory that greater government supervision of the health insurance market could provide savings. That theory, as propounded by the White House brainiacs, was elegant: We know there's a lot of waste in the healthcare system, and we can find it. In the meantime, we will cover everyone, and people will be so grateful that we can then squeeze down on overall healthcare spending. As White House economic czar Lawrence Summers explained earlier this year, "A prerequisite for any serious attempt at cost control is insuring universal coverage, otherwise cost constraints will have manifestly unacceptable human impacts." QED: More people covered, less spending, everybody happy -- except, maybe, for a few Republicans.
The Establishment loved the idea of every American getting a low-cost plan. No costly "Cadillac" coverage, to be sure, but no conscience-shocking deprivation, either. Indeed, many business leaders quietly looked forward to Uncle Sam taking healthcare off their hands; they would happily pay higher taxes to be rid of the health-insurance hassle.
Yet within a few months of Obamacare's enactment, it became painfully apparent that healthcare costs were still rising. Speaking at an event hosted by the U.S. Chamber of Commerce in July, Erskine Bowles, co-chair of President Obama's deficit commission, said of Obamacare, "It didn't do a lot to address cost factors in healthcare. So we've got a lot of work to do." And yet what, exactly, had "we" been doing for the past two years?
Nothing about Obamacare, for instance, was staunching the rise in Medicare costs. In August, the Treasury Department put out a positive report on the entitlement program's projected finances; its rosy-scenario-ing led Medicare's independent-minded chief actuary, Richard Foster, to file his own rebuttal: "The projections shown in the report do not represent the 'best estimate' of actual future Medicare expenditures." The best estimate on spending, he added, was far higher.
In other words, the Establishment healthcare plan was a failing to meet expectations. Voters became angry, fearful of both government overreach and healthcare rationing, even as costs were going up, not down.
Neither the Obamans nor the Establishment seemed to grasp the stubborn reality: People like healthcare -- and they want more of it, not less. A Kaiser Family Foundation poll in early 2009 surveyed national attitudes on health issues; it found that the public, by a more than 4:1 margin, believes that it is not getting sufficient treatment: "Sixty-seven percent of ordinary Americans don't think they are getting the treatment they need." By contrast, just 16 percent of Americans think they have been overtreated. Meanwhile, the popular culture blooms with medical dramas about "the disease of the week"; nobody makes TV shows about health insurance.
The elites in Washington and New York saw healthcare as an opportunity to save money. Not on themselves, of course, but for everyone else. But folks clung to the view that one goes to the doctor to get better and to feel better, not to wave around a government-issued insurance card. The real health problem, in the intuitive popular view, is that we don't have cures, or anything close, for killer diseases.
Enter Shriver and O'Connor.
The first lady of California, in conjunction with the Alzheimer's Association, has launched a new national effort against Alzheimer's disease. She doesn't want simply to treat it, she wants to beat it. And in setting such an ambitious goal, she is invoking the memory of her famous uncle, John F. Kennedy, the greatest goal-setter in modern American history. Speaking to ABC News's Diane Sawyer last month, Shriver said, "We can launch an expedition on the brain, much like President Kennedy launched an expedition to the moon." Ah, for the days when the Establishment thought in terms of constructive and forward-looking projects that were also politically popular.
Then Sandra Day O'Connor joined in.
The first woman appointed to the Supreme Court published an op-ed in the New York Times, joined by Stanley Prusiner, recipient of the 1997 Nobel Prize in Medicine, and Ken Dychtwald, a gerontologist, calling for a Kennedy-esque moon-shot-like effort against Alzheimer's. The trio emphasized the foolishness of our current spending priorities: "As things stand today, for each penny the National Institutes of Health spends on Alzheimer's research, we spend more than $3.50 on caring for people with the condition." Indeed, that care now costs us $172 billion a year and is rising fast, alongside the rise of Alzheimer's in our aging population. And yet, they added, medical science offers a way out of this fiscal thicket: "If we could simply postpone the onset of Alzheimer's disease by five years, a large share of nursing home beds in the United States would empty. And if we could eliminate it, as Jonas Salk wiped out polio with his vaccine, we would greatly expand the potential of all Americans to live long, healthy and productive lives -- and save trillions of dollars doing it." Yes, we saved money on polio treatment by eliminating polio. And while our victory against another epidemic, AIDS, is far from complete, the progress we made has saved not only lives, but also, as the Manhattan Institute estimates, some $330 billion.
Longer lives, money saved.
Talk about a win-win. Curing is cheaper than caring. And the 67 percent of Americans who believe they are being undertreated are ready to reward the leaders who orchestrate that win-win strategy.
We might note, here, a warning to Republicans. Just as the Democrats' expanding health insurance didn't "bend the curve" on costs, neither will shrinking health insurance achieve the desired curve-bending. If people get Alzheimer's, it's expensive, no matter who pays. And the real issue isn't health insurance, it's health. So long as the two parties see-saw on the issue of insurance, they will miss the real opportunity to save money -- by providing health itself.
The challenge is to get this new approach to healthcare -- call it, simply, "medicine" -- onto the national agenda. Getting it past the Establishmentarians who have invested deeply in the idea that when it comes to healthcare for the masses, less is more. Getting it past politicians who would rather fight each other than solve a problem for the nation as a whole.
That's where Shriver and O'Connor have proven themselves to be visionaries. They are changing the debate and, ultimately, they will win, because it's obvious that eliminating disease is a kinder, gentler, and smarter approach than simply paying for the ravages of disease.
James P. Pinkerton was a domestic policy aide in the Reagan and Bush 41 White Houses. He is a fellow at the New America Foundation and a contributor to the Fox News Channel.
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The Right Way to Reform Healthcare
(c) 2010 Robyn Blumner