MPCA Book Club: Week 2

This week the MPCA book club read pages 43 through 104 of former Senator Tom Daschle’s book Critical: What We Can Do About The Health Care Crisis. MPCA AmeriCorps Program Director John A. Taylor provided this response:

Like a scene out of the Star Trek™ franchise, “Resistance is futile,” seems to be the mantra coming from a monstrous entity composed of special interests intent on destroying the framework for health care reform.

Tom Daschle’s portrayal of The History of Health Reform from the early 1900’s to the late 1990’s is indeed a reminder that there is a “. . . tortuous history of health reform” (45) that strikes fear in the hearts of those brave enough to consider tackling the issue. Recent political events in Daschle’s own life have convinced me that the challenges the current presidential administration face, regarding the issue of health care reform, must be accessed through the lens of the past if the giant is going to be slain.

Presidential ambitions and dreams have been dashed against the rock of health care reform. Presidents from Harry Truman to Bill Clinton have watched as their hopes for the American people have been crushed under the weight of special interests, using the weapon of fear to sway the population away from an issue that is strangling the United States economy, wounding its citizenry, and building a wall of confusion around the issues.

Perhaps, it is fear that must be first addressed as competing sectors sit around the bargaining table to deal with a system that “. . . is fundamentally flawed . . .” (103). In his memoirs, Harry Truman reminds us that this is the issue that he unsuccessfully addressed, when he said, “I cautioned Congress against being frightened away from health insurance by the scare words ‘socialized medicine,’ which some people were bandying about. I wanted no part of socialized medicine, and I know the American people did not” (50).

In assessing Daschle’s work Critical: What We Can Do About the Health-Care Crisis, I find myself not as interested in the solution Daschle offers, as I am in the history of the battle. Fear seems to be a dominant part of the struggle. As Franklin Roosevelt reminded us in his first inaugural address, “The only thing we have to fear is fear itself.” Yet it is apparent that even this great enemy of fear found his health care reform plans dashed upon its shores.

As citizens, it is essential that we break free from the fear of what might happen in order to accurately assess the fear of what will happen if we don’t do anything to curb the tide of rising medical costs. We must be concerned about those in need, we must be inclusive as we consider the implications of our decisions, we must recognize that health reform is one of many fundamental issues we need to address, and not allow it to be pushed aside by other seemingly more pressing problems. Difficulties that may in reality be symptoms of a need for fundamental changes in the way our society governs itself.

Daschle reminds us, as he reviews the history of this giant issue, “. . . without fundamental change we can expect medical costs, and the number of people without insurance to grow” (103). That call to innovation has been the strength of the United States, and it remains the hope of its citizens as we move forward in this new century. It is the challenge of this generation, and history will judge us by the decisions we make. Will we give into fear’s roar, or will we be bold and compassionate as we face the challenges ahead? I can only hope that it is the latter.

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3 responses to “MPCA Book Club: Week 2

  1. Not only should we harness the American innovative spirit and move past our collective fears surrounding this issue, we should learn from our society’s past failures!

    Mr. Daschle’s chronicle of earlier attempts to reform the health care system was extremely enlightening, but also useful for planning our next endeavor. When we look closely at what worked and what didn’t we can form new strategies… use our failures as learning opportunities.

    We study history because our past gives us insight for the future. The insight we can gain from studying health reform failures will give us an edge the next time we try to overcome this monumental challenge, and I know we can use every advantage we can get.

  2. It is easy to fall into the trap of doing what we’ve always done rather than stepping back to analyze what’s worked and hasn’t worked, and then formulating innovative tactics based on that analysis. That is what Daschle is proposing, which I believe is also what President Obama is doing. Passage of the economic recovery plan, although thought by many as a short-term stimulus, seems to be a launching pad for reforming the health care system. With provisions including funding for Community Health Centers, health information technology, and health professions workforce training, it appears the stimulus package is a foreshadowing of what’s to come, although its sure not to come easily.

  3. I thought that Tom Daschle’s book Critical: What We Can Do about the Health Care Crisis provided a very informative history of health care reform. It helped to frame “today” in the context of previous attempts to implement universal or near-universal health care.

    However, I am not as optimistic. Once again, health care reform is being proposed and the forces of reaction are bellowing “government medicine” and “rationing” as if we do not have Medicare with which most are satisfied. I also believe that rationing is already an established fact. Regarding the proposed solution, I suspect that establishment of any quasi-governmental board will be successfully attacked.

    The general approach presented in the book appears to be “managed competition”. I prefer the single payer approach. The flaw in any competitive insurance company approach is the lack of commitment to life long preventative and chronic care strategies. In a competitive environment there is “churn” of the membership. As a result, there is no promise that the expenditures spent by the insurance company on a person to keep them well or to manage their chronic condition will result in a financial benefit to the company, since it does not know how long the member will be retained. The improved health status of the patient and expected reduction in need for expensive care may well benefit some other company with which the patient may choose to join in the subsequent year.

    Managed care had a similar problem. As a result the strategies employed were primarily accelerated hospital discharges and limited (rationed) care provided to what was viewed as a transient population.

    One of the advantages of FQHCs is the fact that once a family is established with an FQHC, they can retain the FQHC as their medical home regardless of changes in insurance status. A family may initially be covered by private insurance. Then they may lose their jobs and have a combination of SCHIP, Medicaid coverage and have some members without coverage and on the sliding scale. Their payment mechanisms may change, but the patients remain the same. So, continuity of care; chronic disease management, and health and wellness information have a qualitative return for the patient. At the same time the provision of such services typically sustains the FQHC allowing it to continue its provision of comprehensive care to each patient. Through the use of multiple reimbursement and funding mechanisms, including private insurance coverage, public program coverage and grants, the FQHC is provided sufficient revenue to sustain it and its programs to benefit the community.

    In a single payer system, investment in comprehensive care generates improved health status and reduced costs, providing social, quality and financial return on investment (ROI) on a consistent and predictable basis. Single payer also dramatically reduces administrative costs. Medicare’s administrative costs are substantially less than the private market’s. Although managed competition and quasi-governmental boards might provide some benefit, I believe that a single payer system, combined with massive expansion of FQHCs, the NHSC and the possible development of both for-profit and nonprofit patient-centered primary care homes, provides much more benefit for similar investment. However, I am pessimistic that either will prevail in the present political environment. So, let us hope for continued expansion of FQHCs, Medicaid and SCHIP as well as the NHSC and other in-place programs while we wait for a fertile time for an elegant solution.

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