10/17/2009 05:12 am ET | Updated May 25, 2011

The Emperor Has No Clothes


I am just writing what everyone knows: the Emperor has no clothes. What is touted as health care reform isn't (going to reform health care.)

Start with basics. As enunciated by the President, health care expenditures are dragging us down. As individuals, the costs have reached a truly unsupportable level: medical expenses are now the leading cause of personal bankruptcy and 36 million Americans cannot afford insurance. [Ten million of the 46 million uninsured Americans qualify for currently existing programs and did not enroll.] As a nation, health care expenditures are approaching the unsupportable and certainly make us less competitive globally.

The President openly recognized that the entire "health care system is broken." Financing is only one part of its cost problems, and cost itself is only one part of what is wrong with healthcare. You cannot 'fix' costs without making the other problems worse. (This does not mean that healthcare is unfixable, just that you have to fix the whole system, not just one of its parts.)

  • Non-fatal errors are all too common and most are preventable.
  • Over 500,000 nursing positions are unfilled and medical school applications have been steadily declining.
  • We reward what we do not want and do not measure the outcomes we do want.
  • Medical research is inefficient, even suppressed.
  • Good answers do not exist for many serious conditions from rheumatoid arthritis to diabetes, from asthma to cancer of the breast, colon, or prostate.
  • The system (so-called) is truly broken.

Without root cause analysis, with no evidence, without even what engineers call proof-of-concept, the President offered his answer - an additional financing option - and called it "healthcare reform." Then, the problem itself as well as the answer(s) began to...morph.

From the totally broken system, focus was tightened to the plight of the uninsured. Answers began to change faster than models' clothes on Project Runway. There was no discussion of root causes of the original problem. No evidence was offered to suggest that the various solutions, coming at us like pellets from a scattergun, would fix anything.

A medical analogy seems appropriate. Suppose your doctor said you had cancer and without any change in you or any additional information, then said you had migraines. Suppose the same doctor made no effort to investigate why you were sick. Suppose the doctor suggested a treatment that she guessed might help but had no evidence to prove that it would. Wouldn't you -- rightly -- accuse this quack of medical malpractice?

That is what Washington is doing to our sick health care system. They are guilty of management malpractice.

Continue the medical analogy. Suppose the doctor had evidence that a combination of four different drugs would cure you. Then she said the following. The first drug is too expensive. So I am going to substitute a cheaper drug that may or may not work. The second drug tastes bad so I am not going to suggest that you take it. The third drug is not available on your insurance company's formulary so I had to change to one that was. It is not what I know works but I had to compromise. The fourth drug comes only in a red liquid. Since red is the color of Communism, I am certainly not going to give that to you. What would you think about this doctor?

The above may sound silly but is deadly serious. That is how Congress is solving our broken health care system. They negotiate and compromise. They change the focus and redefine the problem at will. They modify the answer regardless of whether the new one will work. They substitute logic or bias for evidence. They pay little attention to what they say and even less to what we say. They reconcile until the Act they finally pass bears no relation to the original problem. Afterward, there are no consequences to them when their "fix" fails and makes things worse (for us).

Recall that HIPAA -- the law that puts security above all other medical priorities - was originally conceived to deal with the lack of portability (the "P" in the middle) of health insurance. Enacted in 1996, it is very effective at preventing information exchange, but the original problem remains unsolved. Portability got reconciled, renegotiated, modified, adjusted, and ultimately lost in the political shuffle.

The American people do not want political palliatives, excuses, or solutions that do not solve what we all know is -- and you agreed was -- the Problem. Playing the blame sometimes diverts us from the real culprit: the absence of system. Just because you call something "reform" does not mean that it actually reforms.

We know the health care system is broken beyond repair. We know that we need a new one -- one that actually has "system" in the system. You know (or should know) that we will not accept anything imposed on us from above. We need to establish the guidelines. We need to be involved in the planning stages, not simply reacting to your Reform (that-does-not-reform).

If you are our Representatives, then represent us. We want and need a health care system that works. Simply throwing more money into the "waste of the middle" will not fix healthcare. Finally, we resent your increasing the deficit that our children will have to pay and then proudly saying you are "reforming" healthcare for us.

The Emperor is not reforming healthcare, even though he says he is.