Surgery, Please - A Look At Edwards On Health Care

The following piece is part of an ongoing series of OffTheBus reports by citizen policy experts critiquing different aspects of Campaign 08.

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The Kaiser Family Foundation this week launched a series of thoughty, chewy interviews with presidential candidates on our dysfunctional medical system, and John Edwards, who has been trying to get out front on the issue, was first up. But from the tone of the discussion so far, the candidates must think that to perform major surgery on this moribund patient, first we have to anaesthetize the voters.

The format, borrowed from the sedate, PBS-News Hour style where reporters and guests aren't allowed to thwack each other with rubber mallets, is supposed to elevate the debate but instead threatens to launch it into the ionosphere of Platonic Forms. It comes off nice, pat and perfectly incredible, in the original sense of 'not meriting belief.'

The interminable policy chatter about health in this presidential campaign makes me fantasize about how far a proposal to guarantee health care as a 'human right' as Brazil's constitution does would fly here. Not very, of course, but it's the sort of gut-wrenching, polemic-stirring underlying fairness issue that deserves a better hearing than the ultimately disingenuous blueprints for reform that are going to be trotted out from now until, well, your death.

Edwards has some good ideas about health system reform, but you also need a ripping political strategy to give any of these worthy schemes a snowball's chance. The collapse of Hillary C's plan a decade ago illustrated the smug selfishness of our social discourse dating back at least to the Reagan years and how easily the entrenched industrial interests will turn any threat into soundbite mincemeat. Edwards and the rest of the candidates seem unwilling to turn up the rhetorical heat to anywhere near the requisite levels to reverse this momentum.

A good example is his wimp-out on malpractice reform where he repeats the Hillary error from the 1990s. He proposes a prior review process for potential malpractice cases and a 'three-strikes-you're-out' punitive faculty to weed out lawyers bringing frivolous suits, a bland position that will convince no one and expose him, as a former trial lawyer, to a howitzer blast from doctors and insurance industry.

Our current malpractice procedures need to be dug up root and branch, not timidly tweaked. They're ostensibly designed to reduce error and compensate those harmed but do neither while terrifying practitioners and absorbing millions. The Swedish no-fault malpractice system, to cite one example, arguably does better on both counts for a fraction of the cost, and different states have led the way on innovating their malpractice laws in that direction. Edwards' proposal is the sort of fiddling around with a mess that he more astutely criticizes elsewhere.

He finesses the 'choice' issue that helped bury the reform attempts in the 1990s by proposing to allow people to keep their current policies while insisting that everyone have something. He was also right when he answered the inevitable whiner about 'our taxes' going up by saying that tinkering with a junker isn't the answer, junking it is. That way, you spend here and save there, but in the end you're better off.

So he's right as far as he goes, just as when all the Democratic candidates tut-tut Bush's threat to veto the expansion of SCHIP medical coverage for poor children, which alone should be giving the opposition a field day. But where's the moral outrage? Where's the challenge to individual self-interest (including those of the sainted 'middle class'), the call for the solidarity implicit in all insurance schemes--that people contribute when they don't need care to guarantee protection for those, including themselves, who eventually do?

If they don't stir up that hornet's nest, a lot of people, encouraged by the howling wolves of the industrial propaganda machine, will continue to react to the reform proposals by saying, I'm fine--it'll cost me money--I'm agin' it. Instead of pandering to this attitude, someone, somewhere, should be confronting it.

Edwards does call our current system immoral although he doesn't say people have a 'right' to be cared for when sick. But the current discussion is too politically disemboweled to build the momentum for actually achieving the profound change Edwards says we need. The soothing sounds coming from him and his competitors so far only show at best a Clintonian aptitude for obtaining power, not for actually changing the course of events once they get it.

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Comments

[Kendo Nagasaki]

See those programs on TV telling you how to make piles of money off poor people whose homes are in foreclosure due to high medical bills?

Compassionate conservatives at work. Do not disturb.

[Kendo Nagasaki]

US corporations never miss a trick to fleece the less well off whether they are insurance, oil companies or banks. They don't care if they kill or bankrupt you. It's all the same to them.

That's capitalism folks. Vote Hillary for more of the same.

[ScapeGoat]

Just make a one payer system. Make Medicare our national health insurance. Pay for it by putting a flat tax on wages and investment income (so the rich also have to pay) and contiributions by (taxes on) big business. The one payer system will eliminate the need for doctors and healthcare providers to have 5 or 6 administrators who each deal with specific insurers and their plans. Also, medicare has about a 5% administration cost compare to private insurers that have over a 50% administration cost (including their profit; which means, they are making money on sick people).

[outnow]

I favor this plan. The attempt to avoid the shock of "socialized medicine" bogeyman is unfortunately in too many of the Democratic candidates plans.

Take the bean counters out of medicine.

[Steve7]

The problem with all the plans is that they use the current system as the foundation. As has aptly been pointed out on www.healthcaresoundoff.com the current system is infected by Other People's Money syndrome. We do not have real healthcare consumers, we let insurance or Medicare "manage" care. While I understand political forces prevent needed changes we need to create a consumer force before change that works will occur. See the Healthcare Access Card on www.healthcaresoundoff.com. This incremental change may allow us to revise the "insurance" system which really is a banking and financing arrangement and not real insurance. The result is that "choice." really is an illusion. As far as malpractice goes it probably needs reform but after 35 years of representing all segments of the healthcare system, I reject the notion that it is a substantial cause for high costs.