Caring about health care

Yes, I'm in the USA and I do have some concerns about health care here. I have even more concerns about the complete lack of a logical foundation for the current series of arguments being used to sway the voter. I need some answers but I don't need Rush, Sean, Keith, Rachel or the rest of pseudo-journalists feeding me more opinions, sniping, out-of-context quotes, attacks, etc. We as a responsible public (and I believe this to be a truth in peril) need basic information by which we can make decisions to influence our leaders. At this time, we aren't doing that very well. Our leaders have formed opinions, made claims and generated massive books about "what we must do" instead of laying out the problem, the supporting data and ideas by which we could make meaningful, effective decisions.

President Obama has done a good thing by asking the Congress to come up with the proposed legislation. But I also think he has done an absolutely sloppy job of describing the root causes of the issues which make reform an imperative. Despite this, his record looks very good when compared to the liberties the Congress has taken as it has generated its legislation. The radio and news network entertainers have absolutely set the low-benchmark, though. Thanks to them, the public arguments are even more diluted than we need if we are to make informed criticisms and adjustments to those things which may become law.

Before we frame up any new legislation, we need this information clearly communicated to the public so that it may responsibly guide its representatives:

- What elements of health care in the United States are most to blame for rising costs? Is it the aging baby-boomers living longer, needing more care for more years and, resultantly, consuming more resources than the available "Public Option" of Medicare can sustain? Is it a rise in the numbers of individuals and families who qualify and must depend on Medicaid? Has there been a sharp increase in the cost of pre- and post-natal care? I expect this list to declare at least the Top 100 technologies, treatment plans and ailments which are causing this unsustainable cost increase.

- A comparison of cost structures and care quality estimates from European, Canadian and, believe it or not, U.S. State health plans. For instance, it's fairly clear that the Massachusetts plan does a good job of delivering the 'Everybody in the pool!" approach to group plan participation. It's also clear that it penalizes most heavily those people who are least able to afford this law: low-income families and small businesses. Most of the news you'll read about the Massachusetts plan will be celebratory like this platitude from the Boston Globe.

...but when you listen to small business owners and individuals, you find that their tax burden (the penalty applied for not being able to find a care provider which will underwrite your business, like independent mechanics) is driving those operators to consider career changes.

Or we could consider the state of the Canadian health care system, whose quality is merely something we can speculate upon, which, apparently, is still overstressed .

- In the last 30 years, applied health care in the U.S. has moved away from treatment-as-needed to a pre-emptive, maintenance based approach. The idea is that regular visits and evaluation help to extend life at a more affordable rate. While the first assertion is probably true by identifying high-mortality conditions earlier, does this approach deliver the second promise? We need to know this and the data must not be interpreted by the sales folks (read - politicians and pundits).

- Does Medicaid work? This is the second to last remaining element of Johnson's "Great Society" the rest of that vision has fallen by the wayside as we reformed the damage our society sustained under the abuse of welfare laws. It's in scope as the existing "Public Option" so we'd better understand how it's working, right now!

- This statement is repeated often: Health Care will be 35% of GDP in X years. Okay, so break it down. Why is that? There are more factors to consider. Could this be because the other 65% are indicators of decline in the rest of the variables used to measure GDP? You can't use that phrase fairly without consideration of the sum and, to date, that forecasted sum has not been treated openly. It's important to understand because GDP forecasts indicate other issues to correct...and no one in a leadership position has been discussing this point. Yes, I've been listening.

- If you accept that business does a better job of managing business than does government, we need to understand a little more about the efficiencies of insurance companies offering health coverage. I suspect there's more going on here than we're being told and, frankly, the currently proposed legislation appears to favor the demands of these companies more than challenging their current practices.

- If we reform health care effectively, I expect to see scientific principles re-applied to research on treatments and cures. At present, it seems we've moved away from curative technology and created more plans which are lifetime treatment regimens. I'm not sure we're technically mature enough to have this approach managed well and I'm pretty sure that 30 years of treatment for heart disease costs much more money than applying a one-year treatment-to-cure plan.

- Assertion: The Congressional Budget Office has an enviable record of accuracy. We should take their statements seriously. Countering a presentation of measurements and factual projections with "this statement doesn't take into account anticipated savings from unpredictable efficiencies and resulting cost reductions" only strengthens the CBO statement and makes you look like an unpracticed hack. It's insulting. If you want to argue with the CBO, stop talking about your guesswork and generate some real data. I genuinely wish you luck. CBO estimates are tough, trustworthy statements.

- Hey, if cost reduction is the goal, you'd better show us a plan that reduces cost and you'd better show us how it achieves that goal (because the how may impact your lifestyle, too). Stop insulting us. Personally, I have a record of leaving the dealership once the conversation moves in this direction and we all know that leaves an unsold car on the lot. Think about it.

Up to now, I've kept my mouth shut, formed gut feelings, been insulted regularly by the President, Congress and TV, I've been distracted by the major network pundits (who is listening to these folks? They're awful!) and all to the point that the information I need to make rational assessments is even weaker than when we started all this. Get us the data, leave interpretation to us (because it's evident there isn't a body out there capable of delivering that interpretation in a trustworthy manner), tell who the players are and what their stakes are. Then wait to hear back from us.

Mr. President, putting a deadline down is a good idea. It's becoming an albatross, however. Now, with all these questions in minds of the populace, those deadlines are starting to look like hard sells. I've never been comfortable with your motivation for this change and I think you can do better. To the U.S. Congress, the way to my heart is even simpler for you. Stop generating huge bodies of legislation and putting them up for committee vote in just a few hours when digesting those documents may actually take weeks (how much of that stuff was pre-written and who wrote it anyway? I'm very confident that the creative genius at work on this was not a servant of the public solely based on the volume and the way you stuffed it down the cannon's barrel). You TV and Radio folks don't have a thing you need to do any differently. I've already changed stations.