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Taxpayers and the health care debate
The cost of health care
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TEXT OF INTERVIEW
Kai Ryssdal: Even though a health care overhaul has sucked most of the oxygen out of Washington, D.C., the past 10 days or so, a lot of people still don't really understand what the heck is going on.
Beyond the fact that changing an industry that makes up almost 20 percent of the entire economy deserves attention for that reason alone, health care is not one of those things that most people have to deal with day in and day out. So how to make people understand what the problem is and then care about a fix?
David Leonhardt is a columnist for The New York Times. He writes about the economy a lot -- health care today.
David, good to talk to you again.
DAVID LEONHARDT: It's nice to be back on.
Ryssdal: You start your piece this morning with what might be the question about this whole debate. Why nobody can figure out, What's in it for me? How come that's so hard?
LEONHARDT: Well, in part, because this is a really complex piece of legislation, and this is an incredibly complex subject. And so I think if you ask people -- and pollsters have done this -- if you ask people are they in favor of covering the uninsured, they say yes by wide margins. But they look at it, and they look at the staggering sums that get tossed around, and they say to themselves, "Wait a second, why are we doing this?"
Ryssdal: Before we get to the legislation, let me ask you about the health care system itself. Why is it so resistant institutionally to any kind of change?
LEONHARDT: There's a really funny thing with the health care system. We see the benefits, but we don't see the costs. So health care is paid for by us, but it's paid for in ways that we don't see. It comes out of our paycheck and Medicare taxes. It comes out of our paycheck and insurance premiums. And that pays for the medical system. Then we go to the doctor, and we get some treatment. Or we go to the hospital and we have a procedure. We do see that. And so the services are very tangible, the costs are quite hidden. And as a result, what we want is more and more and more. But that is weighing on our wages, it's weighing on our federal budget. It's unsustainable. And yet, when you ask people how do they want to see health care change, they don't often say we need to make it more efficient.
Ryssdal: There is a political question, many obviously political questions to be asked here. One of which is why nobody in this entire debate seems to be advocating for the people who are paying for it, that is, largely households and patients and taxpayers.
LEONHARDT: I think the White House would argue it is trying to take up that mantle. I don't think it's doing it enough. But the answer to your question is that there are very powerful lobbyists and very big industries for whom your waste is their income. And as a result, what you have is every time you propose something that's going to take some waste out of the system, you have a huge outcry, whether it's from the doctors, or the hospitals, or the drug makers. And what they do very cleverly is they don't say, "Hey, don't take our income away." What they say is this will harm people. As a result, politically, Congress has not really been willing to stomach saying no to a lot of these parts of this industry.
Ryssdal: With all the groups who have so much invested in this, from pharmaceuticals, to hospitals, to doctors, to patients, how does the president cut through? How does he get a message out there that's going to stick?
LEONHARDT: He starts with the advantage that he is the president, and the presidency comes with a megaphone unlike any other. But I think that he really needs to persuade people that the system now isn't working that well. First of all, it's so expensive that it really is robbing us of money we should otherwise have to pay for things. And when I say we I don't mean the government, I mean actual families. It is a drag on our income. And the second thing is that, you know, the system really isn't working as well as it should in terms of making us healthier. And there all these doctors out there who would love to spend time with patients, and help them counsel, and think about ways to be healthier. But the incentives aren't for that, they're for more procedures and more tests. So what I think the White House needs to do -- for that matter the Democrats or the Republicans in Congress could do this -- is they need to persuade people that the system isn't working now, because it's too expensive, and it isn't delivering good enough results. And that we need a form of change that will deliver those two things. And that is broader than just covering the uninsured, but it really is the number one issue here.
Ryssdal: David Leonhardt writes the Economic Scene column for The New York Times. David, thanks a lot.
LEONHARDT: Thanks, Kai.
About the author
Kai Ryssdal is the host and senior editor of Marketplace, public radio’s program on business and the economy. Follow Kai on Twitter @kairyssdal.
For the briefest instant, I thought, "finally, somebody is going to speak the simple obvious truth." Mr. Leonhardt correctly observed "that there are very powerful lobbyists and very big industries for whom your waste is their income. And as a result, what you have is everytime you propose something that is going to take some waste out of the system, you have a huge outcry." Then, just at the moment of truth, Mr. Leonhardt not only fails to reveal the real power and industries at work, but misplaces the blame entirely. The one industry that exists only to profiteer off of the waste in health care and is the single greatest contributing factor to the inefficiency of the broken health care system is the for-profit insurance industry. They only exist to make a profit and contribute absolutely nothing to providing health care. The data clearly demonstrate that overall physician salaries and hospital earnings have remained largely flat, or, in many cases, declined over the past 10 to 15 years. Meanwhile, the health insurance industry continues to post astounding profits and pay astronomical salaries to its top executives. Insurers intentionally obfuscate the terms of coverage, deny coverage to those that most need it, routinely arbitrarily deny legitimate claims, and create overly complicated and burdensome claims processes all to maximize profit. With revenues that rival the GDP of some Latin American countries, it is the insurance lobby that keeps real change from taking place.
The most direct solution to the health care crisis is quite simple: outlaw for-profit health insurance. That is what most of the civilized industrial world has done and why they get better health care for much less cost.
Suppose something bad happens and it really matters. Take the loss of the space shuttle Challenger and its crew. That disaster was followed by lengthy follow-up studies by engineers, scientists, and other highly trained professionals, using scientific principles, while undertaking careful, detailed, painstaking studies over many months, in order to reach a consensus understanding on why it happened and how to prevent it from happening again. Nobody at NASA or in the public turned to Congress for those answers. No one pleaded with Congress to “tell us your opinion on why the space shuttle blew up and then draft several thousand pages of new laws to prevent it from happening again.†Rocket science is much too technical and complex, and the consequences of getting it wrong much too great, to leave scientific problem solving to ad hoc political opinions.
The delivery of health care in the U.S. economy is also technical and complex. As with the shuttle breaking apart, to understand why health care costs are going up rapidly requires lengthy studies by economists and statisticians and researchers and other highly trained professionals, using scientific principles, while undertaking careful, detailed, painstaking studies over many months, in order to reach a consensus understanding on why it’s happening and how to prevent it from happening again.
Yet, our government is on the verge of leaping headlong into a “solution†to health care cost increases that is based largely on anecdotes, opinions, and bald because-I-said-so, assertions, occasionally supported with random, isolated facts offered only for purposes of political advocacy.
Where is the science? Can it possibly be that the lives and health of millions of Americans is something less worthy of a full scientific understanding than the loss of the space shuttle’s crew? Where are the articles in scientific journals that reach a consensus on the causes of health care cost increases? Why does anyone think that radical economic surgery on the health care industry should be accomplished by a Congress that lacks any knowledge of economics or of surgery, that doesn’t actually define any problem at all, that offers only vague, fear-mongering assertions (“we *have* to do something!â€), and that has no evidence-based idea why health care costs might be going up in the first place?
It’s an elementary principle in medicine itself, and in engineering and business and the military and professional sports and nearly any other activity where results actually matter, that you first have to define what the problem is, and then you have to understand why things are the way they are, before you can craft a solution. God help us that Congress isn’t interested in doing any of that for health care.
