The economic stimulus package has now been signed into law by President Obama. In addition to the funding allocated for healthcare IT in hospitals and physician offices, it calls for the establishment of a federal agency that would help coordinate research on comparative effectiveness which will determine which medical procedures, drugs and devices work better than others - to the tune of $1.1 billion.
This was really no surprise, as President Obama recently appointed Peter Orszag as director of the Office of Management and Budget. Mr. Orszag is viewed as “one of the country’s leading experts on the looming budget mess that is healthcare.” Furthermore, in his article, David Leonhardt describes Mr. Orszag’s view that “the goal of reform doesn’t need to be the remaking of the healthcare system in the image of, say, the Dutch system. The goal seems more attainable than that. It is like remaking the system of higher spending places, like southern New Jersey or Texas, in the image of low-spending places, like Minnesota, New Mexico or Virginia.”
Predictably, cries of “But what about the loss of freedom of choice!” and the ‘R’ word – rationing – began to emanate from a broad range of patient and provider groups, medical device manufacturers and pharmaceutical companies. That, also predictably, was followed by exclamations of the deplorable circumstances in which patients in Canada, Great Britain and European countries find themselves because of the conditions their governments impose on citizens.
These arrogant and self-righteous assertions reminded me of a conversation I had in 1991 with the number two official in the German federal health ministry during my fellowship experience studying the German health system. I had asked him how the German government viewed U.S. healthcare. In response, he related an experience he’d had with a visiting U.S. congressman who had previously been there to study the German healthcare system. The German official had then explained to the congressman that one objective of the federal government was to provide coverage to all citizens through an employer mandate. In order to ensure the government was able to fund the system, the government exercised control of the level of both capital and operational expenditures. Additionally, qualified citizens have the choice to opt out and go private, which would allow them priority of access to services.
The congressman’s response? “We could never do that in our country! We would never limit choice nor establish two levels of care.”
After relating the story, the German official asked me, “How could he demean and criticize our system when we have made a concerted effort to provide a basic level of care to all of our citizens – and done so by making difficult decisions on how to finance it by controlling expenditures? Don’t such hypocrites understand that the millions of uninsured in your country represent a more deplorable, two-level healthcare system?”
Sometimes I think Americans approach the discussion of universal coverage and health system reform like adolescents. We are critical and intolerant of the beliefs of others, even when they represent an honest attempt to make difficult decisions in the best interest of their citizens.
We try to extol the virtue of our own health system by pointing our fingers at the weaknesses of health systems in other countries without acknowledging the clear deficits in our own. We neglect to admit that those of us who enjoy the benefits of freedom of choice and unconstrained access to healthcare services are able to do so on the backs of the uninsured.
If we are going to successfully make the tough decisions necessary to provide universal coverage and health system reform required to make that universal coverage financially viable, perhaps we need to grow up and start acting like adults.