Wrong diagnosis, wrong Rx
BY KAY MCVAY
Special to The Examiner
TENNESSEE Sen. Bill Frist is undoubtedly a good surgeon and a handy provider of roadside emergency medical service, but the plan he and President Bush are cobbling together for Medicare contains neither a useful diagnosis of the country's current healthcare infirmity nor a prescription for getting us out of our current healthcare blind alley.
The Bush-Frist approach will hardly move us any closer to a genuine solution. In a hospital setting, to prescribe a spinal adjustment when radical surgery is called for is to ignore the injunction to first of all do no harm.
Although the full details of the president's Medicare plan are yet to be revealed, it is evident that the administration seeks to "promote competition" in Medicare and eventually turn it into a program looking more and more like private healthcare insurance.
To most Americans, anything that sounds like more HMO-healthcare is going to be immediately suspect, but the White House and some in Congress imagine such an aversion can be overcome by linking a broad scheme to profoundly revamp Medicare with the popular appeal of adding prescription drug coverage.
The core of the argument is that competition for enrollees between regular fee-for-service Medicare and private insurance will result in lower costs for healthcare coverage.
However, with the costs of drugs and other elements of healthcare delivery skyrocketing, the readily available instrument enabling private insurers to "hold down costs" is diminishing services.
The history of the managed care "revolution" -- which the White House would now superimpose onto Medicare -- is one of drive-through mastectomies, restricted access to specialists, physician speedup, decreased skilled nursing care and shuttered inner-city and rural medical facilities.
Without some action to harness healthcare costs, they will only continue to rise.
The only significant change under the Bush plan would be that Medicare funds would be channeled through -- and siphoned off by -- private insurers.
Moreover, HMO bureaucracies, advertising expenditures and enormous executive compensation arrangements will remain major contributors to spiraling healthcare delivery costs.
Managed care and health maintenance organizations were supposed to make healthcare more accessible and affordable.
Nothing of the sort has happened. Costs continue to rise, far outstripping the general rate of inflation; out-of-pocket expenses for insured patients continue to increase; personnel cutbacks are undermining care quality; and 44 million people have been priced out of healthcare insurance.
The way out of the crisis and past these smoke and mirror "reform" proposals is recognition that the private insurers are superfluous. That is, they are not needed.
Most of the industrialized world and much of the not-so-industrialized world has been able to do without them for quite a while. They have also been able to impose and enforce controls on healthcare cost inflation.
Of course, this has meant no profits to be reaped in a healthcare "market." In the weeks and months ahead, those currently rewarded handsomely by the healthcare industry will be all over Washington and in our faces continually extolling the virtues of consumer "choice" and healthcare "competition" as they line up support for the Bush-Frist plan to get rid of Medicare as we known it.
It was a tremendous accomplishment for our country to enact legislation in 1965 to guarantee that the elderly in retirement would no longer have to be in a state of continual insecurity when it comes to healthcare.
Medicare is a successful and very popular program. People who have paid into the program over their working lives have every reason to expect the benefits will be there when they need them.
What we need now is a plan for shoring up and expanding Medicare, adding a provision for full prescription drug coverage coupled with a thoroughgoing discussion of what we need in a healthcare system and how to get there.
For many of us, this will lead in the direction of a comprehensive, universal "single-payer" type system that guarantees healthcare as an entitlement.
Comment: letters@examiner.com
Kay McVay, R.N., is president of the California Nurses Association.
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