Testing Our Progress

Published April 14, 2009 @ 02:29PM PT

We want quality, affordable health care for all, yes, but how do we know that we’re moving in the right direction? Given that this week is the 64th anniversary of the death and funeral of FDR, and recognizing how much our current national mixture of optimism and timidity in the face of economic uncertainty has many thinking of the New Deal and Roosevelt, it seems worth reflecting on what has often served as the unofficial credo of the progressive movement, from FDR’s second inaugural address:

The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.

I think about this line often when reading through all the different arguments as to why comprehensive reform should include this or shouldn’t include that, should help this interest group but shouldn’t help that, etc. For me, FDR's line has nothing to do with classes or tax brackets. It has to do with who has much in our health care system as it is, and who has too little.

“Those who have much” is easy to answer. In an off-year in 2008, the top pharmaceutical companies still made billions of dollars, with Johnson & Johnson, GlaxoSmith Kline and Novartis making in excess of $10 billion just in profits. The top insurance companies also did well, with UnitedHealth breaking into the top 100 companies because their profits increases 12% in two years, and Humana’s profits jumping an incredible 71%, largely on the backs of Medicare Advantage plans. This during a recession, mind you. Hospitals are dodgier – some have made some incredible profits, while some have lost a lot of money, meaning on average, hospitals are basically breaking even. Similarly, doctors in some specialties are making a tremendous amount of money, while primary care physicians in private practice are breaking even, or even losing money.

“Those who have too little” is also easy to answer. It’s the rest of us. Businesses, large and small, who are dealing with crushing costs that make them less competitive at home and abroad. Families and individuals, who have seen their share of health care costs go up, the aggregate cost of care go up, but the quality of care and the wages they have to pay for it flatline, and the percentage of businesses who give comprehensive benefits go down. State budgets for health care. The federal budget. Those with pre-existing conditions. Those with chronic diseases. Those who need long-term care. Those who live an accident or illness away from bankruptcy. What was said by an IBM executive is true for most of the United States when it comes to health care coverage: “What we buy is garbage.”

From Medicare Advantage, to negotiating rates for prescription drugs for Medicare, to money for comparative effectiveness research, to the competition offered by a public insurance option, to bringing meaningful reform to those who our system leaves behind, how do all the proposals floating around get us closer to making progress? Are we focusing on those who have too much or those who have too little?

(Photo credit: marc.benton on Flickr.)

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Comments (7)

Too many people are without health care.Everyone loses when there is not everyone has health care.Poor people won't go to a doctor unless it is an emergency and doctors don't have enough patients to earn their living because people without health care do not see a Doctor.

Posted by Martin Martinez on 04/15/2009 @ 08:15AM PT
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I don't have the answers but I think things must change in the way healthcare is treated in the US. A family plan for BC/BS Personal Choice will cost $1363.11 per month in my area if anyone is 60 years old or older. Ages 50-59 pay $1051.42 monthly. This is a big drain on the working family.

The words "free healthcare" or "state run healthcare" scare many doctors almost as bad as "malpractice insurance". They feel that their many years of schooling and the fact that they keep us alive and healthy is worth more money than the garbageman and I agree.

Where does my $1000 per month go when I pay my insurance bill? How much is wasted on overhead like excess management spending. A healthcare insurance executive should not be paid more than a doctor although there are some who are.

I would like to see some intelligent answers to the problem from health care professionals.

Posted by jack barr on 04/16/2009 @ 08:48PM PT
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Are doctors deserving of a fair wage, sure. But that wage should also be reasonable. I've seen neurologists who bill $350 for a TEN MINUTE follow up. Even allowing for 10 minutes per hour for paperwork or whatever, that lets you see 5 patients per hour and gives him 5 x $350/hour = $1750! Does he have $1700/hour or so in expenses? Otherwise, I can't possibly see how that amount is justified, even with all the schooling required to become a doctor.

It's not just neurologists either, I've seen similar tendencies to try to bill outrageous rates in other fields - even general practitioners. So doctors really need to start explaining how they justify what they're billing while crying about how any public system "wouldn't pay them what they're worth". Sorry, NO ONE is worth $1750/hour. Not even doctors. This is where a good part of the outrage comes from - the other part being the ridiculous charges for insurance that leaves you with huge out of pocket amounts (while still, typically, denying or delaying necessary care).

Posted by Danetta Amschler on 04/18/2009 @ 01:08PM PT
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UNIVERSAL SINGLE PAYER HEALTH CARE!! Do I need to say anything else.

Posted by Doris Vician on 04/18/2009 @ 05:16PM PT
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Freedom in health care! There is such dated thinking here, e.g., referencing FDR. I'll bet more people were getting health care BEFORE the advent of government programs and insurance companies. What we have now is a bad mix of government, insurance companies and the like. We also have the FDA which is beholden to the drug companies. New drugs cost a fortune because of the development costs. Whatever doctors bill for their services is probably inflated, thus insurance companies refuse to pay the full amount. This is a very complicated issue which has become more complicated by GOVERNMENT. Doctors are not without blame here either. I think their egos are so large that they think they deserve as much money as possible - but they also have to pay big amounts for protection against lawsuits. So there you have it. A mess that no-one is happy with. But single-payer or socialized medicine is not the answer. Insurance for everyone is not necessarily the answer either because there will always be folks who can't afford it. We need a free market in health care that would encourage individuals to take more responsibility for their own health and a market in health care that has more variety, alternative treatments, and caring people who will help those who can't afford the help.

Posted by Janice Moerschel on 04/25/2009 @ 04:45PM PT
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In the "town hall" meetings I have attended on this issue, it seems that everyone is looking out for their own interests (profits). The alternative medicine folks are looking to cash in on this thing just as much as the drug companies, doctors, etc. But, in response to your comments, let's consider that there are MANY medical problems which can not be prevented- Like muscular dystrophy. Can all serious auto accidents be prevented? Let's take a look now at how this "preventive medicine" line would be used by the government, insurance companies or insurance co-ops. "Oh! You have diabetes! Sorry, it's your fault because you did not take preventive measures. Treatment denied." "Oh! You have heart problems! . . . " You get the idea.

Posted by Jane Rodriguez on 07/25/2009 @ 08:27PM PT
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Personal responsibility is not a cure all. People are being blamed for having conditions that can't be prevented. Diabetes for example, even type 2, isn't always "caused" by the patient sitting around and eating too much. It can just as easily be caused by genetics that don't like the "modern American diet" (several Southwestern Native American Nations have diabetes rates over 50% - even when their members are active) or by the doctor failing to recognize and treat conditions like insulin resistance, metabolic syndrome or polycystic ovarian syndrome (PCOS) which can develop diabetes as a complication. Diabetes can even be a side effect (though personally, I think complication would be a more accurate term) of an entire group of medications - the atypical antipsychotics for reasons no one has yet figured out. Also, type 2 diabetes DOES happen to "skinny" people". All this said, insurance companies are calling things like allergies and seizure disorders pre-existing conditions and reasons for denial of coverage - how can one "prevent" these sorts of things?

But if a "free market" was going to solve this, how on EARTH in an only mildly regulated market did we get into such a mess and why is it only getting WORSE? Clearly at the very least more regulation is needed - like recognizing health care as a human right and probably also as a commodity necessary for the well being of society that should be regulated as such (similar to things like utilities and even garbage).

Posted by Danetta Amschler on 04/25/2009 @ 05:53PM PT
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Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.