Medical Reform, A Reality Check

Our government often seems to be run by a cadre of politicians who operate in a labyrinthine system of personal benefits and have mastered the art of gibberish. Especially now, with the economy in a downward spiral and health care the subject of proposed reforms, the public is being assailed by a battery of half truths and downright deceptions designed to counter real change in medical care.

What some people call competition and choice are anything but. For one thing employees who receive benefits from companies aren't free to choose a health provider; that is done by the employer. And ironically, as some who have lost jobs or retired discover, coverage can be refused because of an existing condition that was known and covered by the insurer at their former company. Conservative columnist George Will and others insist there are over a thousand different kinds of medical coverage plans, but that doesn't mean they are equally available, affordable or desirable.

Indeed, affordability is the biggest elephant in the room. Republicans prefer to offer plans that work off tax incentives, the primary moving force behind any and all reforms as they see them. It's what they call incentivizing to encourage competition and exactly what will never make the system responsive to the needs of most ordinary Americans because it remains at its core, a structure that insulates the profits of insurance servers rather than promoting the general welfare. If insurance executives earn enormous salaries, administrative costs reduce benefits and investors must be rewarded, it is clear that the interests of the insured are not the first or most important consideration.

When the Bush administration sought to ingratiate itself with voters it pushed through a prescription drug plan that was, not only unaffordable in terms of budget, but was predicated on making costly deals with big pharmaceutical companies. And questionable aspects of the plan soon became obvious. For example, an expensive diabetes prescription appeared in one formulary, a reason diabetics chose it. In time, however, that particular medication was summarily dropped from the formulary and no longer carried by any provider, apparently because it wasn't profitable enough.

What passes for competition is in effect an arrangement that insures profits for the industry instead of safeguarding the medical needs of regular folks, hardly the definition of insurance understood by most people. Unfortunately research and development accounts for a much smaller slice of the pharmaceutical pie than marketing outlays. It can't go unremarked by anyone who watches television that huge sums are expended advertising prescription drugs - - most ubiquitous of all, drugs to address erectile dysfunction. Every company produces a similar product because obviously it's a sure-fire money-maker. Commercials offer infinite versions of leering males and coquettish females dashing off to nearby bedrooms.

In other instances, we are encouraged to "ask our doctors" about medicines designed to deal with bladder control, indigestion, sleeplessness, Alzheimer's, you name it. We are warned, however, that various of these pills and potions may cause, in some cases, everything from fainting spells to death. Potential consumers are treated as if they are so insensate they are incapable of broaching complaints with their doctors without being nudged into action by the medical industry's profit motive. Worst of all are the lobbyists for insurers and big Pharma and the politicians who are in their thrall. How valid are arguments about the cost of a government choice in an overhaul of our current system when compared with the millions upon millions churned into the campaigns of candidates and the coffers of advertising moguls? And do those gold-plated policies for the rich compete with health savings accounts that could never cover any but incidental expenses?

Senator McCain has said a $5000 tax refund would enable most people to find adequate insurance among the myriad of plans available, assuming sufficient income to make a deduction meaningful. But it isn't clear that price would provide protection in the event of serious medical contingencies. And of course it wouldn't cover an entire family.

A lot of Republicans who think they have easy answers and offer simplistic proposals need a reality check and some Democrats, inclined to tinker around the edges of serious health reform, could use one too.