Melvin Konner M.D. Ph.D.

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...Since the causes of human nature are not a one-way street, I also want to know how changes in our environment make their impact on us--how advances in biology and medicine change how we think about our lives. My knowledge and experience have often led me to comment publicly on medical ethics, health care reform, child care, child welfare, and other policy questions, and I will do that here as well.
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Who Lies About Health Care?

September 27th, 2009

Because I was involved in health care reform in the ’90s–two books, four or five New York Times op-ed pieces, a couple of essays in Newsweek , and two testimonies before U.S. Senate committee—a lot of people ask me to help them separate fact from fiction in the current debate.

Tensions are high. When a congressman from South Carolina, long and widely known as a fool and a boor, yelled, “You lie!” to a U.S. president, it was the shout heard round the world. “Racism” was the cry raised in many quarters, even while the non-gentleman from Carolina apologized and was forgiven by the president.

But the congressman is a hero in places where some think the president was lying, although they would never have shocked their moms (or Speaker Pelosi) with such bad manners. The outburst followed Obama’s claim that illegal immigrants would not be covered by the plan. Obama pretty much accused those who said they would of lying, and one of them called him a liar right back.

Facts anyone? If there is a government option or if government gives individual subsidies or tax credits, illegals will be excluded. However, if employers are subsidized to expand traditional coverage at the work place, then illegal workers will be covered unless they’re fired and deported—not likely.

And of course, unless we let them die in the street, we will pay for their care as we do now—through taxes and premiums that support the hospitals that take care of them—in the emergency room, the costliest and least effective way. And of course, if there’s amnesty, they’re legal, and they’ll be covered.

Not least of the problems is, there is no “Obama plan.” The president punted to Congress. He got a lot of plans, and even the Democrats can’t yet agree on one. Obama’s own “plans” are in his speeches and on his website, and they keep changing.

How about forcing the uninsured bto sign up, as in Massachusetts? Hillary proposed it in the campaign and Obama slammed her, a factor in his win. But he now wants to do it, with big fines to back it up. He wasn’t lying though. He changed his mind.

How else to fund the thing? If young healthy people don’t pay in, and older sick or soon-to-be-sick ones draw a lot out, the plan implodes. As Medicare will, if the burden of paying for it is not distributed throughout society. And of course Obama and the Dems want to insure 47 million more people, all without raising taxes. How will this magic be done?

By cutting costs–there is much waste. Okay, but we’ve been through that before. The immense expansion of HMOs in the late 1990s—part of the corporate takeover of American medicine–was supposed to stop medical inflation, and it did—for about three years; inflation has galloped ever since. Perhaps draconian measures can rein it in, but they will face tremendous opposition in every election cycle.

In fact, the only idea currently on the table that has a chance of paying for the care of the uninsured is the public option, which seems poised to be knocked off the table. This, simply put, is the chance for the un- and underinsured to buy into something very much like Medicare, sans an age limit.

This is a true deal. Conservatives say it’s a stalking horse for single payer (Medicare for all). Doh . It should be. It will charge smaller premiums because it won’t have to pay profits to shareholders and it won’t have nearly as much bureaucracy as private insurers. It will slowly out-compete them, and I will stand up and cheer.

So are the Democrats lying when they say this won’t happen? Draw your own conclusions. But let’s not forget the lies on the other side.

America has the best health care in the world? Big lie. We trail about 25 countries in longevity and infant mortality.

Canadians come to the U.S. for fancy procedures they can’t get there? Partial truth. Far more Americans who can’t afford vital care go north of the border and pretend to be Canadian.

Europeans are dissatisfied with their health care and going private?
No way. They are mainly satisfied, they are offering private options side by side with their national programs, but they’ll never give up government-funded care.

Big tax increases would follow the introduction of such a system? Well yes, but smaller than the premiums they replace.

The government will ration care? Sure, but insurers do it now, arbitrarily and with profits, not patients, in mind. There is no future for health care in our country without hard choices about what is worth doing and what is not.

So let’s get real. Almost everyone is lying. The reality is we will not have affordable, sustainable, quality health care until we have national, mostly publicly funded, universal coverage. And that’s no lie.

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