Thursday, July 23, 2009

Has The "Revisionist" History Caught up With Us

"Those who speak most of progress measure it by quantity no quality." George Santayana.

A couple of months ago, I responded to a comment by an acquaintence who said that it would be great to have national, free health care. It didn't take me long to figure this person as a liberal or rather progressive (that was not her only "progressive" comment). As the same time, I was reading Robert A. Heinlein's libertarian classic "The Moon Is A Harsh Mistress." In Heinlein's book, the motto of the Moon is TANSTAAFL, the acronym for "There Ain't No Such Thing as a Free Lunch." Oh would more people understand such a statement. No matter what you talk about in life, there is a cost-sometimes easy to shoulder and sometimes not.

After pointing out to this liberal chucklehead that "free" health care comes with a price tag, the most immediate being that the "price" of a "free health care" is increased taxes. She of course quickly noted that she didn't mind paying taxes--which is easy to say until the actual tax bill comes in. But let's assume that she is sincere in her belief that she will pay the tax bill, which is all fine and dandy, but I don't want her running my business or finances, let alone insisting I pay for something like that. But there are other costs, many of which have been detailed by others.

What is more troubling to me, is that this supposedly well educated woman has no idea of what she speaks when it comes to the notion of health care, i.e. that it is a right in America. This woman insisted that we in America could make it work since hadn't really been tried before in our country. This is where I find that in our world of near instant information, there are so many people who act or speak without having any information.

In the grand scheme of things, this particular woman is just a single person; a clearly committed citizen who truly believes and advocates for her beliefs. I don't agree with her, but I do respect her in her ignorance. I think that once she begins to learn the facts, her tune will change--most intelligent people can be educated.

But the difference between this woman and the leaders we now have in Washington is not as great as it should be. I can forgive a single, relatively young person for their lack of knowledge. I cannot forgive high leaders, with access to the absolute best and latest information on a subject for the same ingnorance.

I used to look forward to leaders who have a vision, a belief that American and the World will always get better. As much as I don't believe the Republican Party should keep looking back to Ronald Reagan and be looking for the "Next Reagan," I do believe that the GOP does at least look backward with a purpose (even though I don't agree with it). However, I have, grudingly, come to the conclusion that our "hope and change" President and the "progressives" in Congress have failed to even consider history--at all--even directly relevant history.

President Obama was not only a law student but a law professor and the heart and soul of legal analysis comes from the application of past cases (read past experience) to the current fact pattern. Such an analysis will inevitably lead to consistency in the law, and point the lawyer to a probably outcome. Sure, lawyers can and often do argue for an extension of the law, a change in the law or that a given case doesn't apply to the facts because the fact patterns are different. However, past experience is the primary instructor in the legal profession. My, My, My how far our president has come to ignore even the recent past.

This long ramble does have a point--health care in America. Representatives Marsha Blackburn and Phil Roe, both of Tennessee are trying to instruct the nation and our president about the failures of single payer health care. We don't have to look beyond our borders, to Canada or western Europe to see the problems of universal single payer health care--you can look at Tennessee.
Tennessee was home to a failed attempt at universal single payer care, and has lessons to teach a President who has promised that in pursuing his goal of universal health care, he will learn from the policy failures of the past. In 1994 Tennessee implemented managed care in its Medicaid program, creating a system known as TennCare. The objective was to use the anticipated savings from Medicaid to fund and expand coverage for children and the uninsured. The result was a program that nearly bankrupted the state, reduced the quality of care, and collapsed under its own weight.
Keep in mind that TennCare was intended only for a small subset of the population, those who qualified for Medicaid--i.e. those without the funds to pay for their healthcare. Remember TANSTAAFL? Here is the lesson:
TennCare lessons challenge the Administration's thinking on the benefits of a "public option" solution to assuring American's have the care they deserve. As a Tennessee doctor who provided care under TennCare and a state legislator who had to find ways for the state to pay for it, we learned these lessons the hard way. They shaped the way we both approach health care policy. With Democrats promising to pass a similar system in the House by August, those lessons are worth sharing with the country now.

"Free" Care Is Expensive: No matter how forthright the Administration's cost estimates are; no model accounts for the rational decisions that push people to over-utilize the "free care" a public option offers. TennCare's gold plated coverage included every doctor's appointment and prescription. As such, patients with a cold opted to charge the state hundreds of dollars for doctor visits and medicine instead of paying $5 out of pocket for over-the-counter cold medicine. Over-use caused TennCare's anticipated savings to evaporate and its cost to explode. While TennCare consistently covered between 1.2 and 1.4 million people; costs increased from $2.5 billion in 1995 to $8 billion by the time of TennCare's restructuring. It consumed a third of the state budget including nearly all state revenue growth. When the illusion of "free" care is fostered, it is always over-utilized.
Reps. Blackburn and Roe also point out that the "government" plan was pushed by many small employers. Small employers who currently provide health insurance for their workers will most definitely make the calculation regarding maintaining that insurance or paying the 8% surtax and if you don't believe that, you are deluding yourself.

Millions of Americans will be forced on the rolls of the public option under Obama. More people need to take a good hard, long look at the lessons of TennCare.

I understand the goal of health care reform, that is to make sure more people have access to affordable quality health care. A noble goal to be sure, but it is a goal that has multiple paths to success, but that path should be considered in light of history. The opening quote to this post was by Santayana and clearly not his most famous.

More and more of our leaders have failed to look to our history, despite their access to that history. The public option for health care will be expanded beyond all measures right now available, of that I have no doubt. It will be TennCare writ large and it will bankrupt this country faster than Medicare and Social Security combined. Is that really the lesson we need to experience?

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