Op-Ed: US health care- A crisis, when politicized, becomes a paradox

The ongoing Third World War, otherwise known as the US health care system (based on casualties) and its related ideologies of doubtful pedigrees and parentage, has returned to center stage as President Obama prepares to tackle it.

One of the most damning legacies of polarized politics, this will be a Herculean task, at best. This is a cultural problem, and a serious one. It’s easy enough for foreigners to laugh at the fact that the country that produces most of the world’s best and most innovative medicine and medical practices has one of the world’s most medieval health systems. The fact is that this whole concept of ultra expensive medical costs and fees has come from the US, and is global. It began with the brilliant idea of treating things that aren’t businesses like they are businesses. That included hospitals. All of a sudden there has to be a profit out of a car accident, or depression, or some other form of self indulgence. Public health is a cost to budgets, and a competitor to private health care, so all politicians naturally gravitate to the private side. Result, crash of public health. Then health insurance became an issue. It’s a lot more profitable to charge $1000 than $10, and there’s no law against it. If everybody charges $1000, there’s no cartels in health care, just a coincidence based on similar costs, which presumably everybody in the entire industry is too illiterate or too lazy to reduce. Or maybe Christmas is based on the number of patients you can find. Health care was always going to be the pig at the wedding breakfast for the Democrats. It was part of their platform, from day one of the campaign. The GOP never even really pretended to care much about health, and confined itself to blowing costs of prescription drugs out of the water in 2008. So a huge, totally dysfunctional system, whereby health care is now largely nominal, if not entirely theoretical, is now the Obama administration’s baby. It’ll be interesting to see how the administration approaches this unholy mix of greed and grotesqueries. Hillary Clinton, as a candidate, put out a health policy which scared the hell out of the industry. It established benchmarks, set bottom lines, and in fact came across as a legitimate attempt to establish a public health system which had some hope of functioning. As distinct from the usual bean counting and thunderous mediocrity, it was unique. Interestingly, the issues raised about health care are now rarely if ever about actual services, but how to persuade the various oligarchs in the health industry to condescend to do something useful. Things like “cost growth” are apparently considered normal issues. One of the stated aims of administration policy is to reign in cost growth. Cost growth is a legacy of decades of overpricing, rather than any vague semblance of efficiency in medical costing. Anywhere you look at costs, from about the late 80s onwards, you’ll find inflated figures. It's accepted, a built in inefficiency, and it's also largely responsible for the massive increases in costs to consumers. The industry is also resistant to anything called “public”, on principle. In Australia, we have a scheme called the Pharmaceutical Benefits Scheme, which is subsidized medicine. Drugs listed on the PBS are available at rational prices. It saves sick people from going broke, and they can actually get their hands on the medicine they need. All Australian political parties refuse to tamper with the PBS, because it works so well. US states have been investigating it, to deal with their own crippling health costs. It’d work in the States, too, if it was introduced, as an alternative to impossible prices. The only real opponents of the PBS? US drug companies, on the vague principle that even if it means people can buy their drugs, it’s “socialism”. That’s the mentality the Obama administration will have to deal with. Any relationship to medical realities, social crises, or actual pandemics like TB, will be mainly accidental. Anyone would think the health care industry was above the law, and beyond normal competitive practices. Whatever health care once was, it's now no more than a large bloodstained parasite. It’s accountable to nobody for its commercial practices. You’d be safer in Afghanistan playing hide and seek with the IEDs than in the financial aspects of paying for health care. People on normal incomes, or those on fixed incomes, can forget about health care. The disease of top of the range costs has spread globally. India can now provide top level medical services at a fraction of the cost of the US, which is now hopelessly uncompetitive in prices, as are many other Western nations on the Charge Anything bandwagon. A world full of sick people is a sick world. We can only wish the administration luck in dealing with this hideous situation. The paradox is this: 1. The industry is largely responsible for its own failure. Its cost structures have systematically crashed the system. It will also have to be the driving force of any real reform, and any chance of actually making health care workable. The only way it can be convinced to do that is to show it some benefit in dollar terms, because it's no longer able to comprehend the idea of actual service provision. The disease, in effect, is its own cure. 2. The political system is no longer calling the shots in health care. The genie got out of the bottle decades ago, and is now funding politicians who are supposed to be acting in the public interest. Democracy, anyone? Because there's precious little of it available in this sector. There's an old joke: If the doctor's away, send for a well known apple. Might be cheaper, and certainly quicker.