A Provocation from James Pinkerton: Why the Health Care Debate Is Boring — And How to Make It Interesting!


obama health care.jpgThis is a guest note, exclusive to The Washington Note, by James P. Pinkerton — a contributor to the Fox News Channel and policy blogger. Pinkerton is also fellow at the New America Foundation, and contributing editor at The American Conservative magazine.
TWN invited Pinkerton to share this ‘provocation’ on the subject of health care reform in order to generate healthy discussion and debate here on the blog. We look forward to civil, informed discussion — but be respectful.
Why the Health Care Debate Is Boring — And How to Make It Interesting!
Is there a bigger snooze than “health care reform”? Any article that begins “A better plan to provide health care . . .” is likely to lose most of its readership in the first sentence.
But at the same time, few categories of news are more compelling than medical breakthroughs — or medical calamities, or medical news in general. People like to learn about new treatments and cures, and they are also fascinated by epidemics, disasters, autopsy reports, environmental dangers, and information about defective products and recalls.
Thus the paradox: “Health care” is dull, but “medicine” is compelling.
To put it another way, “health care” is theoretical: Who finances it, and how? Who gets it, and how? Such a policy debate is obviously important; it is just not very interesting.
Discussions of health care policy are like discussions of economics. In fact, health care policy is a subset of economics — the studying of the allocation of scarce resources. And while some find health care economics so interesting that they make it their life’s work, to most people, it’s just more dismal science.
But “medicine” is intensely practical. It’s about you. What medical news should you click on? Or which medical drama should you watch on TV? Which medical thriller should you read? What medicines should you take? What advertisements should you consider and evaluate? Which doctor, or hospital, should you go to?
In other words, while only a tiny fraction of the population is really interested in health care policy, near 100 percent are interested in medical matters of one kind or another.
So the concept of “health care” has managed to do the seemingly impossible: It has drained away the flesh-and-blood fascination that people have for their bodies, and for other people’s bodies.
It’s almost as if the Washington wonks — right as well as left — have conspired to make “health care” boring, so that ordinary people, interested as they are in “medicine,” won’t bother them, the wonks, as they do their work on “health care.” Could it be that liberal health-care experts wish to cook up schemes for rationing and cost-control far from the public spotlight–and that conservatives, wallowing in the minutiae of “medical savings accounts,” wish for similar obscurity?
If so, then the policy experts have gotten their wish: “Health care” is too boring for most people to worry about; instead, people tune into “medicine.”
But of course, this bifurcation of “health care” and “medicine” will not last for long, because soon health-care policy will impinge, in a big way, on medicine. And that’s when, most likely, the wonks’ policies will hit the fan, because it’s unlikely that anything that health-care theorists come up with in Washington will prove pleasing to practical-minded medical consumers.
Indeed, there’s a grand canyon between the tiny elite of health-policy-propounders and the masses of mere medicine-consumers.
Right now, politicians, reading from talking points provided by their nerdy staffs, can promise anything. But if and when medical consumption starts really to change, most likely for the worse, that will be a different story for previously apathetic Americans. “Controlling costs” is a great buzz phrase, but costs that are controlled mean real pain for real people.
Now if the Obama Administration and the Congress can control costs in just the right way — if they succeed in implementing a fair health care plan that cuts only “waste, fraud, and abuse” — they will, of course, be heroes to the voters. But if, maybe, a new health care plan causes shortages, or prevents the creation of new drugs and therapies, or shuts down hospitals, look out. An estimated 25 million Americans are members of disease-support groups; they might suddenly realize that “health care” has affected the progress of “medicine.”
So how to make “health care” interesting?
Easy. Call it “medicine”; as marketers say, tangibilize the intangible. For instance, could Michael Jackson’s life have been saved if an automated external defibrillator (AED) had been in his house? An AED costs about $1300. That’s a lot of money, but the cost of these life-saving devices be brought down through volume production and discounts.
Or how about Steve Jobs and his liver transplant? We shouldn’t begrudge him his new liver, but each of us should ask: “Where’s mine, if I were to need one?” Yes, liver transplants are expensive, but how much cheaper would they be if new livers were grown from test tubes, and if the surgery could be robot-ized? Or if some new and cheaper technique for dealing with liver failure were created?
And then there’s Barack Obama himself. During his June 24 ABC News “town hall” from the White House, the President was asked a pointed question by Dr. Orrin Devinsky, of New York University, and gave a revealing answer.
Devinsky observed that elites often propose health care plans that restrict options for the general public, knowing that they themselves will always have the personal wealth to buy the best possible coverage on the open market. And so Devinsky asked Obama if he would commit to social solidarity, and lead by example — by pledging not to seek out extraordinary medical help for his family, beyond what his own proposed plan would provide. As reported by ABC’s Jake Tapper and Karen Travers, Obama, a multimillionaire even before he became president, refused to make such a pledge, saying, instead, “If it’s my family member, if it’s my wife, if it’s my children, if it’s my grandmother, I always want them to get the very best care.”
Well, all right then. Now we are getting some human-interest drama. And are we perhaps getting a little bit of hypocrisy, a double standard or two? To Obama the political leader, “health care” is a policy prescription for the nation. To Obama the family man, “medicine” is personal–his own business, to take care of on his own.
But for advocates of sweeping health care “reform,” the personal is political — or at least it should be. If it’s a good standard for him, then it should be a good standard for everyone else as well.
Yet for now, the debate over “health care” is too narrow–a battle between liberals enamored of central planning — oops, I mean the “public option” — and conservatives enamored of “market forces.” And so regular people tune out, even though both the left and the right policy elites seem to agree that “medicine” is too expensive. But Americans will tune back in, with a vengeance, when the scrimping results of new health-care policy begin adversely to affect real medical care.
Thus the challenge to those of us who trust medical providers more than we trust health care experts: Let’s get the focus on medical outcomes, now, before the policy-process people do real damage.
Medicine is not only more important than health-care policy — it’s a more interesting, more vital, story.
— James Pinkerton


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