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


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

  1. Zathras says:

    There is an important idea buried within Mr. Pinkerton’s mountain of prose. It is the idea that reducing spending on health care in the United States is bound to hurt someone.
    It has to; there is no way it cannot. Health insurance companies may add to the costs paid by patients and their families, but they also employ many thousands of people. More doctors engaged in general practice and preventive care means fewer doctors with highly specialized (also highly compensated) practices; this would provide better care for more people, but much worse care for a few people with unusual medical conditions. A policy decision to reduce the wildly disproportionate amount of money spent on patients in their last months and years of life is probably required to bring America’s per capita spending on health care closer to that of other developed countries, but all of those patients have families.
    I wonder whether the health care debate is taking place among people talking about making hard choices but not about what makes choices hard — namely, that some people will get hurt if they are made. I understand Pinkerton’s suggestion about focusing on medical outcomes, though the resistance to that suggestion appears to me to come as much from the medical profession as it does from the nameless “Washington policy wonks” he takes shots at here. What I don’t track is his talking about outcomes as “magic medicine beans” — defibrillators and cheap, easy new livers. That’s mostly not what outcomes are about at all. What they are, in the long view, is one way to spend less on health care for some patients without reducing the quality of the care they receive too much. Focusing on outcomes isn’t a way to make health care reform interesting and fun; it’s just a way to make hard choices a little less hard.


  2. PissedOffAmerican says:

    I’ve stayed out of this one because of Steve’s admonission to “be respectful”. How does one “be respectful” to someone that is so unmindful of “truth” that they would actually prostitute themselves to a news agency like Fox?
    But one short little consideration that comes to mind is the FACT that the “field of “medicine” that this Fox News mouthpiece so reverently worships is rapidly becoming unacvailable to the huge majority of Americans. Cheney’s continued hearty beat speaks volumes about the miracle of modern medicine. But bottom line, if I had Cheney’s condition, I’d be dead.
    This Fox News prostitute, (It IS respect, I coulda called him a whore), will have “medicine” bequeethed to the same social ranks as these people want to place eductation with their ridiculous programs advocating “vouchers”. “Medicine”, and education are being ceded over to the rich, much like the car enthusiast standing outside the Ferrari dealership, looking through a window at a world he can never enter. When people like Pinkerton are finished, education, and medicine, will be equally inaccessable.
    Hmm, did I say “will be”??? Pardon the mistake. Like I said, if I had Cheney’s heart condition, I’d be dead by now.


  3. Igor Marxomarxovich says:

    Obama qualifications to reform health care:
    No birth certificate
    Cannot stop smoking
    Difficulty telling the truth.
    Therefore, I Igor produce Obama Birth Certificate at http://www.igormaro.org
    Compare Obama Care vs Igor Care at Obama vs Igor Care


  4. ICDogg says:

    “Cherry slowly unbuttoned her shirt, revealing, first in shadowy enticement, then in all their glory, her full, ample, supple pouting breasts. Then the technician put her in the mammography machine, which was paid for by a property tax levied by the county hospital district, while the technician’s and doctor’s fees would be paid by her employer-sponsored insurance plan. Cherry would like to quit her job as a lap-dancing waitress at The Spooge Club to pursue her dream, the dream which revealed to her the secrets of a functioning star drive, but, in the absence of an affordable, truly portable insurance plan, she just couldn’t take the risk.”
    –from “TheOther” on Fark


  5. Anne Markward says:

    Mr. Pinkerton states, “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….”
    Absolutely. I trust the medical providers (the docs) far more than the health care experts (the [private] insurance companies) when they say I need a certain test, or certain prescription. That’s the point of affordable public option health insurance: to allow 97% of us basic health care, even though we realize it may not be perfect, not triage-less medicine.
    Look at New Zealand – basic health care for all kids, all residents, all those on legal work permits. The emphasis is on the GP level of prevention, not on the ED level of catastrophic last attempts.


  6. ... says:

    the usa has money for war and the anticipation or movement towards war, but no money for the health of its own citizens… what a sad kettle of fish…one day the usa will pull itself out of its miasma but it looks like all hell has to break out first…


  7. Eric Garland says:

    The reason the healthcare debate seems boring is that the leaders don’t accept that future healthcare costs will bankrupt the republic. When the Boomers pass the age of 65, two things are going to happen: half the doctors are going to leave the system, and costs will double from all the heart failure, liver disease, and diabetes coming down the pike from the 70 million people born between 1946 and 1965. Our $2 trillion a year expenditure will go to $4 trillion by some forecasts.
    Naturally, this is impossible; states will declare bankruptcy before reaching that number. This is, of course, exactly what California is just beginning to do at this very moment. The rest of the states will follow, politicians will bloviate, doctors will attempt to flee the downward price pressure, insurance company execs will suggest that any changes to their profit margins will result in all children getting polio, and the status quo will be maintained at a terrible cost.
    Exciting, no? Sadly, that’s not the narrative presented – it’s just another boring rehash of the same political pablum about “being able to keep YOUR doctor” and scare tactics about Canadian centralized care. This fake dialogue is great for the lobbyists who want plenty of time to design the system in their interest.
    Irrespective of whether we gain the courage to have a real discussion, $2 trillion in extra costs is coming down the pike. For some, that’s excitement enough. It’s only dull and boring if you are having the same debate from 1983 and expecting a different outcome.
    Perhaps it’s time to have an actual debate?


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  9. questions says:

    One problem with over-anecdoting is that for every anecdote, there is an equal and opposite re-anecdote (there’s probably a better formulation than this one, but I couldn’t help it.)
    Indeed, stories of suffering move us, help us to understand other people’s positions, encourage us to develop empathy and so on. But such stories are open to deep inaccuracy. A story about a cancer patient who couldn’t pay for some new 35 thousand dollar a dose chemo drug moves us. But then we find out that the drug doesn’t extend life, or does so trivially, or hasn’t been shown to work on this particular kind of cancer. Our heartstrings have been pulled, we feel, we pay. The patient dies anyway, and someone else suffers because of the diversion of scarce resources.
    I’m not convinced there are easy answers for health care. I am convinced that there are huge numbers of competing interests that are legitimate.
    Healthy people are simply less likely to think of themselves as potential patients (discounting the future for the present). Low income people don’t have the resources to put into the system, well-insured people prefer to keep what they have since it already works, industry people want to keep their income, doctors don’t want pricing power to be handed over to a single authority. (I assume here that those many who support a single payer system think they’ll be able to set their own reimbursement rates. This one should be fact checked.) Young people are far from death. Older people have Medicare already. But sick, and especially sick and under/uninsured people, are desperate for change. There are real differences, and the significance of these differences shows up in survey data and in the mixed signals in Congress.
    Pinkerton makes it seem easy. Just tell some stories and we’ll get a great system. But the stories we need to hear are a psychic drag because they all have to have the following message: YOU WILL GET SICK, YOU WILL DIE, YOU WILL WANT BETTER CARE AS YOU DIE, YOU WILL PAY AND YOU WILL STILL DIE ONE DAY– not such an easy thing to sell. Oh, and in the process of giving you that care, we will charge you or you and your employer or you, your employer and the public a minimum of 10,000 dollars for family coverage.
    Loss of money, certain death anyway. Wow! there’s a narrative.
    I’m all for soft power in many situations, but I think that impersonal data may work better than the anxiety-inducing fact of loss of wealth and gain of death.


  10. Ben Rosengart says:

    Mr. Pinkerton wrote:
    “Controlling costs” is a great buzz phrase, but costs that are
    controlled mean real pain for real people.
    * * *
    Costs that are uncontrolled mean real pain for real people too.
    People denied coverage through rescission; people taking lower-
    than-prescribed dosages because they can’t afford their pills;
    people going without care.
    Perhaps Mr. Pinkerton doesn’t know any of these people?


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