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Everyone Is Having the Wrong Healthcare Debate

By STEVEN MERAHN, MD

In 1807, in an effort to spite the British and French for shipping interference (and forced recruitment of American citizens into military service), the United States Congress passed an Embargo Act, effectively shutting down trade with these two countries. Britain and France quickly found other trading partners; the US, then limited in our capacity to sell products outside our borders, was left with a devastated economy and a gaping hole in our face. It took only weeks before Congress passed a loophole; they repealed the act within 15 months of its passing. It was a great lesson in unintended consequences.

Today, ignoring history, both Republicans and Democrats seem to spar continuously around healthcare: whether the message is about tearing down the Affordable Care Act or about some version of Medicare (For-All, For Whoever Wants It, For America, or For Better or Worse), both parties are terribly wrong.

Assuming the social imperative for healthcare is to eliminate preventable morbidity and disability (and associated costs) and improve (or sustain) quality of health of all our citizens (in order to help as many of them as possible remain productive, contributing members of society), another approach to ‘universal care” would be to flip the figure/ground relationship for our current efforts: instead of developing better payment systems, let’s develop and commit to a universal clinical operating framework that ensures that every member of society has the same opportunity to optimize their health status.

“Centralizing” the methodology around a universal model for how we plan for care, and allocate resources to ensure care plan goal achievement, would be far more valuable to society than centralizing the sources of funds to pay for care, because then we’d know what we’re paying for.

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Engaging Responsibly In the Health Care Debate

flying cadeuciiWith no apology offered, I will be venturing into a very subjective realm, namely, a characterization of today’s healthcare dialogue and what, in my opinion, might be an improvement.

I would suggest we have fallen into the trap that was partly enhanced by email and blogs, namely, that we can say outrageous things impolitely and without consequence.  With email we tend to be much blunter and impolite than we would be face to face.  On blogs, we can be positively toxic.  It’s like driving in a car with a tinted windshield that no one can see through.  You are anonymous and therefore can act less responsibly.

Another vignette.  I grew up in a very small upstate New York town where everyone knew everyone else.  You used your car horn to beep “hi” or to warn, and not in anger, ever.  When you waved at someone, it was with all five fingers.  And so on.  I think you get my point.

The healthcare debate always has stoked emotions like almost no other.  It is intensely personal, and the stakes are high.  We’re all involved and engaged.

As I’ve written in the past, I first earned my stripes as a lawyer representing my local Blue Cross plan in rate hearings.  These rate hearings always started with “public comment.”  The comment ranged from pure outrage to controlled anger to discontent coupled with suggestions.  What did we pay the most attention to?  Of course, the latter.

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