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David Reynolds | A killer plan

Sorry, Mr. President, I don’t wish to die. I know that my death and those of other seniors will help you reform our nation’s health-care system without increasing its cost. But can’t you find a better way? I don’t live in Europe, so I prefer that society doesn’t toss me aside just because it thinks I’m expendable.

I know that Mr. Obama’s campaign was all about “Change,” but this particular change is more than I can take. Maybe we can go back to 1993 and enact HillaryCare. At least her plan wasn’t a killer one. She didn’t propose moving money out of Medicare and make other foolish moves to pay for the 15 percent of Americans without health insurance, many of whom are young, make over $50,000 and think they don’t need it.

Recently I wrote about a grandson. He will be 10 next month. I would like to see him graduate from high school, maybe even college. With Medicare, supplemented by the same insurance accessible to Congress and their staffs, I expect to make it. But with what I read about cutbacks to seniors and their doctors, I’m not so sure. I like my doctor. He lives quite modestly. He certainly isn’t getting rich. And his hospital, your community hospital, isn’t getting rich, either. In fact, it was going broke before Carilion rescued it.

That is why this “Robbing Peter to pay Paul” feature grips me so much. I know there are a lot of old Peter’s out there who could cough up a few bucks (when not coughing up a little blood) to help the younger Paul’s to pay for their medicine. But will it help? I don’t think so. Medicare works! Ask anyone over 65.

I know there are innocents fresh out of college sitting in the White House and up on Capitol Hill who are not happy with the fact that most of Medicare’s costs occur in the last year of life. (A doctor at the Greenbrier Clinic told me it is 90 percent.) I feel sorry for them. Maybe they would also like to reduce military spending (now less than 4 percent of GDP) by not spending what amounts to a general’s salary in order to protect a private in combat. But we do, thank God. Which brings me to my point.

We are a nation with a religious heritage that says life is sacred – no matter how fragile that life is. And therefore we don’t look kindly when our reverence for life is discarded with a budget meat ax. That is why we don’t like killer plans. If you disagree, let us talk. It will take longer than having a beer at the White House. Even longer than a congressional recess.

Currently Medicare is not a killer plan. It is a humane one that does not subscribe to the comparative-effectiveness research or evidence-based medicine that is practiced elsewhere. For example, the U.K. single payer medical system uses quality-adjusted life years, or QALYs, to decide who gets what. QALYs take into account life expectancy. You know who gets left out.

But you say that is the old country, it can’t happen here. But it already has! Last February Congress slipped inside its thick and expensive stimulus package a section for funding QALYs research. Soon we will have the formulas to tell us how best to ration health care based on age.

It is easy to be against anything. There are too many conservative Dr. No’s out there on this subject. So let’s change that. Let’s end on a positive note – a more humane one. Did you know that there is bill in Congress based on individual responsibility called the Patients’ Choice Act of 2009? Probably not. That is because it is difficult for any sane news to get beyond the Beltway.

Sanity in medicine means quality over quantity. Years ago when I was selling travel and a long trip was not affordable, I would suggest cutting back on the number of days, not on the quality of the experience. So, if we are willing to behave as adults and not have everything in the candy store, there is a better way than to let patients die: raise the minimum age for Medicare, just as we recently did for Social Security. When I was born FDR enacted Social Security starting at age 65. Since then average life expediency has increased eight years – a change brought about through modern, but expensive, medicine. So why not balance our health budget on minimum age and not make it a life-or-death proposition? And within that budget have certain principles we can all agree on: no preconditions; catastrophic coverage; personal selection of risk pools and thus premiums levels; and competition between private insurance companies. Come to think of it, that is the type of health insurance Congress has. And I have, too. Let’s share a good thing.

 

– Column by David Reynolds


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