Wednesday, December 16, 2009


Last September I was asked to write a piece for a local Democratic Party publication.

The parameters were simple:"No Republican propaganda, No Rush Limbaugh rants...just what you think."

I wrote it and submitted it, but in the end, the editorial review board rejected the essay.

Well, it's their loss. Here it is for PlumwoodRoad readers who may find it offers a useful perspective that they haven't heard elsewhere:


By Jed Skillman

Many post-WWII Boomers can remember falling out of a tree, getting cut by a garden tool, or coming down with a bad case of flu, then getting hauled off to see the doctor. Later, while on the way out of the doctor’s office, Mom or Dad would stop at the nurse’s desk and write a check. In those days the American health care system was a relatively simple and low cost proposition.

It was common, well into the ‘60s for doctors to work out of a room in back of their homes, or in an office across the hall from an insurance agent. A doctor set broken bones, stitched bad cuts, gave tetanus or small-pox shots, and frequently advised “take two aspirin and call me in the morning”. Americans went to the hospital if they were injured in an accident, or to have an appendix removed, get a hernia repaired, or deliver a baby. Following invasive surgery, patients were often laid up in bed for days. There was little in the way of out patient surgery. People who went into the hospital for more serious illnesses, like cancer, likely didn’t come out at all.

Americans of that era had different expectations of their health care system. “Modern medicine” had brought clean drinking water, advances in hygiene as well as an end to the use of mustard plasters, cod liver oil and Epsom salts. Penicillin had been around for a while. Treatment for tuberculosis was new, as was vaccination against polio.

In 1965 the US male/female life expectancy had risen to a very impressive 69 years. This still left a lot of room for improvement. I can remember attending a cook-out where a doctor friend of my Dad’s, old Doc Ritz, stood behind the grill smoking a cigarette while serving hotdogs to us kids. Ah, the good old days.

But that was then; this is now.

Over the past few decades the advancements in the science and art of medicine have been phenomenal. In the year 2009 Americans have access to a fast, efficient medical system. It is important for us to keep in mind all the good that our current system provides. There are problems, yes, but every one of us personally knows someone who was diagnosed with a serious medical problem and began receiving treatment within hours. The lump was discovered on Tuesday; the operation was on Thursday.

The American people benefit from thousands of new tools and techniques that were unimagined a few decades ago. This is nothing to be taken for granted. There are MRIs, CTs, artificial replacements, stints, angioplasties, colonoscopies, mammograms, radiation seeds, arthroscopic surgical techniques and vastly improved pharmaceuticals in use every day. These things didn’t just invent themselves. Highly educated, highly creative people conceived, refined and marketed those new medicines and tools.

The results are obvious. The US life expectancy today stands at just under 79 years, almost 10 years more than in 1965. And, not only are Americans living longer we’re living better, with more pain-free, more active, and more productive lives. How many times have we heard the phrase “80 is the new 60, and 50 is the new 40”?

Medical progress is not a problem. The debate over Health Care Reform should focus on the one single sore point: cost. As we have all seen, medical related expenses have blown through the roof. In recent decades they have increased 300-400%. Some years have seen insurance rates increase 20%, one year to the next. What has gone wrong with pricing?

That is the question. If we answer it correctly we’re on our way to curing the problem. Get it wrong and we will make things even worse.

So far, the only answer coming our of Official Washington is buried somewhere in the tattered pages of that 1000+ page health care bill that the House of Representatives was ready to vote on earlier in the summer. They were ready to vote on it, largely unread.

Note: Since I wrote this essay in September, the House bill has grown to over 1,700 pages and the Senate bill has drifted out beyond 2,100 page reef. This thing has grown to such colossal proportions that it sounds like something out of a cheesy sci/fi movie; Attack of the 50-Foot Health Care Bill

Recently, in news stories and at town hall meetings, The Public started asking questions: does the bill allow for portability? Will the nation’s 1,300 health insurance companies be able to compete across state lines same as auto and home insurance companies? Will individuals be allowed to take a tax deduction for privately purchased coverage, like businesses do? Will there be meaningful tort reform and the elimination of “junk” malpractice suits?

Those questions, which have gone largely unanswered or ignored, are key to any successful reform of health care. And those are the easy questions.

The tough questions cut closer to the bone when it comes to personal beliefs and values: Will tax money be used to pay for abortions? Will tax money pay for the 12 to 20 million illegal residents? And, what’s the difference between a Health Care Resource Allocation Review Committee and a “Death Panel”? Those questions have not been ignored, they have been reviled.

This much is clear; mixing Medicine and politics is dangerous. This bill does not represent a search for practical solutions. What we are witnessing is a Congress tinkering around with Life. We see Washington sawing and chopping and patching together some Frankenstein of a bill that they hope will rise off the slab and grab enough votes by the throat to pass. But with every passing day Administration leaders telegraph the fact that they don’t have a clue what they are doing. There is a reason that of the 525 members of the House and Senate, only three got through medical school.

Since the days of the Ancient Greeks the primary rule for physicians has been “First, do no harm”. Before Congress prescribes – and imposes – a cure for our ills, they owe us a fair and unbiased examination. They have a responsibility to offer the public an honest consultation with no hidden agendas and no CYAs. And we have the right to seek a second opinion. Anything less is pure quackery.

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