Tuesday, February 7, 2017

Ted Cruz on the Joys of Cesarean Sections

Tonight I tuned into CNN to watch the debate on Obamacare between Ted Cruz and Bernie Sanders, hoping to see some substantive argument.

I've recorded it and will try to bring myself to watch the whole thing later, but 15 minutes was all I could take tonight.  I did not throw anything at the TV. 

Ted, of course, thinks he's the world's greatest debater. He did everything but bring out his high school debate trophies. 
Bernie has only one note to hit: We got class warfare, people. The rich get good health care; the poor do not.
It's the fox and the hedgehog--but in this case the fox does not know many things; he knows very little and the hedgehog needs to know more than one thing.

Neither one of these men has the faintest idea what they are talking about.  If these are the men who will direct thought on our healthcare system, then we are all in big Trouble in this country.

Ted rolled out the same tactics Republicans have rolled out since at least 1965, when Medicare was first introduced. 
Here's the drill, in case you haven't been listening: 
1/ The Democrats want socialized medicine.
2/ Socialized medicine means government control of your health choices, of your doctors and your illnesses.
3/ Government control means rationing and poor health care, health care denied when you most need it and when you are older. 

He presented some "facts" to bolster his case:
1/ A litany of sob and horror stories from the socialized medical wards of the United Kingdom, stories of people waiting hours for an ambulance to arrive, people waiting three months for a hip replacement surgery, people being kept on gurneys waiting hours in emergency rooms.  Oh, the humanity! Oh, the suffering. And Ted is just so appalled on their behalf, and outraged at the thought all this may someday be visited upon his American brethren, if the Democrats get their wish.

And Bernie failed to rejoin: All these anecdotes happen all the time, and worse in America,  right now. Every day. The commercial, for profit system we have now generates daily dysfunction. If you want horror stories about what happens in a healthcare system, you need look no further than our own. 

2/ A recitation of numbers of all the Canadians who have come to the US for health care. Oh, it's like the Berlin Wall, all those Canadians trying to leap across the border trying to escape Canadian health care. He actually invoked that image of machine guns on the border pointed inwards toward Toronto to keep all the Canadians from escaping to good American healthcare.

And Bernie never replied saying that it's actually the Americans who now embark on medical tourism, flying to Thialand and elsewhere because it's less expensive to pay for the flight and the hotel room than to pay what you must after your commercial insurance welches out on your hip replacement in the States.

Bernie started to say that the fact is most Canadians and most Brits are very satisfied with their systems and would not trade theirs for ours. But all the polls and surveys when it comes to "happiness" necessarily deal in soft data and can be manipulated, so it's a worthless argument to have. 

3/ Then there's the MRI/C section/Mammogram ploy: 
Cruz rolled out numbers to show that more mammograms, more  MRI's and more Cesarean sections are done in the USA than in the United Kingdom. And this shows conclusively how superior American healthcare really is. 

Of course, we are a nation four  times the size of the UK, so you might expect we would do more MRIs/mammograms/C sections. 
But setting that aside,  the fact we do more of these tests is given as proof of the superiority of the American system which denies nothing to anyone.   All these wonderful things would be denied under a socialized healthcare system is what Ted says.

Bernie never replied that Ted's own argument refutes his premise: If these tests were done for the past 6 years under Obamacare, then what Cruz is saying is Obamacare has been superior to the UK system, providing Americans with more care than the UK's National Health.  So Obamacare did something wonderful, this disaster Ted wants to repeal. 

But let's get past the sophistry, the debater's points to the truth: The very fact that so many more MRI's, C-sections and mammograms are done in the US is evidence of the inferiority of our profit driven system, not proof of its superiority.

The reason these tests are done in such profusion in the United States is not that they are good medical care or even necessary: The MRIs are a cash cow for radiologists and hospitals. An MRI in the United States costs $4,000; in the UK it is $75. Is there any wonder why so many more MRI's are done in the USA than in the UK?  
The incentive for the American doctor is an irresistible temptation; not so in the UK. The smaller numbers of MRI's in Britain tells us they are doing better medicine there, not worse.

As for C sections, the fact the UK does so many fewer C sections is evidence of the superiority of the medical system in the UK, not the contrary. All too often, we do C-sections here in the States not because it's best for the mother and child, but  for the convenience  and  profit of the obstetrician.  "Call the Midwife" is a British show, not an American show. Both Bernie and Ted should watch it. 

 As for mammograms, we think of these as wonderful, life saving tests, but over the past few years as data as been analyzed, it has turned out they, too, are probably overused and result in detection of "lesions" which are over treated and which may not actually need to be removed. Yes, they can be life saving but the profit motive and well intentioned desires may have clouded our visions about the virtues of mammograms.  
In fact, the old joke that more people live off cancer than die from it may be illustrated by the overuse of mammograms. The issue is not settled, but it is not a good example of how much better we do in the USA, but how we may oversell tests which add expense but not quality to care. Too often in the US, we squander resources on things which do not benefit the public health in America.

We spend more money in the last 8 weeks of life doing things like putting people on respirators and putting in feeding tubes which is money poorly spent. The patients aren't thanking us for it. Sometimes the families insist on it, but the patients aren't thanking us. Yes, a national health care system might tell us what we don't want to hear, but it is a good thing it tells us what we need to hear.

Bernie, did not address the problem Ombamacare ran into because of the rule that patients could not be denied because of pre existing conditions: Insurance companies quickly discovered with all those sick people on their ledgers they were losing money. This was predictable.  
This truth allowed  Cruz to make his one good point--there are five states with only one insurance company left offering health insurance in the state:  insurance companies have fled the health care field.  Forced to take on people who really need healthcare is the ultimate nightmare for any commercial insurance company serving its stockholders:  the last thing an insurance company wants is people who actually need health care.

Obamacare was so injured in childbirth, it was doomed to a short life. The wonder is, it did as much good as it did. Costs fell nationwide and care expanded. (A portent of things which might be, if a single payer system ever emerges.)  Obamacare was killed by a thousand cuts, by the health insurance industry most of all. It became not the instrument to rescue the national health and well being but the tool to rescue health insurance companies.  

The only way to make a system work which will accept all the sick people,  is to require all the healthy people, who outnumber the sick, are paying premiums, as happens with Medicare. 

Health insurance as a commercial enterprise is a bad bet looking for a way out. The mission of a national health insurance plan like Medicare is to provide care. In that sense, it's mission is to spend money, not make money. This is exactly the opposite with commercial health insurance which Ted extols as the best possible option for healthcare and the public health.

Bernie did say the solution was Medicare for all. He did say we ration medical care by class--the rich getting good care and whatever care they wish, while the poor go without because they have lost insurance. 

But Bernie never made a coherent cogent argument that medical care is the one part of our economy for which the profit motive is poisonous and destructive rather than something which drives innovation and higher levels of effort.  And to make any health care system work, the entire nation has to accept it wants to create it, as it has decided with Medicare.  

The Swedes do not want to pay for health insurance for the Spaniards. The Brits do not want to pay for health care for the Greeks. This is because the Swedes don't like the Spaniards all that much and the Brits aren't crazy about the Greeks.  Americans do not want to pay for other Americans. They have to be made to do it. They are forced to pay Medicare taxes.  But, in the long run, Americans are glad they paid into Medicare and into Social Security.

Sometimes, you have to force people to do what's good for them, because you do not want to wind up supporting people when their luck runs out. 

That's the argument Bernie Sanders should have made.

Ted Cruz had nothing new to say. He just enjoyed himself with a slick version of Green Eggs and Ham, thinking he'd scored lots of points by telling horror stories about unfortunate patients which have no relevance to formulating policy for systems of medical care. 
Well, actually, he did have one new thing to say: Cesarean Sections are the new measure of quality of care in the American health care system. You can't say the Republicans do not break new ground on public health.
These stories are the Obamacare version of Trump's stories about the rapist Mexican immigrant or the kid who became autistic after a measles vaccine.  
Is this really the best the Republicans have to offer?
If these two are really in charge of guiding thinking in Washington about shaping a workable health care system, Heaven Help Us All. 

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