Yesterday, the Obama administration announced yet another fix to the nascent Obamacare healthcare program--this time delaying the requirement that businesses of a certain size, defined by the number of employees, could delay paying for health care coverage for their employees.
This can be seen as part of the normal process of government: A regulation is promulgated; affected parties complain, seek a redress of grievances and are accommodated. It works this way with farm legislation, with requirements for increased gas efficiency from auto makers--you name it.
But, in a larger sense, this is really a reflection of a basic flaw in thinking. Republicans, libertarians, conservatives of all stripes categorically rejected the idea that health care is an enterprise, a responsibility which belongs with the people or with its elected government. Healthcare, to Republicans/T party loonies/libertarians is a commercial venture, and is most efficient and best provided when the profit motive drives efficiency and innovation.
President Obama and his party had no chance of getting even the first step of health care reform had they not conceded this point. What Obama was able to sign into law was a health insurance industry resuscitation act--a law which provided millions more customers for the health insurance industry.
Mad Dog, getting crustier and more ossified with each passing month, has long groused that America, when it comes to health care, is only now just catching up to where Great Britain was over 40 years ago. When Mad Dog found himself in London as a fourth year medical student doing an elective, he was shocked and dismissive about what he saw as a second rate medical care system. Patients were admitted to hospital and never seen by their primary care practitioners. Patients were cared for by hospital based physicians, who then returned the patients to their local general practitioners, with a report.
When Mad Dog asked these patients when they expected their own doctors would be coming into the hospital to write their admission orders, the patients reacted in confusion. "What? You mean Dr. Jones? Why would he come here? He'll see me after I'm home."
In America, the line was you wanted, nay, you needed to see the doctor who knows you best when you are in trouble, when you get sick enough to be admitted to the hospital. This was an article of faith among American physicians. Not seeing your own patient when he was admitted to the hospital smacked of "abandonment." It was part of that strong bond between doctor and patient. He is MY patient. I must arrive on my white charger and direct his care, protect him, defend him and be sure I steer him through the dangerous shoals of the American hospital.
It turned out, of course, this was a lovely story, but it was sentimental and not the best medical care. Having practiced in this system, once he graduated, Mad Dog quickly saw the dangers and problems with this system. Community hospitals often cleared out after 5 PM, with no doctors on the wards, patients left entirely in the care of nurses, who often spoke little English and were inadequate to their tasks. Doctors, busy in their offices, could not come in to see their patients who had arrived earlier in the day, and so they called in "holding orders," for patients based on what the Emergency Room doctor who had seen the patients told the doctors who had not seen the patient. Too many telephone calls from nurses ensued, too many doctors called in orders over the phone, blind.
When Mad Dog arrived in the hospital, he discovered Mad Dog's twenty-third law applied: Whatever you had been told over the phone, it was wrong.
The English hospitals were far safer, far better run in 1972 than the American hospitals were in 2000, until the American hospitals finally discovered and accepted the idea of "hospitalists," doctors who stayed anchored on the wards, able to go to the bedside, examine the patient, generate orders for tests and treatments based on what they could see first hand. True, they did not "know" the patients as well as the patients' family doctors, but they knew the acute illnesses very well and they knew what was happening in the immediate present.
Hospitalists provided better care.
There are a whole host of ways in which the National Health System of the United Kingdom, circa 1972 surpassed the care in the United States even 40 years later, from the use of midwives, the organization of superior home care following hospitalization, the rational restriction of extreme care for patients who would not benefit, to the use of blood products in the treatment of gastrointestinal bleeding.
And all through those years, when the United States health care system was wasting money, providing inferior care and spending far more money than Britain doing all this, the Republican Party and the conservative voices all loudly proclaimed, "We have the best health care system in the world. People come here from everywhere around the world for the best care. Why would we want socialized, inferior medicine when we've already go the best?"
Of course, we might have had the best care for the top 10% of America's richest people (although Mad Dog doubts even that) but we clearly had inferior care for the rest of the 90% of American citizens.
And 2012, the Republican Party still blocked the path toward improving American healthcare, and the result was Obamacare, about which the Republicans still loudly complain and they plan to seize control of Congress in 2014, riding on the horse they have been whipping while facing its tail rather than its head.
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