HEALTH COSTS DRIVEN UP BY CONSTANT POLITICAL MEDDLING

In my lifetime, I've watched a lot of costs plummet... power tools, tires, computers, telephones, air travel, batteries, and household appliances, just to name a few, and in each case, the quality has increased dramatically over the same time. During that same time, health care quality has also increased (with a lot of exceptions), but the costs have skyrocketed. What in the hell is it about health care that makes it such an exception?

I'm going to present some powerful clues... food for thought. I said that we don't know whom to scream at concerning health care costs, and that's the germ of a clue. There is one group of people who, for many decades, have been claiming to be knowledgeable about and concerned with health care costs, and promising they will do something about it. Politicians. The problem is precisely that they have been trying... and trying... and trying. Like all other "solutions" produced by government, their results have been exactly the opposite of what they intended.

In the 2004 Minnesota legislature, 40 pieces of legislation concerning health care were considered. FORTY! If you've ever read a legislative bill, you know that's a massive amount of legal language, complex enough to drive one to distraction, filled with qualifiers and exceptions... and loopholes that will require clarification, modification, and more legislation in the future. Every bill pleases some people and displeases others who will introduce contrary legislation or try to revoke the original... and it goes on and on and on.

The seemingly simple idea of using legislation to improve something (anything) adds immense complexity to a field that is complex to begin with. Medical science is complex, unpredictable, and constantly changing. Add in political tinkering that is often misinformed, or politically biased, and very slow to change, and you've taken a complex scenario and made it damned near impossible to grasp.

One natural result has been the rise of very big corporations in health care. Only an organization with enough size to justify legal and legislative specialists can understand and respond to the complexity created by government tinkering, and that's just the beginning. An organization with that level of expert specialization can affect legislation... introduce it, lobby for and against bills, and create publicity to sway public opinion in favor of their positions... which are positions, naturally, that will further tip the playing field in their favor.

Minnesota also has a weird moratorium on hospital construction (here's your chance to read a bill). It's too complex to go into here, but in 1984, our legislature concluded that there was wasted hospital capacity... too many beds available. Most of us less well-informed folk might think that would actually be POSITIVE... but not our legislature.

Allina wanted to build a hospital in Sartell. They had to seek an exception to the moratorium. The impending presence of new competition in Sartell got the folks at St. Cloud Hospital all excited. In an explanation of why Allina should not be allowed to open a hospital in Sartell, just 6 miles from them. St. Cloud Hospital says:

The St. Cloud Medical community has grown into a regional referral center for Central Minnesota. We have created competition for the Twin Cities hospitals.

So... competing against Twin Cities hospitals is good? Well, uh, I mean... they go on to say:

Competition does not work in health care - it actually drives up costs.

Huh? I guess they mean that competition is good if you're the new kid trying to make a buck, but bad if you're already established and trying to protect your business. To be fair, I'm sure I could find similar contradictions from Allina, but they're a lot bigger, have better writers, and wouldn't be so easily detected.

As soon as politicians get involved in trying to "fix" something, complexity sets in like a never-ending plague, and it always has the effect of killing off the little guys and enabling the big ones. It always has the effect of reducing competition and raising costs. More importantly, it drags resources away from the core business and into attacking and defending through legislation. Health care isn't just health care any longer. It's an industry politically regulated and tinkered with to such an extent that the actual health treatment and care is little more than a by-product.

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MIXED SYSTEM COMING IN CANADA

In 1997, Quebecer George Zeliotis was told he would be waiting a year for a hip replacement. There was no private medical option in Canada. And rather than do what some Canadians who can afford the time and money do - head for the US - he filed a lawsuit with Montreal Dr. Jacques Chaoulli, a longtime advocate for private medicine. The case was twice shot down in Quebec courts before they brought it to the highest court. The Supreme Court of Canada has ruled in favor of same-sex marriage and medical marijuana - hardly a gang of right-wing killjoys. Yet Chief Justice Beverley McLachlin and Justice John Major, in their ruling, concluded that "delays in the public health care system are widespread, and ... in some serious cases, patients die as a result of waiting lists for public health care." The court also emphasized the serious psychological suffering caused by prolonged denial of care.

Our socialized health-care system is idealized in the US by the likes of Hillary Clinton, Ted Kennedy, Michael Moore, and the California senate, which recently passed a bill guaranteeing publicly funded health coverage to every resident of the state. Here at home, true believers hold the system as close to them as the flag. Any suggestion that the system is less than perfect, or that it may be beneficial for a private tier to coexist with the public, is bound to start arguments.

This, in spite of a US-Canada sponsored study on the state of healthcare that showed Canadians and uninsured Americans had quite similar levels of satisfaction when it came to healthcare. In the same report, more Americans overall (53 percent) than Canadians (44 percent) were said to be "very satisfied" with the state of their health care.

The day of the Supreme Court ruling, there was some hyperbole, with Prime Minister Paul Martin boldly asserting that "nobody" wanted two-tiers, and Saskatchewan's Premier Lorne Calvert declaring Canada was on its way to an American-style system. "American-style health care," to your average Canadian, means a system where people routinely have to sell their homes to pay for treatments. The relative truth of that assumption aside, what we appear to be headed for is European or Australian-style healthcare, in which private and public intermingle nicely.

As to the prime minister's statement, a June 2004 poll found a majority of Canadians - 51 percent - in favor of allowing a parallel private care system. Support was highest in Quebec, at 68 percent, and in Saskatchewan and Manitoba, at 57 percent.

Recently, I had orthopedic surgery. The biggest challenge for me was the desperate Yellow Pages search for a family doctor to refer me to a surgeon. When that was accomplished, it was a three-month wait to see the surgeon, followed by three months more for the surgery. I have no complaints about the care, the surgery, or the kindness showed to me by everyone from the family doctor to the hospital staff. As someone who could not afford to pay for surgery, I'm grateful a surgeon was available to me.

But I also wouldn't mind if other Canadians opted out of our system. I'd assume that ultimately good things would trickle down to me in the form of - for starters - shorter waiting times and fewer doctors leaving Canada. Americans who hold Canada's system up as a model should keep in mind that there are better models than equal access to something inadequate.


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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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