Wednesday, February 25, 2009

Public health response to President Obama’s speeach

From the perspective of public health, President Obama’s speech was nearly a home run. He addressed the fundamental policies that will improve the health of the nation:

Political participation, income equality, education, and peace.
He called for generosity, resilience, and community.
He explained his economic policy, and gave us hope.

He also said he would reform the health care system.

He said he would do it quickly, in consultation with key stakeholders: doctors, businesses, and workers. He emphasized that the focus would be to control the costs of health care, which are skyrocketing a century after Teddy Roosevelt first called for reform.

But he hedged his bets. His plan will be only a “downpayment on what we must have: quality affordable health care for every American.” He stuck with the program for cost control he campaigned on: large investments in preventive care and electronic medical records, and reducing waste, fraud and abuse. There will be a new effort to conquer cancer, and better benefits for veterans.

It's genuinely exciting and encouraging to hear, “It cannot wait, it must not wait, it will not wait another year.” Now, the hard realities set in. There are two fundamental conditions for controlling health care costs that the U.S. lacks, in contrast with every other industrialized country. One is getting everyone covered. We can't stop whipsawing prices until we have everyone in the same tent. The other is authorizing a negotiating entity -- in most cases the government -- with the political will and the power to take on the customary practices of the medical industrial complex. This includes wringing out the administrative waste for which we continue to reward the predatory health insurance industry, as well as clinical excesses. More rational financing systems are generally associated with systems that produce better outcomes. Predicting that it will work in reverse is ... optimistic.

It's an enterprise that will require, at some point, taking a hard stand. The public that the President inspired to organize over the last year will have to provide the ballast for this effort to succeed.

Having dispatched the knotty problem of health care, the President said we would also have to address the equally difficult problems of Social Security. In fact, as he is well aware, the minor fiscal adjustments required to sustain Social Security are but a blip compared with the task of fixing our health care system. The reference to tax-free universal savings accounts seemed to be a troubling nod to the Peterson Institute, which has been waxing frantically in full-page ads about the U.S.’ deficit spending on “entitlements” while referring only in passing to the trillions detonated in Iraq. (Baseline Scenario, February 2009, by Peter Boone, Effective Intervention, and Simon Johnson, Peterson Institute for International Economics.

Meanwhile, the best the Republican respondent Gov. Bobby Jindal could do to attack the competence of government was to decry the Republicans' own failures during Katrina. He distorted Obama's quality improvements as government-run health care. Interestingly, he did not say that his own prescription, to leave health care decisions to doctors and patients, would apply to the reproductive choices of women, girls and families.

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