Opinion

Let's declare war on terror over health care

In the continuing absence of universal access to health care in the U.S., terror abounds. The terror of being uninsured if you become ill, the terror of personal bankruptcy due to health care costs, the terror of pre-existing conditions that prevent obtaining health insurance — all have led to a state of fear in this country. Having reconsidered the previous administration's “war on terror” that led to so much abuse of power and loss of domestic freedoms and so little success in the Middle East, we should now commence a national effort to combat this real form of terror in our own country.

Many have made the case in the past that national security is health care security. Recently, Rep. Charles B. Rangel, D-N.Y., and others have come to this realization, as well. We cannot field an army without a healthy populace. Our economy cannot support our wars unless we have a healthy work force. In the case of the Pentagon, we do not question the national imperative to maintain our security. We entrust an enormous portion of our taxes to this single, “government-run” agency to defend our country, and we are all proud and grateful for the heroic job that our young men and women do. However, let us suppose that we applied the same criticisms to our national defense that some do to any effort to establish a national health security plan, through health care reform.

Would we say that the government should not run the defense, that anything our government does is doomed to failure? Would we be better off leaving our national military security in the hands of a private, free market, where you buy what you can afford? Would we say to poor neighborhoods and states that, since they cannot afford the same quality of defense that wealthier neighborhoods can, that they cannot be equally defended? Would we encourage the wealthiest neighborhoods to buy the best in private armies that Blackwater might have for sale? I hope not. Let us agree, however, that the national security is integrally related to national health security.

With more than 45 million of us uninsured and many millions more underinsured, let us agree that it is imperative for the U.S. to defend itself against this terror. Some say that we now have the best health care system in the world. Sadly, this is simply not true. While we can provide extraordinary care to those who can pay, so many Americans have no meaningful access. As a nation, our health care is, in fact, poor. OECD data show that the U.S. spends more per capita on health care than any other Westernized nation. Yet, we have the worst population-wide outcomes of the same group of countries. In heart disease, cancer, infant mortality and other areas, we are last among our peers in outcomes as a nation. How can this be?

In the health care business, as it has evolved in the U.S., the economic incentives for providers are aligned to reward the performance of as many procedures as possible on people who can pay, through varying levels of insurance or their own wealth. Performing as many procedures as possible, necessary or not, certainly does not reliably lead to better public health. Often, expensive procedures performed without scientific rationale increase risks to patients, not to mention costs. Outcomes are worse; costs are higher, just because the funds are provided through perverse economic incentives.

President Obama is exactly right that reduction in costs is essential and primary to any successful reform of health care. It is ludicrously false economics simply to take the number of uninsured people and multiply that number by the costs of what our system currently spends on average. This false calculation leads, inevitably, to the frightening cost and deficit estimates that those who oppose real reform use as scare tactics. Real reform begins with changing economic incentives to reward good medical decisions, based upon widely available scientific evidence. We have to pay for good decisions, not for the maximum number of procedures. With good decisions and fewer procedures will come the lower costs that we must achieve. Paying for good decisions will also result in better outcomes, along with the lower costs. Finally, we can begin to pay providers for those better outcomes, as we recognize and measure them.

The public option is absolutely essential to a successful war on health care terror. Only with a publicly supervised option can we ascertain that every American has access to care. Also, through the public scrutiny of such a system, we can be certain to reward good choices and good outcomes. The insurance companies complain, through their political allies and expensive advertisements, of unfair competition. One might imagine a private security firm complaining that the Defense Department has analogous unfair advantages in its business. However, if a government–sponsored health program should prove to be as undesirable and ineffective as the naysayers suggest, then we should expect the private insurance companies to do very well indeed.

As patriotic Americans, let us support the president in his effort to bring health care access to all Americans. This “war” requires courage and determination. To paraphrase U-2, we “have to believe it to see it.” Let us believe in the importance to our nation of access to health.

Baldwin is president and professor of surgery at Texas Tech University Health Sciences Center in Lubbock. He was formerly the DeBakey Chairman of Surgery at Houston's Baylor College of Medicine.