Healthcare Reform: A Crash Course in Manufacturing Uncertainty

The news this summer has been a lesson in how the modern American political process works. Barack Obama ran on a platform of standing up to special interests, and he has spoken out about the special interests of the medical insurance and prescription drug industries. Fighting those interests, however, is even more of a David and Goliath struggle than it used to be.

When I hear the news about healthcare reform, I keep thinking about another David. David Michaels, a former occupational safety official in the Clinton administration, wrote a book called "Doubt is Their Product: How Industry's Assault on Science Threatens Your Health." The manufacturing of uncertainty began with tobacco industry in the '50s. In an effort to counter the negative publicity as study after study linked tobacco to a myriad of health problems, they developed a process designed to shed doubt on the prevailing research. They bought scientists and public relations experts to design and spin studies with contrary results, forestalling government-mandated warnings and the regulation of tobacco. Michaels exposed tobacco industry documents spelling it all out.

The technique was soon adopted by other industries whose products were coming under fire, such as asbestos, lead and benzene. Drug manufacturers used it to delay the removal of the pain killer Viox, which caused 100,000 heart attacks. The same technique postponed warnings about the dangers of giving aspirin to children, resulting in hundreds of additional deaths.

The concept of manufacturing uncertainty, however, has shed its need for scientific research as it morphs into the political process. Certainly the fundamentals have been there all along, but wealthy opponents of healthcare reform, utilizing the rapid dissemination of information made possible by the internet, have taken it to new heights.

The idea is to find something that will either scare the public, cause various groups to turn on each other rather than unite against the runaway greed of multinational industries or confuse them into uncertainty. Using these tactics behind the scenes, it has been possible for the major corporate players to negotiate "in good faith" with the government, granting "concessions" and behaving like good citizens. In fact, big pharma and the insurance industry win either way.

Americans have been pitted against one another – young against old, rich against poor, sick against healthy – in a masterpiece of public relations. It's those elderly folks who are draining the system. It's those healthy young people who won't buy insurance. Sick people are that way mostly because of personal choices. Why should those of us who have made something of our lives pay for lazy people?

The healthcare reform bills currently stalled in Congress have come under increasing criticism. The nay-sayers, however, make their own recommendations which don't stand up to scrutiny.

The article "Three Free Fixes for Health Care Costs" by Rick Scott, published June 9 by the Conservatives for Patients' Rights (CPR), illustrates the point. Scott, CPR's chairman, is the former CEO of the Columbia/Hospital Corporation, who was ousted after the hospital chain was investigated for fraudulently over-billing the government. Though Scott was never charged, the hospital ultimately paid over a billion dollars in fines, the largest such settlement in history.

In his May 11th article "Former Hospital CEO Rick Scott Leads Opposition to Obama on Health Care," Washington Post staff writer Dan Eggen sheds light on Rick Scott's agenda and loyalties.

"A lawyer with no formal medical training," Eggan writes, "Scott built Columbia/HCA into the largest U.S. health-care company before he was ousted by the board of directors in 1997. He was also once a partner in the Texas Rangers with George W. Bush. Scott now runs an investment firm and owns, among other things, a chain of walk-in urgent-care clinics in Florida called Solantic."

Scott started CPR, a non-profit lobbying group, with $5 million of his own money in March 2009 to lobby against President Obama's program. CPR was blamed by White House spokesman Robert Gibbs for orchestrating the angry protests at Congressional town hall meetings on healthcare reform earlier this summer.

Scott's first free fix would give the same tax breaks to people who are privately insured as those who are insured by their employers. Second, standardize insurance claim forms. Third, make hospitals and doctors post prices and outcomes, so patients can make more informed choices.

There's no doubt that these suggestions sound good. It is folly to suppose, however, that any of them are without taxpayer or societal costs.

By definition, the tax break -- certainly the only fair thing to do -- would reduce what the government has to spend. That means, assuming fiscal responsibility, that something else will have to be cut. That always affects somebody's job as well as the lives of those not receiving the axed services. Additionally, the standardized forms are not going to materialize from thin air. Whether it is the government or the industry which oversees the process, there will be costs. If the goal of simplifying and reducing paperwork is met, people will lose their jobs.

The third suggestion would require constant government oversight in order to ensure accuracy and honesty. This is particularly true nowadays when hospitals and nursing homes are consolidating, increasing the potential for price-fixing, fraud and covering up medical mistakes, as Scott's own history attests.

And, of course, these "fixes" don't address the problems of the uninsured – problems which now fall squarely in the lap of the taxpayer when treatable illnesses are allowed to progress to the point that expensive, emergency interventions are required. Nor do they address the effects of unchecked conflict-of-interest issues between doctors, institutions and big pharma. For an in-depth look at the misinformation behind CPR's "Squeeze" campaign, see Jenny Gold's "Ad Audit: 'Conservatives for Patients' Rights "Squeezes the Truth" on the Kaiser Health News Network: http://www.kaiserhealthnews.org/AdAudit/080309squeeze.aspx

There are two groups, both active in the healthcare reform debate, which have similar names, but are polar opposites in their philosophies. One is "Patients First", sponsored by the Americans for Prosperity (AFP); the other is "Put Patients First", a campaign of the National Health Council (NHC). Both parent organizations are nonprofits and both have petitions.

"Patients First" is the most visible. Its brand new buses, full of "Hands-Off-Our-Health-Care!" advocates, are making the rounds of the town hall meetings. They call themselves "the nation's premier grassroots organization committed to advancing every individual's right to economic freedom and opportunity." This does not include the right to healthcare, however. Their petition does not suggest anything. They think that lobbyists, unions and politicians are trying to seize control of health care which will result in the loss of freedom to choose your own doctor or health insurance and unavailability of timely medical attention.

"Patients First" fails to address the fact that the "freedom" they currently have is manipulated by global industries or that economic freedom without healthcare insurance is an illusion. Their message has a nostalgic appeal to a world in which we no longer live. That world of many small businesses rendered government "interference" unnecessary.

On the other hand, "Put Patients First" provides a united voice for the more than 100 million people with chronic diseases and disabilities.

"What makes us unique," says NHC Director of Communications and Marketing Nancy Hughes, "is that it is the only organization of its kind that brings together all diverse segments of the health care community to confront systemic health care issues and to provide a voice for people with chronic diseases and disabilities and their family caregivers. Our core membership includes approximately 50 of the leading national patient advocacy organizations."

The list of NHS members is a veritable who's-who of mainstream charities, professional groups and industry powerhouses, from Easter Seals, the March of Dimes, the National Council on Aging and the American Academy of Nursing to the Association of American Medical Colleges, Biotechnology Industry Organization, the National Pharmaceutical Council and Microsoft.

"The Campaign to Put Patients First," Hughes says, "is a nationwide, three-year initiative created by NHC in 2008 and dedicated to mobilizing people with chronic conditions to work for effective and affordable health care."

The "Put Patients First" petition calls for Congress to "Cover Everyone, Curb Costs Responsibly, Abolish Exclusions of Pre-Existing Conditions, Eliminate Lifetime Caps and Ensure Access to Long-Term and End-of-Life Care." Visit: http://www.puttingpatientsfirst.net/petition/

Patient advocate Trisha Torrey is among those who believe that many Americans are being used by special interests who want healthcare reform to fail.

In her August 8, 2009 post to About.com, she writes, "And the reason those people want reform to fail is because they have been sucking lots of money -- OUR money -- out of the system -- money that won't be so easily available once reform goes through."

Of those whose mega incomes and bonuses are threatened, she writes, "They will make up anything at all, even if it's a pure lie, to incite ordinary citizens into believing things that just are not true."

Torrey states that $1.4 million is spent each day on Washington lobbyists. She explains how people can tell if they are being used and requests that people check their facts before getting upset and especially before passing on inflammatory rhetoric.

AARP (formerly the American Association of Retired Persons), contrary to claims earlier this summer that they don't support the current reform efforts, is actively engaged in clearing up the misinformation. They too believe that, "There are special interest groups trying to block progress on health care reform by using myths and scare tactics."

Visit the section "Don't Let the Myths About Health Care Reform Scare You" at: http://aarp.convio.net/site/PageNavigator/Myths_vs_Facts

AARP's conclusion is that the current legislation is not socialized medicine; won't lead to people losing their private insurance or their freedom to choose their own doctors and hospitals; won't lead to rationed care; won't hurt Medicare and won't allow anyone – government, insurance companies or anyone else – to make life and death decisions for you.

AARP, which sells supplemental insurance to Medicare recipients, also tackles the fear that reform is too expensive. One of the startling facts they list is, "If we do nothing to fix health care, families with Medicare or employer-based health coverage will likely see their premiums nearly double again in the next seven years."

They illustrate the urgency of the situation, listing facts such as the medical-cost-related bankruptcies, findings that one in three Americans report having a family member who must skip medication or postpone treatment due to cost and the fact that rising government healthcare spending is jeopardizing other priorities. They conclude, "The fact is, we can't afford not to fix health care."

Ironically, the most publicized rumor about healthcare reform – Sarah Palin's "death panels" – is based on an amendment introduced not by liberal Democrats, but by a Republican, Senator Johnny Isakson of Georgia. Nobel Prize winner and Princeton professor Paul Krugman, in "Republican Death Trip," (published August 13 by The New York Times ) quotes Isakson as saying that claiming the amendment had anything to do with euthanasia is "nuts."

"And not long ago," Krugman writes, "some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for 'advance directives' for medical care in the event that you are incapacitated or comatose. That´s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill."

The next casualty of cleverly orchestrated scare tactics was the public option. Far from being a scourge to the free enterprise that so many Americans would like to protect, it would have promoted competition. Government run healthcare programs such as Medicare have a much lower overhead than private insurance companies. Unlike the private companies, Medicare is not supporting huge salaries and bonuses or paying high-powered lobbyists.

In the wake of back-pedaling by the administration on the public option, a very curious thing happened. Some supporters of healthcare reform withdrew their support. Bob Herbert's Aug. 18 Op-Ed piece "This is Reform?" in The New York Times summarizes the reasoning. Without a public option, according to Herbert, there may be more people receiving coverage, but there will be "no competitive pressure for private insurers to rein in premiums and other Charges."

"Forget about the nonprofit cooperatives," writes Herbert, "That´s like sending peewee footballers up against the Super Bowl champs."

"Insurance companies are delighted with the way 'reform' is unfolding," Herbert's article continues, "…If the oldest and sickest are on Medicare, and the poorest are on Medicaid, and the young and the healthy are required to purchase private insurance without the option of a competing government-run plan — well, that´s reform the insurance companies can believe in."

Obama's attempt at healthcare reform may fail at the hands of the special interests, which have forced advocates to address outlandish claims instead of refining the legislation. If so, this will also benefit a group – virtually invisible in the current debate -- malpractice attorneys (those who represent patients as well as the high-powered, insurance company lawyers). Despite Obama's pledge to take politics as usual out of his presidency, no tort reform is included.

The reluctance of healthcare advocates, who understand the control that special interests have over our healthcare, to embrace any changes to what is often a patient's only recourse is understandable. Nonetheless, medical malpractice insurance costs and the occasional huge "awards" – a third of which goes directly to the trial lawyers -- are major contributors to the cost of healthcare.

Worse yet, our litigious society has transformed doctors and patients -- whose relationships should be based on compassion, cooperation and trust -- into potential adversaries. Doctors practice "defensive" medicine, ordering tests and procedures they know are unnecessary to protect themselves against the possibility of lawsuits.

Patient discomfort, inconvenience and skyrocketing costs are not the only results of defensive medicine. Though new testing methods have decreased radiation exposure, Americans receive so many more tests that annual radiation exposure from diagnostic testing has increased.

Under the current system, malpractice insurance companies, which advise doctors on diagnostic testing as well as how to keep records to minimize damning information, have the edge in convincing juries of their clients' innocence. Furthermore, all not-guilty verdicts are presented as frivolous lawsuits. Mistakes, which are bound to happen, are covered up, eliminating opportunities for doctors and institutions to learn from them.

The word that I keep waiting for but have not heard bandied about in the current national healthcare discussion is "attrition." Without a conscious redirection of the labor force now employed to bury us in confusion and brainwash our doctors into believing that "new is always better," no significant change is possible. Congress recently lavished billions on a banking industry which, to President Obama's dismay, has not demonstrated any gratitude for the help, or shame for what their reckless practices are continuing to inflict on the American public. Training medical professionals to be aware of the special needs, weakness and vulnerability of older patients, simplifying, streamlining and standardizing all medical industry paperwork, banning advertisement of prescription drugs and promoting transparency on all levels should be priorities, both for cost control and the impact on public health. Supporting health insurance and hospital paper pushers and even big pharma sales reps and ad writers and transitioning them into green industries would be a far better use of taxpayer dollars and would help move the country in the right direction in several areas. Maybe, we could even relocate some of those lawyers…or, is that just me?

Post Script: The Passing of Ted Kennedy

Calling this article "finished" has given me fits. Every time I thought I was done, there has been news of yet another bend in the road. I struggle to understand how so many people can defend multi billion dollar industries as though they were Mom and Pop corner stores and at the same time speak openly with such callused disregard and disdain for their fellow citizens, all the while claiming that America is the greatest nation in the world.

As I write, Senator Ted Kennedy's body is being flown to Washington for one final trip to the Senate before burial at Arlington. Two things have been running through my mind all week: the first, a quote about a lesser figure in Greek mythology; the second, a passage from the Declaration of Independence.

Aedos is a lesser goddess in Greek mythology. Actually, she was more of a personified emotion like Nemesis, with whom she is often mentioned. Nemesis was the personification of righteous anger. Usually, Aedos is translated as shame or modesty, but its true meaning is much deeper. The twentieth century scholar and author Edith Hamilton illuminates the meaning of the Greek word "aedos" in her 1942 book "Mythology."

"It means reverence and the shame that holds men back from wrongdoing," Hamilton writes, "But, it also means the feeling a prosperous man should have in the presence of the unfortunate: not compassion, but a sense that the difference between him and those poor wretches is not deserved."

Compassion, itself an evermore scarce resource, is not the ultimate expression of the human heart that some may think it to be. Perhaps, it is merely a matter of semantics, but the distinction is significant. We can accomplish great and meaningful acts of compassion while still withholding "aedos" – the heart-knowledge that allows us to truly relate to one another.

Whatever his faults were, Ted Kennedy understood in his heart that his wealth was not a reward, bestowed upon him because of his merit; it wasn't something that he deserved or didn't deserve, but a blessing. He knew that merit or the lack of it is not the defining factor of poverty and other human suffering. When he reached out to others, personally or through the legislation he sponsored, it was with the heart-knowledge that things like wealth, achievement, race, sex, disability, belief or lifestyle are not the essence of the core humanity which we all share. Having one less person in this world with "aedos" – especially at this critical point in healthcare reform -- is truly a loss.

The line from the Declaration of Independence is the one which I assume – perhaps in error – is still being drummed into the heads of school children as the quintessential expression of the American dream.

"We hold these Truths to be self-evident," the Declaration states, "that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness."

Jefferson uses the phrase "among these," which I take to be an indication that he believed there were other inalienable rights as well. Setting that aside, however, let's look more closely at the three he does mention.

Keep in mind that no one is disputing the following facts: over 46 million Americans don't have health insurance, 15,000 previously insured Americans join them each day; medical expenses are a major contributor to the bankruptcies which plague the economy; under the current system health insurance premiums have risen and are projected to continue to rise while benefits are continuing to fall; the diseases which go untreated at early stages because of a lack of insurance ultimately necessitate more expensive interventions, often paid for by taxpayers; and, American health care, even for those with insurance, doesn't produce the benefits of longevity and other markers of health currently being experienced in many other nations.

My questions are for those who are opposed to healthcare reform, especially those who are happy with the status quo. Without access to affordable healthcare, are life, liberty and the pursuit of happiness possible? Does our government today honor the intent of the Declaration of Independence and the principles of the founders of our great nation by allowing healthcare to continue to be a privilege rather than a right?