Looking North

Almost everyone is getting tired of the healthcare debate as it goes on and on--a fire that keeps burning without much new fuel to feed it. One of the striking, and disturbing, aspects of the debate is the lack of facts to back up the wild speculation of many participants. The S.F. Chronicle this morning had an article that clarifies some of the misconceptions about the Canadian healthcare system that are beging spread in the U.S. Many Canadians are watching in horror as Americans spread wild rumors about what goes on just north of our border. For starters, it's not true that Canadians can't choose their own doctor. They can, and most have a wider choice than Americans who are tied into the network authorized by their insurance company. The length of time to wait for treatment has also been wildly exaggerated. Emergency treatment is provided as quickly as it is in the U.S., as are treatments for acute illnesses and lifesaving surgical procedures. Elective surgery may have to be postponed, especially in rural areas, but that is true for many Americans too. It is important to look at our neighbors as well as ourselves when we make sweeping generalizations about health services. This article is a good primer to start with.

Choose wellness (we do have a choice)

One in ten Bay Area homeowners will be at least 60 days in arrears in their mortgage payments by the end of this year, according to a study reported today in the Chron. Grim. So difficult for those households and the people who care about them. We're all reading that the residential foreclosure problem has moved beyond the sub-prime borrowers to the ever widening pool of people with market-priced mortgages, but no job. This unemployment problem isn't about to ease any time soon, they say.

Also today, we learn that the deficit will be even greater than previously estimated. It's the downturn. People without jobs or with part-time, low-paying jobs can't do their part in a consumer-fueled recovery. This will revive the argument that the country cannot afford healthcare reform.

Why people don't see that all these jobless need and deserve healthcare is a mystery. More of a mystery is why people can't imagine themselves, their family members, or their neighbors jobless and/or health insuranceless. Americans have generosity of spirit as a defining characteristic. Now would be a good time for that to be on display.

There will be a massive deficit whether or not we have healthcare reform. Choose healthcare reform as a priority, and let another program take the budget savings hit. Not education. Weaponry could be cut. So could NASA. The federal government isn't like California in being limited as to where budget cuts can be made. Choose health and well being. Talk it up. LLII.

ps. Does anyone know why the Shuttle and rocket programs are located in Florida, where the weather is always a problem for launches and landings? The weather is perfect year-round in San Diego. Jobs for California! Talk it up.

Still wonder if we need reform?

The overwhelming need for better healthcare systems in this country has been demonstrated again in Ingleside, California, where a medical charity has offered free testing, check-ups, and dental care to thousands of people. Lining up for hours and sometimes staying overnight was less onerous for some potential patients than going more months or years without care. How can a country and a state as prosperous as ours offer so little to so many people. The dental needs alone are overwhelming, but we haven't begun to address those. Let's hope Americans can at least agree on how to provide adequate medical care for all the people who need it.

One sign of hope, also noted in the N.Y. Times, is the attention that is now being paid to areas in the U.S. which do manage to provide reasonably-priced care. One issue with healthcare is that it has to be local. If good care doesn't exist close to where you live, you are out of luck--you can't order many medical services online. By looking at the communities that have overcome some of the price barriers, other cities can learn how to do it. One key seems to be the provision of electronic records that can be shared by providers. Moving more of our medical record keeping online would not only improve jobs but also offer new jobs for the young people coming out of schools and colleges. This is certainly a step worth taking.

Do you know what's in those health bills?

The healthcare issue is absorbing more and more attention from the media and the public. We hear about surprising anger from retirees at town halls and even at family dinner tables and local coffee shops. Perhaps it's time for all of us to learn a little more about what is actually in the healthcare bills now being considered in Congress. In the nick of time the N.Y. Times has come through with a brief primer on the proposed legislation. While this article doesn't answer all the questions, at least it is a start toward a responsible discussion and may help both advocates and opponents of reform agree on what is actually on the table. No one can predict what may follow from the adoption of any particular bill, but we can at least get over groundless worries like euthanasia and "killing granny". Americans have usually been able to face up to the facts when the time comes for action, perhaps that time is now.

Figuring out the costs

One of the most popular topics of conversation these days among Americans trying hard to understand the debate over healthcare is the issue of whether higher cost bring better care. A number of articles have discussed the Dartmouth studies on regional differences in the cost of healthcare to patients covered by Medicare. Today's N.Y. Times provides an overview of those studies by one of the researchers involved. Although there are some questions raised by critics, such as questions about whether people in some parts of the country are just sicker than others, the evidence seems overwhelming that much of the difference comes from the attitudes and practices of the doctors and hospitals involved. Let's hope the educators developing curriculum for medical schools are taking a serious look at the results of these studies and designing courses that train doctors to consider the implications of their decisions on the nation's healthcare. Our hopes for true and lasting reform in healthcare depend as much on our young doctors as on lawmaker's decisions. And while we're at it, let's reconsider covering more of the costs of medical education so young doctors don't face the burden of overwhelming debt that conflicts with their desire to give service where it is needed most.