Where is this train wreck headed?  Wending its way through the various Senate and House subcommittees, the health care reform debate of 2009 is approaching a crescendo.    What do we have to show?   The question I posed in a previous post still has yet to be answered – just what is the problem?  Is the problem greater access?  Is the problem escalating insurance premiums?  Is the problem stratospheric and ruinous hospitalization bills?  Is the problem rapidly declining quality of care?  Or is this simply become a matter of whose team wins?  The bill fails — the president sinks.

Andrew Weil concludes:

But what’s missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what’s even worse than its stratospheric cost is the fact that American health care doesn’t fulfill its prime directive — it does not help people become or stay healthy.

What is so dismaying to this practicing physician is the distinct and deplorable lack of physician input.  Max Baucus?  What does he know about the practice of medicine?  Tom Daschle?  What what does he know about the practice of medicine apart from his un-registered status as a lobbyist for the insurance industry.

So many reasonable, articulate and prominent physicians have written in defense of real reform that is not even remotely related to the plethora of congressional legislative resolutions.   Bernadine Healy, past Director of the National Institutes of Health (NIH) has written forcefully against the assault on patient-physician choice.

Jeffrey S. Flier, Dean of Harvard Medical School, recently wrote an editorial grading the current legislation.  Grade F.   Wouldn’t it seem logical to turn to some of the top medical schools for just a tad bit of advice oo the effect of legislation on medical education and practice?

Marcia Angell, editor-in-chief for the New England Journal of Medicine, one of the most widely read and prestigious journals in medicine, has written extensively about the corrosive effects of Big Pharma.  From a unique vantage has she written in Huffington Post:

Instead, it [the House bill] enshrines and subsidizes the “takeover” by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994.
First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers — government and employers — will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.

And finally David Brooks, in the New York Times, has written an unusually eloquent and distilled view of our current juncture:

Reform would make us a more decent society, but also a less vibrant one. It would ease the anxiety of millions at the cost of future growth. It would heal a wound in the social fabric while piling another expensive and untouchable promise on top of the many such promises we’ve already made. America would be a less youthful, ragged and unforgiving nation, and a more middle-aged, civilized and sedate one.

Which in essence reiterates my contention you can have quantity or quality.   But don’t fool us into thinking you can have both.

This year-long spectacle has had it all.  Liberal versus conservative.   Progressive vs. atavistic.  Democrat versus Republican.  Educated versus “the salt of the earth.”  Big Government versus free enterprise.  Regulation versus laissez-faire.  These have all been artificial and irrelevant.

I agree with Arianna Huffington that the numero uno issue facing America today is jobs and the economy.  The punditcracy assures us that the recession is over.   This is a statistical notion.

And the number two issue is plummeting educational opportunities.   Education is the lifeblood and the future of our nation.

Every president enters office with a public and a private agenda.  Jimmy Carter uttered those immortal words, “I will never lie to you.”   But Eric Alterman says otherwise.  Shrub came into office with a secret agenda to avenge a personal attack on his father.  That was the spark.  And what about Barak Obama?

I think he came into office with a secret agenda to make right some painful personal medical losses in his family.   A most laudable pursuit.  And he promised Teddy Kennedy to pursue health care legislation with all his might.   But the health care crisis was never number one on the public  agenda.  So we have spent one year while the more immediate crises languish.    Not for much longer.

Can we start over again?  Probably not.   Somewhere deep inside Tom Harkin’s Senate Health, Education, Labor and Pensions Committee are some better conceived ideas.

Please, allow the marketplace to present you with creative ideas.  It has been done with Urgent Care Medicine.  It is being done every day with Anti-Aging and Longevity Medicine.   Advocate a paradigm shift.

You never asked the right people.   You still have not asked the right question.   How do we achieve a healthier nation-state?