A part of me wants to find the healthcare debate in the US to be hilarious. Corporate bought and paid for Brownshirts, of course uninsured and begging for donations to cover their own healthcare costs, storming and disrupting Town Hall discussions. It about the only tactic that could work, aside from the totally dysfunctional nature of American governance right now. Reality must be distorted, and distorted massively to even generate the pretense of a debate.
Every time I read about a Teabagger ranting about how socialized medicine will destroy this country I think of the VA system. There it is, a huge and vastly important universal healthcare system—government run, single payer and therefore socialist—right here in the brave and privatized United States: The Veterans Affairs hospitals. If you've served in the military, you can go to the VA. If it's within five years of your last active duty service, or you have injuries related to your service, you can go and get healthcare pretty much for free. Given how brutal service can be to the body and mind, that covers a whole hell of a lot of your fellow Americans; the equivalent of about the entire population of Ontario is treated by the VA. How do they do, health wise, compared to those of us blessed with employer-based private health insurance? Better. Objectively better.
SETTING: 5 VA medical centers and 8 commercial managed care organizations in 5 matched geographic regions. PARTICIPANTS: 8205 diabetic patients: 1285 in the VA system and 6920 in commercial managed care. MEASUREMENTS: We compared scores on identically specified quality measures for 7 diabetes care processes and 3 diabetes intermediate outcomes and on 4 dimensions of satisfaction. Scores were expressed as the percentage of patients receiving indicated care and were adjusted for patients' demographic and health characteristics. RESULTS: Patients in the VA system had better scores than patients in commercial managed care on all process measures (for example, 93% vs. 83% for annual hemoglobin A1c; P = 0.006; 91% vs. 75% for annual eye examination; P < 0.001). Blood pressure control was poor in both groups (52% to 53% of persons had blood pressure < 140/90 mm Hg), but patients in the VA system had better control of low-density lipoprotein cholesterol and hemoglobin A1c (for example, 86% vs. 72% for low-density lipoprotein cholesterol level < 3.37 mmol/L [<130 mg/dL]; P = 0.002). Satisfaction was similar in the 2 groups.
Yeah, diabetes is a huge and growing health problem. But that's chickenshit, your Teabagger friend might say. What about cancer? If you're in the VA system, you're about three times more likely to have your colon cancer discovered and treated before it's metastatic—compared to the poor saps in private healthcare. (27% vs 77%. If colon cancer is found before it's metastatic, it's treatable. If not, you're pretty much toast.)
And so on.
Objectively, our present system is a complete and abject failure. Compared to every other industrialized nation, we spend more and get less from our healthcare system. Even for those who claim that the US is exceptional, the VA provides an example of another (and better) way to do things. Still, I must agree with Matt Taibbi, the outcome of this debate is about as predicable as a Lions game.
The reason a real health-care bill is not going to get passed is simple: because nobody in Washington really wants it. There is insufficient political will to get it done. It doesn’t matter that it’s an urgent national calamity, that it is plainly obvious to anyone with an IQ over 8 that our system could not possibly be worse and needs to be fixed very soon, and that, moreover, the only people opposing a real reform bill are a pitifully small number of executives in the insurance industry who stand to lose the chance for a fifth summer house if this thing passes.
It won’t get done, because that’s not the way our government works. Our government doesn’t exist to protect voters from interests, it exists to protect interests from voters. The situation we have here is an angry and desperate population that at long last has voted in a majority that it believes should be able to pass a health care bill. It expects something to be done. The task of the lawmakers on the Hill, at least as they see things, is to create the appearance of having done something. And that’s what they’re doing. Personally, I think they’re doing a lousy job even of that. I lauded Roddick for playing out the string with heart, and giving a good show. But these Democrats aren’t even pretending to give a shit, not really. I mean, they’re not even willing to give up their vacations.
This whole business, it was a litmus test for whether or not we even have a functioning government. Here we had a political majority in congress and a popular president armed with oodles of political capital and backed by the overwhelming sentiment of perhaps 150 million Americans, and this government could not bring itself to offend ten thousand insurance men in order to pass a bill that addresses an urgent emergency. What’s left? Third-party politics?