DURHAM -- My granddaddy had a pack of hunting dogs, some of which liked to chase cars. One day we were trying to break them of doing so, and he stopped short and said with a twinkle in his eye, "I wonder what that dog thinks he is going to do if he catches a car?"
So it is with Republicans who say they want to repeal the Patient Protection and Affordable Care Act (PPACA). What are they going to do if they catch the car?
Before health care reform was passed, our health system was unsustainable and was going to bankrupt our nation. If the act is repealed, our health system will again be unsustainable and will bankrupt our nation. If PPACA is the last step, we still won't have a sustainable health care system. However, it is a step in the right direction and can be improved upon.
The law has many flaws, but does two important things.
First, it gives us a route to providing health insurance coverage for everyone, a precursor to dealing with health care cost inflation. This may seem paradoxical, but so long as the uninsured get some care, albeit late and in the most expensive settings, these costs are shifted throughout the system in ways that are hard to address.
Second, there are some aspects of the law that have a chance to reduce the rate of health care cost inflation, such as the Independent Medicare Advisory Commission, experimentation with new ways of paying for care and eventually a tax on high-cost insurance.
If you are worried about health care cost inflation (as I am), you should be insisting that politicians say what more they would do to address cost inflation in addition to PPACA and not let them get away with simply saying that want to repeal Obamacare. Or that they want to repeal the portions of it that have the best chance to deal with cost inflation because they say they will lead to rationing.
I am for rationing in the same way that I am for the sun rising in the East. Not rationing means everyone gets whatever they want, with no limits. A market, for example, is nothing more than a means of rationing scarce goods.
To deal with health care costs, our nation must grow up and come to grips with the facts that we all will die and that there are limits to what can be done to forestall this inevitability.
We do not seem to be able to discuss this thoughtfully. During August 2009, there were breathless charges of "death panels" that resulted in the removal of expanded payment for palliative care consultations in Medicare from the bill. Palliative care addresses symptoms and helps patients think through difficult decisions. The removal of expanded palliative care funding meant that, politically, a pound of flesh had been won by opponents of PPACA.
One August later, a randomized control trial published in the New England Journal of Medicine showed that early use of palliative care improved quality of life, increased survival and reduced costs for patients with stage IV lung cancer. Lo and behold, not only were charges of death panels not based in reality, but those who pushed this line of opposition managed to remove from the bill something that benefits patients and actually reduces costs.
Those you heard talking about death panels in August 2009 either didn't know what they were talking about or were being purposefully misleading.
We see from the recent census report that the number of uninsured increased to nearly 51 million in 2009 and that the absolute number with employer-based insurance dropped for the first time since it has been tracked. In spite of declining coverage, pre-PPACA health care costs were rising in a manner that will bankrupt our nation.
This is the reality we will have if PPACA is repealed. Our country needs Republicans and Democrats to point out additional ways to address cost inflation in the health care system, within the framework of PPACA.
When you hear someone saying he wants to repeal the health care reform law, ask him what our country is going to do if we catch the car.
