Morris brutally honest, but his healthcare view is false choice

Dick Morris’s column “Death of U.S. healthcare” (May 13) is refreshingly, if brutally, frank about the logical implications of viewing healthcare as a zero-sum game. As such, it is a useful contribution to the debate over healthcare reform, by making it clearer what is at stake. Among critics of reform efforts, he is not the only one to believe that 40 million-plus Americans need to remain uninsured in order to protect the access to care currently enjoyed by those who still have relatively unrestricted employment-based coverage — but few are as honest about this perspective.

If these were the only two alternatives, the future would truly be grim — particularly since the current system is itself unsustainable and employers are increasingly unable to pay for the benefit structures of the past. Therefore, the only way to avoid change for the currently well covered would be for the reserve army of the uninsured to grow.

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Fortunately, the zero-sum scenario is a misperception rooted in a lack of understanding of how our system functions and a failure to seriously consider the experience of the rest of the developed world, rather than just cherry-picking statistics. At more than 16 percent of GDP when last officially measured, and probably more like 18 percent today, the cost of U.S. healthcare is off the charts compared with that of our economic competitors, while we produce worse results than other nations, not just for the poor but for the middle class. There are more than enough resources in the system, if managed in a coherent way, to meet all the needs. Our main problems are out-of-control healthcare prices (yes, including fees to specialists though not primary care physicians) and the overburden of administrative waste inherent in our fragmented private insurance system with its innumerable middlemen.

Morris claims that constraints on doctors’ fees will lead to a crisis in physician supply; but it is caps on medical school enrollment and residency slots, not reimbursement, that control physician supply. U.S. medical schools turn away thousands of highly qualified applicants annually. Bright and dedicated young Americans will continue to seek out medical careers even when the potential for a financial bonanza (particularly for specialists) is reduced, just as they do in Europe, Canada and elsewhere. Indeed, the appeal may increase as careers in finance for the best and brightest lose some of their allure.

We don’t need a reserve army of the uninsured to protect access for those who now have “good” coverage, nor do we need to ration lifesaving care. What we need to do, instead, is to correct the economic imbalance that now exists between healthcare payers and providers by allowing buy-in to a public plan; provide incentives for the creation of coordinated systems of clinical care built around clinical teams and systematic, evidence-based care processes; and bring everyone into the tent, especially since we are paying for their acute medical care anyway. If we fail to do so, not only will we lose a historic opportunity to improve care for the whole population, but we will do enormous damage to our economy’s future and ultimately experience a coverage meltdown that will affect all of us, including Mr. Morris.

New Brunswick, N.J.



The writer is a professor at Rutgers University and director of the Center for Pharmacotherapy, Chronic Disease Management, and Outcomes; director of the Center for Education and Research on Mental Health Therapeutics; and associate director for health services research at the Institute for Health, Health Care Policy, and Aging Research.



Bush torture team
not above the law



From Nancy Sellers

(Regarding article “Senate panel to hold torture hearings,” May 6, and related coverage.) Believe it or not, there’s a growing chorus to let the Bush torture team get off without a day in court.

The Justice Department’s Office of Professional Responsibility released a draft report that reportedly concludes that the lawyers who drafted the “torture memos” were legally sanctioning illegal interrogation methods. It asserts that they committed lapses of judgment but claims that they should not be prosecuted. Evidence suggests that crimes might have been committed with the knowledge and authorization of high-level Bush administration officials.

We can’t hide the truth about torture, and enforcing the law is not a political decision. There should be a thorough investigation. If crimes have been committed, our legal system demands accountability.

It would be a dangerous precedent to conclude that lawyers who played a critical role in an illegal program are immune from criminal investigations. No one is above the law.

Washington



Economy not improving, contrary to what they say



From Yossi Gestetner

In the past two weeks, the following reports were worse than what economists expected: the GDP of the first three months, the Consumer Price Index (inflation), the retail sales of April, and first-time requests by laid-off workers for unemployment benefits.

Is it not time for these “economists” to snap out of this myth that the economy has turned the corner? Is it not time for these “economists” to expect less from Obama’s economic policies? If they do, I am certain more reports will be in line with their predictions.

Spring Valley, N.Y.