Published in The Journal Record
March 25, 2020
Recently I watched a Trump health official being interviewed on cable news about the supply of ventilators in hospitals. These machines are vital in the care of Coronavirus (COVID-19) infected patients since respiratory distress is a major symptom of the disease. The question was, “Could our hospitals exhaust their supply of these machines?” The correct answer is, “Yes.” That could surely happen when demand exceeds supply. The official, however, explained there are plenty of machines ready to be distributed should the infection rate get far worse. This is, of course, nonsense.
In her effort not to alarm the public, this expert engaged in health gobbledygook. Let’s be clear. Our health system is not designed to handle significant spikes in patient activity due to natural, manmade, or pandemic disasters. It is designed, staffed, and equipped to address the average caseload that occurs 99% of the time. In fact, we would not want, nor could we afford, a system with a surge capacity to handle all possible catastrophes. Such capacity would be frightfully expensive and detract from the mission of addressing the needs of patients who present themselves with the normal vicissitudes of health misadventures.
This should not surprise us. There is not a system upon which we rely equipped to expand rapidly enough to address all our needs in a time of widespread panic. Reflect on how quickly our grocery stores have emptied with the COVID-19 scare. Our financial institutions have the same limitations. We expect to be able to withdraw our money from our bank any time we wish. But if all of us decided to do it at the same time we would be sorely disappointed. Our money is simply not there. The banks have lent it out. Their business model depends on paying an attractive interest rate on the cash we deposit, then turning around and lending it at a higher rate. The difference in the two rates is their profit.
Our whole personal and economic lives are built on the theory of average use rates. Our sense of equanimity is bolstered by our confidence in our systems. When we find our store is empty, our gas line is too long, our money not easily available, and our hospital system is stressed to capacity, we must realize it will take leadership both public and private to help us manage difficult times.
Published in The Journal Record
February 26, 2020
My parents, particularly my mother, taught me to be polite and deferential to women. Gestures such as holding the door or a lady’s chair was considered polite and gentlemanly. As I get older I find it’s not uncommon for women to now hold the door open for me. I suspect these modest gestures can be traced all the way back to the chivalrous acts of French and English noblemen who were called knights. Part of their mantra was to display courtesy, kindness, and deference to the opposite sex. In fact, the word chivalrous gets its meaning from a French phrase having to do with horses since the knights were usually mounted.
For years the tradition in health care was that the poor should be taken care of by physicians and institutions based on their ability to pay. It would not be uncommon for rural doctors to be compensated by their patients and families with a sack of potatoes or a bushel of peaches.
This began to change as the technology of health care became more expensive and scientifically robust. For hospitals to attain this new technology they would have to generate a significant amount of cash to make these expensive capital acquisitions. The technology surrounding health care has become amazingly sophisticated but also amazingly expensive. The ability for health care institutions to make this technology widely available but also cheap enough for the average citizen to enjoy has disappeared.
The advent of health insurance, both private and governmental, has removed some of the barriers to access, but still wide segments of our population must rely on the generosity of providers when accessing the health system.
So, we are left with a dilemma. The more sophisticated our health devices, procedures, and training become, the more it becomes out of reach to the average citizen without the help of some external payment system.
To solve this dilemma, it is now suggested that the only humane and reasonable choice is to provide health care to everyone at taxpayers’ expense. Ultimately, we will be presented with a Hobson’s Choice of providing health care services to everyone while dumbing down technological advances or leaving a significant segment of our population either without the latest innovation or relying on the generosity of the providers’ community.
Published in The Journal Record
January 29, 2020
Last month we learned that President Lyndon Johnson needed help with social conservatives to pass Medicare. Enter United States Representative from Arkansas, Wilbur Mills.
Mills chaired the House Ways and Means Committee which made him a very influential legislator. He foresaw the likely possibility that if Medicare were passed it would be but a short time before members of his party would demand something similar for the rest of the country. He devised companion legislation that was dubbed Medicaid to forestall this anticipated desire to expand Medicare to the entire population.
Mills did several things that were particularly pragmatic and far-reaching. He suggested that Medicaid should cover certain categories of the poor, particularly those with the greatest public enthusiasm such as pregnant women, children, and the poor elderly. In addition, he was particularly clever in making Medicaid a joint federal/state program with the states paying roughly half the cost, but also maintaining control over who and what was covered and what providers would be paid.
As would be expected, any government program such as Medicare was likely to be opposed by a conservative coalition of conservative Democrats from the south and northern Republicans. Anticipating this Mills knew that conservatives love programs where the state had considerable autonomy. Thus, he was able to pull off a hat trick by aligning Medicare and Medicaid together but allowing the states to have considerable control over Medicaid and significant leverage in how the program would be managed within their state.
So, in July 1965 Lyndon Johnson signed both the Medicare and Medicaid programs into law – Medicare, an individual tax supported insurance program for the elderly; and Medicaid, a social welfare program funded by the federal and state governments designed to help certain categories of the poor.
Today Medicaid covers 59% of low-income children. States pay, in general, 17% of their general fund into the program. It covers 60% of nursing home residents and 37% of child births. Mills, therefore, eliminated until this very point in our history the call to expand Medicare to the entire population. His artful maneuvering of the political system eliminated the desire for a “Medicare for All” program until today, with the Democratic party clearly moving in that direction.
We must admit that Wilbur Mills was spectacularly successful in avoiding a single payer system for two generations.
To see the clip of Stan’s recent interview on KSBI Channel 52, please go to: