Before I moved permanently inland to the Shenandoah Valley, I had always lived on the coast. If I wasn't working, I was often sailing. Sailing, like camping (real camping, not RVing) gives you a feeling of partnership and achievement with nature. You don't control or master the environment, but you learn to use it to your advantage, most of the time. Every so often Mother Nature decides to teach you who is really in charge.
When I sailed the Chesapeake Bay, these lessons were often exciting. When we saw a squall coming, we'd don our foul weather gear, reef the sails, secure our life jackets, and ride her out. I have vivid memories of my young son and daughter, howling at storms like Lieutenant Dan. The ride was more excitement than real risk.
Offshore sailing in the Atlantic and the Gulf of Mexico is a different story. Out there, in the really blue water, storms deserve more respect. Even a heavy, well-built boat of 25 feet can get tossed around like a soda bottle. I have one particularly memorable image of the tiller and everything else tied down on deck, and the family huddled below deck. In that setting there is no question of control, you just hang on and pray.
Although I no longer sail, I get the feeling we are pointed into heavy weather. The first clouds started forming when the front page featured the president with a smiling group of insurance executives. It's like an old photo of cheerful Wehrmacht officers. Regardless of what they say, these companies have only one motive, and it is not the good of humanity. They are willing to help bring down healthcare costs, and they have years of experience trying. What they are not concerned about is the quality of care, or the providers and recipients of the care. The salaries they pay themselves are like neon signs declaring their real motives.
The skies got darker still when the Big O and the pharmaceutical executives reached a landmark agreement. In return for cutting their income on overpriced drugs to the elderly by less than 1% of their profits, they are now lauded members of the team reforming healthcare. Physicians have taken payment cuts amounting to 30% to 50% per service over the last decade. Have you had your picture taken with the president yet?
The most alarming factor is the makeup of the touted "Obama Healthcare Team." "Unlike the Clinton Era reform team," we are told, "the Obama team is made of people experienced with healthcare policy." "Policy" is the key word here. The team has no representation near the top from experienced providers. I am constantly amazed at how lawyers, be they the Clintons or the Obamas, think they know enough about everything to reform it. They will deal with the money and the regulations, but avoid the really tough questions.
Have you heard talk about how we are going to limit care? Any long discussions about the money we spend prolonging death rather than make the tough choices on how we will allow people to die naturally? Who is debating the $6 billion spent on consumer ads for prescription drugs, or the indirect costs of those ads in terms of more expensive drugs and wasted physician time discussing them? Does 12¢ on the dollar need to go to insurance? Is the nationwide orgy of cardiology self-referral being mentioned?
President Obama has admirable goals for health care, and I believe in the end he may create such a system. But Congress is about expediency. The quick way to provide more care for less money, while protecting the interests of those on the reform team, is to pay less per service. Time to reef the main and tie the tiller. We're in blue water.
