TCS Daily

Kerry's Saving Grace

By Sydney Smith - July 22, 2004 12:00 AM

John Kerry knows what's important. It isn't vigilance against terrorism, or education, or foreign policy, or the economy. It's healthcare. Earlier this month Kerry told New York Times reporter Louis Uchitelle that healthcare would be the number one priority of his administration. And if his $650 billion dollar plan proves more than the budget can bear? Well then, other programs will have to be sacrificed. Healthcare is "sacrosanct" he told Uchitelle.

That's a very scary proposition, assuming that Kerry means what he says, because the Kerry plan is an ambitious one that has the potential to become the monster that ate the GDP. Its centerpiece is the expansion of Medicaid and the State Children's Health Insurance Program to include families who earn three hundred percent of the federal poverty level. To give you an idea of how generous that is, the federal poverty level for a family of six is $25,210 a year -- a very meager budget for a family of six, to be sure, and one that deserves federal aide. But, under Kerry's plan families of that size making up to $75,630 a year would also qualify for Medicaid.

A six member family is not the average family size, but it happens to be the size of my family. And so I can say with certainty that an income of three times the poverty level is a very comfortable income. For this family of six it buys a three bedroom house in a quiet suburb, two cars, a family health insurance policy, and money left over for savings. It just doesn't seem right to ask the teachers next door to pay higher taxes to buy health insurance for a family like us. Nor does it make sense to sacrifice their salary to education budget cuts for our healthcare insurance.

And make no mistake, taxes would have to go up and budgets would have to be cut to meet the insatiable demands of today's healthcare market. The Kerry plan's $650 billion estimated price tag is based on the state of today's healthcare. But if history is any indication, that estimate will be dwarfed by the healthcare of tomorrow.

Consider Medicare. Thirty-five years ago, at its inception, the program spent $358 per enrollee. By 2002 that number had shot up to $6,711. And that's for a program that doesn't cover prescription drugs. In 1969, Medicare's first year, treatment choices were extremely limited whether for life-threatening infections, cancer, or heart attacks. The main focus of medicine was to treat disease, not to prevent it. Today, our pharmacopiea offers an unending array of treatment choices for all manner of ailments. Drugs are used not only to treat life's diseases, but life's despairs. And medicine focuses as much on treating potential disease as it does on treating established disease. The number of ways in which we can spend our healthcare dollars just keeps growing apace.

It may be true, as is often said, that a healthy nation is a strong nation, but before we gut other programs for the greater health, perhaps we should define exactly what we mean by "health." Will our tax dollars be spent to keep each and every one of us as free of disease as possible, or is the goal the loftier WHO definition of "complete physical, mental, and social well-being"? And even if we agree that a utopian ideal of health is unatainable, how will we define disease? Will we be spending money to treat established diseases or will we also be spending it to treat "pre-diseases"? Will we only be spending those tax dollars on medications that are known to save lives or will we also be spending them on expensive medications of very little benefit? Will we pay only for immunizations against infections that threaten life on a large scale, or will we also pay for those against diseases that threaten life on a small scale? Will we accept every new treatment recommendation that comes down the pike, no matter how expensive, or will we set a threshold of cost vs. benefit that each treatment has to meet before it's subsidized?

These are all questions that need to be answered, for this is the state of healthcare in the 21st century. We have embraced the utopian ideal of health. In our zeal to eliminate disease and suffering, there is no treatment so expensive that it will not be recommended, no disease so rare that it will not be prevented, no risk so small that it will not be minimized, and no inadequacy so trivial that it will not be treated. Especially if someone else is paying.

The Kerry plan would expand the amount of state and federal money spent on healthcare without providing any incentive for curtailing the cost. It's a mid-twentieth century solution for a very 21st century problem. Add to that Kerry's espoused willingness to sacrifice everything to keep it solvent and you have a recipe for disaster. The only saving grace is that Kerry so rarely means what he says.

Sydney Smith is a family physician who has been in private practice since 1991. She is board certified by the American Board of Family Practice, and is a Fellow of the American Academy of Family Practice. She is the publisher of MedPundit. She recently wrote for TCS about medical "truths."


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