I wish our government could do a few things as well as Kentucky Fried Chicken does chicken (and biscuits, for that matter). My qualifications for judging fried chicken are sparse, but genuine: I grew up in the south, eating my grandmother’s fried chicken. Recognizing the difficulties of doing things on the monumental scale that KFC does, I really believe they do chicken right.
It’s too bad the government can’t learn a little bit from KFC. Government does a small number of highly focused things effectively. At the local government level, fire and police protection is mostly adequate to excellent; at the national level, the military has kept us intact as a country for over 230 years. But by and large, government does almost nothing well.
When it comes to health care, government has performed up to its mediocre-to-unacceptable reputation: expensive, tons of bureaucratic details, unable to effectively combat overuse and fraud, etc. The next chapter in health care, the so-called Health Care Reform (actually, a gratuitous solution to an undefined problem), is being mindlessly rushed toward becoming the Mother of all Government Disasters. But its spectacular failure won’t be for lack of funding: how about eight to sixteen times that of the Department of Defense?
We might imagine how Colonel Sanders, and the management teams of the subsequent KFC owners, would approach the task of making health care affordable, accessible and effective. First, they would make sure they know what the goal is. This sounds overly simple, but has anyone heard a single elected or appointed government official state a real goal, or endpoint, of health care reform? The only defensible real goal (as yet not mentioned by Obama, Pelosi or Reid) is healthy Americans, substantially healthier than they are today!
We are not going to go from our current state of health to being as healthy as we can be in a short time. It will take at least two generations; but we would be consistently improving all along the way!
First, we need to implement an ongoing healthy living initiative with the goal of assuring that everyone has the opportunity to learn all of the practical information that we have accumulated to date about health maintenance and disease prevention. This initiative, involving public schools and universities, government health agencies, and private organizations from the health care community, can be implemented and maintained indefinitely for what amounts to pocket change, compared to the cost estimates for the currently envisioned “health care reform”.
A world-class, full-court-press health initiative can, on its own, significantly reduce health care costs as more and more Americans take heed. This effort, unlike any of the “health care reforms” proposed to date, starts accruing health benefits and health care cost savings from day one. This initiative is also essential to the long-term success of any genuine health care reform.
Second, the current health care system must be documented and defined, including its strong points, deficiencies and everything in between. For example, medical schools failed to ramp up for an impending shortage of doctors: why did that happen, and what are ways to prevent a recurrence? This systems analysis will be a large and costly project, involving operations research problem-solvers, systems analysts, and experts from every public and private area of health care. It would, of course, be broken down into multiple sub-projects in order to keep each segment within manageable size. While this effort will be costly (although nowhere near the sums politicians are proposing for “reform”), it is the critical first step if we are going to have health care that is effective, accessible, and affordable by our families and by our country. The health care system analysis also provides the information necessary to make truly informed decisions on public sector / private sector responsibilities and authorities.
This approach has several advantages. Improvements can be recommended, approved and implemented as the various segments are completed. It would be expected that some elements could be started independently, while others will need to be coordinated with related segments. Projected costs of the individual recommendations will be much more accurate than would have been possible with one giant “health care reform” unknown.
Third, we must eventually get around to open, honest and thorough discussion and debate of “entitlements”. One entitlement, Social Security, is by far the largest item in the federal budget. Another, Medicare, is the second largest item in the budget, far more expensive than the much-maligned Department of Defense (the fourth largest budget item, behind number three, Interest on the National Debt). Unsustainable cost is the most immediate and most obvious concern about entitlements; but you will presently see the real problem that entitlement creates for effective health care.
Our Social Security program works exactly like the scheme Bernard Madoff pulled off; Social Security is also headed for the same collapse as Mr. Madoff’s little $65 billion, tragic fiasco. Medicare, which was originally projected to reach a $15 billion per year cost by its 15th year; actually reached that level by its third year, and the government has been scrambling ever since to try to keep it under control (by reducing provider reimbursements, thereby effectively rationing health care). Also, the government has been unable to root out the intractable twenty-plus percent of fraud and waste from the Medicare and Medicaid programs.
The critical “entitlement” questions that need to be asked, studied, and debated are (1) “What is the obligation of each individual citizen?” and (2) “What is then the obligation of the government?”
Although cost, or cost-versus-worth, is the concern usually debated, the most serious entitlement problem is rarely, if ever, mentioned. Most people are familiar with Descartes’ “I think, therefore I exist” (cogito ergo sum). But in our entitlement era it has become “I exist, therefore I deserve”. We can, and do, endlessly debate all the moral aspects of entitlements. But the one thing we forget to ask is: does our entitlement mindset actually create a barrier to accomplishing the intended benevolent result?
In the case of health care, “entitlement” creates the illusion that absolutely nothing is required of the individual. But I seriously doubt that a single medical professional can be found who would agree that an ignorant, uncommunicative, uncooperative patient could truly benefit from his or her health care—irrespective of cost or accessibility. While we have heard the word “accountability” in almost every utterance by the politicians in power, they are nonetheless extremely reluctant to ask individuals to take a serious interest in their own health. It appears that the vote-attracting potential of entitlements precludes the advocating of personal responsibility, and it therefore also makes healthy Americans an unattainable goal.
Given the choice, I would prefer Kentucky Fried Chicken for my primary health care over any form of “universal health care” that the political powers have proposed. An added bonus might be a drumstick and a biscuit with honey at each doctor’s appointment.
Tags: disease prevention, Entitlements, health care reform, health maintenance, Healthy Americans, Mother of all Disasters
