Health care needs reform, not overhaul

Tuesday, August 18, 2009 | 12:01 a.m. CDT; updated 11:11 a.m. CDT, Thursday, September 3, 2009

COLUMBIA — Dwelling, as many of us are, on the overly emotional catfight over the administration’s health care reform legislation, I find myself likening it to maintaining an automobile. Although the family car might still provide reliable transportation to and from work and to recreational activities, after periods of operation it will require certain preventive maintenance — oil changes, engine tuneups, new tires and, in some cases, a visit to a repair shop.

This analogy is appropriate for the discussions now in progress. Our health care system, though not perfect and admittedly in need of some reform, is in working order as we do have access to physicians and health clinics and no one is denied emergency hospital care. The question to be answered then is, quite simply, “What to do about it?”

Much as with the family car, the options are reduced to “do we change the oil and tune the engine,” “repair it, “ “trade it in for a similar but newer model that we have learned to trust” or “scrap it for a new, more expensive one with all manner of bells and whistles?” The answer is found in the obvious: Can we make the payments? The overriding questions that many have with the proposed health care reform are twofold — why the seemingly unreasonable urgency and who pays for it?

Because most polling data concludes that a majority is satisfied with both their health care and health insurance (a recent CNN survey found that about than 8 of 10 satisfied.), is it prudent to scrap a system that is not broken? In the end, we must live with the final decision. Accordingly rather than point fingers and call names, we need to recall the adage: “act in haste, repent at leisure.”

As for the contentious town hall discussions dominating headlines, most of us do and should deplore rudeness, threatened violence and disruption of either factions right to be heard by unruly and boorish behavior. These activities, uncivil and unacceptable by any standard, also have the potential to incite backlash that will further damage the discourse. Nevertheless, neither political party owns a monopoly on ill-mannered and disorderly conduct. Is it not ironic that during the eight years of President George Bush, protest and dissent were deemed patriotic?

The attempt by the Obama administration and the Democrat Party leadership to dismiss the dissent in the health care debate as either uninformed, generated by special interests, fomented by talk radio or unpatriotic grossly underestimates the genuine unease and doubt emerging among the people. As an example, asserting that the proposed reduction of $500 billion in Medicare will have no affect on coverage is not playing well among seniors.

Likewise, the almost cavalier treatment of the individual and collective costs of the program in projecting that it can be covered by the raising of taxes on only the top 5 percent is finding fewer takers. As outlined in a bipartisan study by former Congressmen Rudy Boschwitz and Tim Penny in the Aug. 3 issue of Investor’s Business Daily, the soaring history of Medicare and Medicaid costs from 1968 to 2007 casts doubts upon government estimates as well as ability to control expenses.

Since 1968, Medicare costs have gone from $5.1 billion to $436 billion and Medicaid from $1.8 billion to $190.6 billion, an increase of 85 and 105.9 times, respectively.. In contrast, the federal budget grew by only 15.8 times, from $178.1 billion to $272.9 trillion, while the oft-maligned defense budget increased only 6.7 times, from $82.2 to $547.9 billion dollars. Consequently, the public is rightfully and demonstrably concerned.

The administration and the Democratic leadership have done little to endear themselves or to engender a spirit of cooperation with Republicans or independents. House Speaker Nancy Pelosi's referring to dissenters as swastika-bearing Nazis and as un-American, or California Sen. Barbara Boxer’s revelation that the protesters are too well dressed to be genuine or grassroots in nature are not exactly excerpted from Dale Carnegie’s “How to Win Friends and Influence People.”

Other ill-advised administration actions that unnecessarily alienated and even enraged a considerable segment of the public came from Janet Napolitano’s Department of Homeland Security and from the health care communications officer. Homeland Security's labeling of veterans, anti-abortion rights activists, supporters of third-party conservatives and libertarians and National Rifle Association members as fodder for dangerous militia groups was sorely lacking in political acumen. Equally insulting, the communique from the health care office exhorting people to forward “fishy” e-mails criticizing the president’s proposals smacks of 1984's Orwellian “Big Brother.”

For the president to advance positive reform, he must lose the “my way or the highway” attitude — the Democratic majority in both chambers is sufficient to pass his agenda; accordingly, the opposition cannot be just Republicans. To succeed, the administration must seek common ground with its opposition and realize that when changing the spark plugs will cure the problem, there is little incentive to buy a new car.

J. Karl Miller retired as a colonel in the Marine Corps. He is a Columbia resident and can be reached via e-mail at





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Gregg Bush August 18, 2009 | 12:45 p.m.

Sgt. Miller-
On this issue, you have no credibility.
You don't work in the health field.
You don't have to purchase private insurance in the marketplace since you have access to the best government-run single-payer health-care money can buy - the VA.
Please stop poisoning the atmosphere of health reform with rehashed charts and graphs, protesters are patriotic, swastika signs, jabs a Speaker Pelosi, and worn automobile methapors - people's lives are at stake.
I will support you if you want to begin a movement of VA for all.
Otherwise, you're just in the way.
Gregg Bush, Columbia MO

(Report Comment)
Allan Sharrock August 18, 2009 | 1:40 p.m.

Gregg, Mr. Miller is a retired Colonel not a SGT.

The VA loses money therefore it is not sustainable for our nation.

The difference between you and Mr. Miller is that he has earned his right for VA care while you (assuming you are not a vet) have not.

(Report Comment)
Gregg Bush August 18, 2009 | 3:44 p.m.

What a dunce am I! I had a Sgt. Miller deployed to Iraq. I question a man's credibility and then undermine my own.
And thanks for the article, Allen. I read it.
The Fire Department is a net loss for municipalities - so is law enforcement. That something "loses money" is not the measure of sustainability.
Wherever I look, I hear people with health insurance telling me about health insurance. Col. Miller is not a stakeholder in the debate - he'll get his deserved health care regardless if the bill is "reform" or "overhaul".
The bottom line is that the real stakeholders need to engaged in debate - providers and patients. Send the corporate bureaucrats packing. Send the government bureaucrats packing. Let physicians be physicians - not insurance paperwork generators (in my job I see a lot of that).
As far as I can tell, aside from taxes, Col. Miller is no stakeholder. And while there are a host of things I don't want my tax dollars going towards, I pay my taxes anyway. A fire truck, fire house, or fire hose doesn't generate profit, but they do inhabit a framework whereby other organizations may. A hospital must be thought of similarly. That our tax money should go to health care, or fire care or police care, we should be happy to pay.
The 5th promise in the Preamble to the US Constitution is "to promote the general welfare." While that doesn't necessarily mean hospital care - fire, police, and health all contribute to promoting the general welfare.

(Report Comment)
Allan Sharrock August 18, 2009 | 9:07 p.m.

If Col. Miller is married then his wife would not qualify for VA until his death so he would have a stake, other than taxes. (I couldn't find any benefits for living spouses for the VA hospital on their website) Now the argument against the 5th is where do we draw the line with "general welfare." I worry that once we start down the slippery slope of everything is a entitlement then when will the government stop? You have to admit politicians hate getting rid of government programs. Whoever they run against on either side uses it as ammo. It wouldn't matter if the program was the biggest waste in the world that is the reality of politics. Our elected officials are not leading by example. They need to first create the system and then put their own families and selves in the program. Because they are elected they can work out the kinks quicker while we the people can see how much it costs. While this is going on the government needs to first eliminate the mandate that prohibits a person from buying insurance from across state lines and put in some serious tort reform. They passed a stimulus bill, a tarp bill, and a clunkers bill, all with mixed results. I don't think it would hurt to have them be the guinea pig for awhile.

(Report Comment)
Gregg Bush August 18, 2009 | 11:56 p.m.

True, Allan, elected officials are not leading by example. Decision-makers must not be insulating themselves from the consequences of their decisions.
But the "slippery slope" argument is specious. We have lines on roadways, traffic signals, speed limits, age limits for alcohol, seat-belt laws, fire codes, roadways, prisons - we can delegate lots of things with positive results. But all of those things we delegate must be monitored by educated stakeholders. All government authority must be monitored.
I like my fire department, even if they get a good healthy audit from time to time; I like my police department, even if they get a Citizen's Review Board; I'd like my hospital to be non-profit, too.
One shouldn't have to file for bankruptcy for being ill or having an injury. Look at the most recent American Journal of Medicine study -
But that's the crux of the matter, Allan. You and I can have a fundamental disagreement over paying for health care, without being disagreeable. We can have our opinions and appreciate the education.
And I finally can spell your name correctly.
Now, if only cooler heads can prevail inside the Beltway.

(Report Comment)
Don Milsop August 19, 2009 | 1:54 a.m.

Gregg, obviously you have never received medical care(less) under the VA either. Most VA hospitals are teaching hospitals. The care is decidedly substandard. The employees are civil service, ergo, extremely difficult for the VA to rid itself of. The vast majority of veterans, at any opportunity, avoid medical care at the VA in favor of their own private insurance and private medical services for care. Perhaps you didn't know this. However, it is the history of medical care for veterans in this country for over 80 years.

I personally have slept on the hard floor next to dying veterans beds to ensure they would receive adequate attention during their final days. This was because of neglect of the nursing staff. One friend of mine, former PFC John D. Murphy, lst Parachute Battalion, lst Marine Division, a veteran of Gavutu and Guadalcanal, suffered from a broken back and an amputated leg.

John had prostate cancer surgery at the VA, and the doctor failed to remove the entire cancerous prostate. It soon spread to his bones and other organs. The day before he died, he was reguesting pain medicine. A nurse told him to be quiet, he wasn't hurting that bad. And this was in front of his wife.

So please, do not tell me about how great the care is in VA facilities.

(Report Comment)
Ray Shapiro August 19, 2009 | 1:56 a.m.

("Health co-ops’ Fans like Cost and Care:
Dr. Barbara Detering, a family physician at Seattle’s Group Health insurance cooperative, perhaps the best-known cooperative in the country with 580,000 patients, said her organization’s governing structure is only one part of its success. A major reason for its achievements is that Group Health’s doctors rely on a holistic, more conservative approach to medicine, she said.

They work closely with patients to explore alternatives before rushing into costly tests and surgery.

“It is not as much about an insurance co-op as it is about the integrated nature of the care and the strong emphasis on primary care,’’ said Detering.

Another key feature: Detering and other Group Health doctors are paid salaries instead of getting compensated for every service or procedure they provide. That eliminates the financial incentive - common throughout US health care - to provide lots of expensive care.

“My incentives are to try to meet the [patient’s] medical needs in the most efficient way possible, because I’m not going to make more or less money depending on how many tests I order, or how many procedures I do,’’ Detering said.

When Detering meets with patients, she will discuss options before ordering expensive tests or surgeries, but she stressed that such procedures are approved when necessary and done at a rate comparable to other organizations. For example, she said she might suggest that a person with a sprained knee wait before having an MRI, and she might discuss options other than surgery for certain conditions.")
source and more:

(Report Comment)
Don Milsop August 19, 2009 | 2:03 a.m.

Whoa, let me back up here! Colonel Miller has no stake in this? He put his entire body on the line on several occasions during his 30+ years of service as a Marine. By God he earned his say and more by virtue of his sacrifice to his nation. Gregg, you can't even begin to understand what our military endures even during peacetime. Go to your local VA cemetary. Look at the headstones. The aveage age at death for a retired Marine, regardless of a 20 year or 30 year career is 57 year of age.

I would suggest you try to educate yourself a great deal more before you beginning uttering thoughts on subject for which you are totally unqualified to expound upon.

(Report Comment)
Ray Shapiro August 19, 2009 | 2:24 a.m.

These reports offer you information about the quality of care your VA medical center provides.
Prostate Cancer Treatment Problems at Philadelphia VA Medical Center
Veterans' health care system fails Gretna Marine
Army Ousts Head Of Walter Reed Hospital
General In Charge Is Relieved Of Command Due To Inadequate Treatment Of Soldiers

(Report Comment)
Mark Foecking August 19, 2009 | 4:14 a.m.

I hear the VA has really turned it's care around. In the 90's when they were seriously facing threats of mass closures, and vouchers for veterans care at private hospitals, they undertook a significant effort to bring their level of care up. By several measures, they've succeeded.

VA hospitals, however, are not really comparable to private hospitals. Much of their care is uncompensated, and their patient population is quite different than a hospital like Boone would have. I'm not sure how relevant it is to discuss the VA relative to the currently debated health care bill.


(Report Comment)
Gregg Bush August 19, 2009 | 3:13 p.m.

I read some of our other points, and you seem reasonable and measured. And thank you for proving my point with respect to the VA.
Individuals with access to health care, aside from an hospital Emergency Department, should leave decisions on the future of health care to the those that have the greatest at stake -
These are the real heroes of health care. Temporary treatment centers that rival refugee camps - humbling. I have decent health care, and I work in the health field. But I also know that many are more schooled and thoughtful than I am on the issue.
We need experts, not opinions; we need calm, not bluster; we need data, not anecdotes.
And we need leaders, not politicians.

(Report Comment)

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