There is a moon shot here: Don Berwick's exit from CMS & the irrationing of healthcare

In my blog post yesterday, I mentioned the sometimes ridiculously high cost of healthcare, and the resulting lack of coverage for many people.

No one wants rationing of healthcare; rationing connotes a period of barely adequate consumption in a time of war. Yet coming from the same root as "rational," rationing is the product from a conscious effort to equally and fairly share a limited resource.

Our high prices create "irrationing." Think of the harm to Deamonte Driver, a boy with a gap in his Medicaid coverage, who eventually died from an untreated toothache, to Nikki White, a young woman with cancer who was denied benefits by her insurer for her pre-existing condition of lupus, and to Natoma Canfield, an uninsured woman whose cancer was detected far too late, among far too many others. That's irrationing; irrational, needlessly cruel and jarringly wrong for the richest and greatest country on earth.

In 2009, Dr. Don Berwick told a biotechnology journal, "The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open."

Now, as he exited his leadership role over the Medicaid and Medicare programs, Dr. Berwick said, just as Americans supported manned missions to the moon without knowing the details of rocket science, they ought to support the universal health insurance law because of its ultimate destination. "We are a nation headed for justice, for fairness and justice in access to care," Dr. Berwick said. "We are a nation headed for much more healing and much safer care. There is a moon shot here."

Thanks to Robert Pear for his interview in today's New York Times.

David, Goliath, Max Baucus, and Nikki White: The Senate Finance Committee's plan for national health insurance

Nikki White was a slim, young and athletic college graduate. She had a job, and health insurance. At 21, she had been diagnosed with systematic lupus erythematosus, a chronic inflammatory disease that gradually weakened her to the point where she could not work. When she lost her job, she lost her health insurance. She tried everything to get medical care, writing letters for months, but no insurance company would accept her because of her costly pre-existing condition.

Finally, she collapsed when at her home in Tennessee, and was rushed to the Emergency Department. She received plenty of free care, including six months in an intensive care unit (costing taxpayers hundreds of thousands of dollars). It was far too late, and she died in 2006 at age 32.

Every 12 minutes, an American like Nikki dies. You read it right, and I’ve checked the math. That's the key finding of a study that determined that 45,000 Americans die each year from the lack of health insurance.

The same day the study was released, the value of insurance company stocks rose on the news that Sen. Max Baucus submitted the Finance Committee's health insurance plan. Investors believe that Baucus' scheme would be highly profitable for insurers, who will gain millions of paying customers. Insurers would not have to compete against a public program. Instead, these highly experienced, financially stable Goliaths would compete against nonprofit co-ops, i.e., young start-ups. Insurers are adept at cherry-picking the healthiest, least expensive people to insure, likely leaving the sicker, more costly uninsured people for the nonprofit co-ops. It's easy to guess who'll profit in that marketplace. That's why insurance stocks rose.

Here in Massachusetts, we don't have this problem. Here, Nikki would be alive. We have some excellent insurers – and near-universal health insurance.

Advice to non-Massachusetts residents: Move here. If you don't want to do that, call your senator or congressman and insist they support a public option for health insurance.

Read how universal health insurance saved someone’s life. Thanks to Nicholas Kristof for the source story in the New York Times of Sept. 13, and Dr. Andrew Wilper et al in the December 2009 [sic] issue of the American Journal of Public Health.