The Moon and Health Reform

July 22, 2009

(Wrote the following editorial for a general-interest audience; it’s up at The Huffington Post)

Yesterday we celebrated the 40th anniversary of the moon landing. What else? Oh, right. More pundits and politicians told us that meaningful health reform was impossible. In 1961 the president of the United States set the goal of landing astronauts on the moon and returning them home safely within 10 years.

We did it in eight years — and while we were at it we created Medicare and implemented the Civil Rights Act. Just how tiny have we become in the last forty years?

The moon landing changed the way we thought about ourselves. It gave us pride, and a belief in our own abilities. It became a folk saying, common in everyday conversation and television commercials: “If they can land a man on the moon (it was always a man in these sayings; we’ve come a long way), why can’t they make a cup of coffee I like without caffeine?” Forty years later, you can even get a decent cup of decaffeinated coffee at Starbucks or the Coffee Bean.

If the president were to set a goal like President Kennedy’s today, we would probably see Republican senators saying that the GOP should “slow him down” because it would “break him.” And Republicans who thought it might be good for the country to meet such a goal would be confronted by pundits like Bill Kristol, who said this of health reform: “(T)here will be a temptation … to try to appear constructive, or at least responsible … Resist the temptation. This is no time to pull punches. Go for the kill.” Meanwhile Blue Dog Democrats might be afraid that a bold stand on the issue could hurt them with swing voters.

And yet polls show that the public wants meaningful health reform with a robust public option. To paraphrase that line from Sunset Boulevard, the American people are still big. It’s politics that got small.

It’s true that the recent Washington Post/ABC Poll shows weakened support for deficit spending to stimulate the economy (the question is phrased somewhat differently in the recent poll, which could skew the results, but the decline is dramatic). Hence the new, poll-driven concern about ensuring that health reform doesn’t “raise the cost curve.” The first response on the Democratic side has been to propose the partial taxation of employer-provided health benefits (a proposal which may not make as much sense as it seems to make).

There’s a bolder, smarter, better way to lower costs and improve health outcomes: Why not create a new national mission, on the scale of the mission to the Moon? Here’s the outline for such a mission: To learn what medical techniques work best, for which people, so that we can have the most effective medicine in the world within ten years. That means we’ll need to study, identify, and reduce the use of unneeded and harmful medical procedures, starting now.

One good place to start is with the McKinsey study on excessive use of costly services in the US (although we should make more comprehensive studies of this problem a national priority). McKinsey estimates that we spend $480 billion more per year than other industrialized nations on medical services, after adjusting for population and other factors. That figure isn’t justified by either our level of health or the results we get from our care. We’ve been hearing a lot about the reputed $1 trillion cost of reform over a ten year period, but even a 25% dent in this excess spending would give us reform that saves money. Why not make it a goal to use our nation’s imagination and ingenuity to make those savings a reality?

Some will say this is a form of rationing. That’s not true. It’s not ‘rationing’ to let people know that the painful and invasive operation they’re about to undergo isn’t necessary, and may even make them worse. You’re not ‘denying’ them something. You’re protecting them.

The nation that launched a manned moon mission in eight years can fix this problem — but only if we stop tinkering with the small stuff and start looking at the big picture.

In other moon-related news this week, the Indian state of Haryana announced that it would provide free travel insurance for a million religious pilgrims. Fear of ill fortune brought by this week’s eclipse might made travelers reluctant to come to the state for their ritual bath in the waters of Brahmsarovar, the pond of Lord Brahma. That could deprive Haryana of much-needed tourist revenue at a critical time.

The lesson of Haryana’s “eclipse coverage” is this: Insurance is too often a reflection of what we fear, rather than what we can prevent. Americans should make it a national goal to learn the difference in the next ten years, and then manage their care accordingly. If we can land a man on the moon – and make a decent cup of decaf – surely we can do that.


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