Twin peaks: US and coastal health reform

in People Issues by Admin — August 20, 2009 at 5:00 am | 3 comments

Editor’s note: almost every description of the collapse of the Mississippi River delta includes a diagram consisting of two overlapping curves like sine waves. The first portrays the accretion, abandonment and subsequent deterioration of a subdelta lobe, followed with some delay by a rise and later decline in primary and secondary productivity. My old friend and former LSU faculty colleague Jim Stone recently reminded me that this often reproduced graph was his idea from the seventies that he called the “double breasted theory of Louisiana coastal function.”  This post involves another set of twin peaks, challenges that cry out for government assistance.

As baby boomers get grayer and medical technology gets pricier the actuarial bottom line is that, absent drastic reform, US health care costs will “sink” the US economy in twenty years. It strikes me that this dire situation, about which we’re hearing quite a bit lately, closely parallels the bleak projections of sea level rise and subsidence that could drown much of south Louisiana within the same time horizon. 

A rising crescendo of emotional personal accounts of hardworking people around the country whose medical bills have made them homeless or bankrupt sounds remarkably like the urgent pleas for help from Louisiana coastal residents either displaced by Katrina or at risk for the next devastating storm. 

The simmering health care crisis finally awakened serious political debate over the critical need for and essential elements of a reformed health care system. Much of the public dialogue on health care in congressional town hall meetings has been cynical, ill informed and laced with urban myths. Political responses to these comments have often been esoteric, jargon-laced descriptions of plans to, for example, “bend the fiscal curve.”

For over two decades the residents of south Louisiana have been calling for bold decisive action (also sometimes unrealistic) to save the coast. This outcry succeeded in generating in 1989-90 a state/federal restoration program that has become, like the national health care system, balkanized, complex, expensive and cumbersome. Large scale restoration measures, even those with broad support, have been postponed in favor of years of endless committee meetings, a series of plans with numbingly detailed lists of projects and scattered “band-aid” feel-good projects that have little long term significance. 

Close your eyes the next time you hear a national news broadcast on health care reform and mentally substitute comprehensive coastal protection and restoration for universal and affordable medical care. 

The following commonly-repeated descriptors of dysfunctionality capture the remarkable similarity between the issues of “fixing” both south Louisiana and the national health care system: 

1. Rapidly expanding costs and funding limits;
2. need for expensive new diagnostic technology and testing (studies); 
3. program rationing – saving or resuscitating marginal areas; i.e., employing extraordinary measures for high risk conditions vs. pulling the plug; 
4. “death panels,” committees of bureaucrats charged with making priority policy decisions with life or death consequences; 
5. reluctance to mandate low tech, cost-saving, preventive, life style-changing measures, e.g., elevating structures;
6. unrestricted reoccupation of high risk neighborhoods, i.e., urban sprawl (analogous to obesity) vs. relocation into planned communities with higher density development; 
7. mandated universal insurance participation; FEMA “FIRM” program; insurance disqualification because of “prior condition;” 
8. inflexible, balkanized, expensive government control (corps of engineers); 
9. congressional bickering and political gamesmanship. 

A major challenge for solving the dysfunction of the national health care system and the collapse of the Mississippi River delta is neither technical nor fiscal. It’s political. For example, if national health care reform passes it will probably be without the support of delegations from red states such as Louisiana, although at this point I don’t believe that Mary Landrieu and Charlie Melancon have committed. 

Lo and behold, the lone vote for health care reform might come from freshman Republican Congressman Cao from Bill Jefferson’s former district 2! 

Members of the Louisiana delegation will no doubt justify nay votes on health care reform with such hypocritical phrases as “keep government out of health care,” knowing full well that VA health care and Medicare are successful models. On the other hand these folks will have no trouble accepting maximum government input when it comes to funding coastal protection and restoration. 

The following phrase guide includes terms being thrown around loosely at town hall meetings on health care, along with their coastal analogues: 

Affordability: 100% federal. Choice of provider: e.g., COE vs. FEMA. Competition: levees vs. ecosystem restoration; Death panel: CWPPRA Task Force (throw Granny Boudreaux overboard). Expanded coverage: move the coastal boundary further north. PhrMA lobby: Chackbay native son’s* golden egg laying goose. Public option: Letting the public decide on restoration priorities. Single paye(e) plan: award all the engineering contracts to Shaw Coastal. Socialized system: coastal policy decisions made during a fais do do. Tea baggers: Drinkers of coffee brewed outside Louisiana. Universal coverage: protection for everyone in Venice, Grand Isle, Iles des Jean Charles, Holly Beach. 

To complete this tongue-in-cheek analogy, my sense is that serious progress over the next few years of an affordable, realistic, sustainable program that succeeds in preserving a significant portion of the Mississippi River delta system has about the same chance as the passage and signing of a meaningful and effective health care reform bill by the end of the year. I strongly support both.

Len Bahr

 

*Billy Tauzin