And Bloggers On John Edwards
Were one to draw the Venn diagram of patient compliance and presidential campaigns, one would anticipate the intersecting portion would be minuscule if it existed at all. Further restricting that intersection to an overlap patient compliance, presidential campaigns, and public controversy certainly, one would think, doom that result to the ignominy of the null set.
Well, as of 2 September 2007, one would be wrong.
That day, presidential candidate, John Edwards elaborated on his healthcare plan to the folks in Tipton Iowa in a speech described in Edwards Backs Mandatory Preventive Care, the AP news story by Amy Lorentzen:
From the lighting of that fuse to explosions of outrage in the conservative blogosphere required only a few hours.
Consider, for example, a Newsalert post published at 7:52 PM the same day the speech was given:
The AP reports on Comrade Edwards:
… [An excerpt from the AP story referenced above follows] …
Comrade Edwards is going to force you to go to the doctor whether you like it or not.You will not be free because Comrade Edwards wants a monopoly on your health care.
And, just in case the reader doesn’t pick up on the subtle political connotations of “Comrade Edwards,” the post is headed by the following emblem:
How about a few other examples, just for grins?
From the post with my favorite title, Healthcare Part VIII – Drop that Twinkie or I’ll Shoot! at Angry Bear,
No word if Edwards will give us veggies.
And from John Edwards: “you can’t choose not to go to the doctor for 20 years” posted at Althouse, come these passages:
Daystar51 goes beyond lambasting Edwards for promoting “mandatory preventive health care” to speculating on the possible origins of this notion buried in the candidate’s psyche:
Mandatory preventive health care? Come on, no one could think that.
But Edwards says he does. He says if you’re going to be in the system, “you have to go in and be checked and make sure that you are OK.” Only he doesn’t happen to mention any way to opt out of the system. His plan “requires that everybody be covered. It requires that everybody get preventive care.” Not only that, but mental health is part of Edwards’s plan. I can only take this to mean that annual check-ins with a psychiatrist would be required, cradle to grave.
I wonder whether Edwards’s plan is designed to fund pill police to make sure you choke down all the good things Doctor gives you.
Interestingly, medical malpractice litigation was Edwards’s specialty when he practiced law. He tried more than 60 med-mal cases, more than half of which brought verdicts exceeding $1 million. He reported an AGI of $11.4 million in 1997. Tidy.
Perhaps Edwards is now enthralled with doctors because his wife has breast cancer. Perhaps his compulsory exam plan is a token of his appreciation, a way of paying doctors back.
An blog/article, dated September 5, 2007, in US News & World Report wields the British healthy practices incentives plan as a blunt instrument to batter the obligatory preventive care Edwards espouses:
The dream of universal healthcare, as outlined so far in the Democratic presidential race, looks like this to me: Every American (says John Edwards) gets health insurance or at least most people (says Barack Obama). Will it mean higher government spending? Probably. But it can be paid for via higher taxes on wealthy Americans (Edwards). But who knows, maybe through greater use of technology, cost savings will be enough to avoid a tax increase (Hillary Clinton).
But as the various plans get looked over, explained, and debated, it seems very likely that all sorts of unanticipated aspects to them will pop up, such as this recent piece of insight from Edwards regarding his plan, via an AP story:
“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”
Certainly at first glance, Edwards seems to be advocating a system where you get health insurance only if you follow certain government-prescribed healthcare routines, like regular doctor visits. Now after re-examining the Edwards plan, liberal blogger Ezra Klein concludes that patients “will have incentives to avail themselves of preventive options. But there won’t be any mandate for X doctor’s visits every Y years.” Maybe he’s right. But then again, maybe Edwards was accidentally describing the future of any government-directed healthcare system. Just look at Great Britain. That nation’s national health system already demands that obese patients lose weight before receiving hip replacements. But the out-of-power Tory Party wants to go further, according to London’s Evening Standard (via the Drudge Report):
Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans. Patients would be handed “NHS Health Miles Cards” allowing them to earn reward points for losing weight, giving up smoking, receiving immunisations or attending regular health screenings…. But heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act…. Those who abused the system—by calling an ambulance when a trip to the GP would be sufficient, or telephoning out of hours with needless queries—could also be penalized…. Yet while the Health Miles Card would award points for giving up smoking and losing weight, it could penalise those who are already fit and well because they would receive no benefits under the scheme.
Weird Is Relative, writing in What’s the punishment for noncompliance? Endless jury duty?, implies that the Tipton Iowa speech may be fatal to the Edwards candidacy:
It would be difficult to misunderstand the perspective of Not Larry Sabato, who exclaims in John Edwards on Health Care,
This kind of crap is exactly what allows politicians like George Allen to talk about the “nanny state” and collect votes. I totally support universal health care so every American has coverage- but if some people choose not to use that coverage they are given- that is their decision. How is Edwards going to enforce this – will he send the police out to get people who miss their scheduled preventative doctor’s appointments?
In fairness, not every blogger or commenter was bashing Edwards, but pro-Edwards postings are difficult to find. Plunderchat is a one of those few who straightforwardly support the mandatory preventive care, declaring in John Edwards Looking Good on Health Care that
First: “It requires that everybody be covered.”
To make health care affordable for everyone, you need to spread the cost out across the entire population. Twenty-year-olds will often opt out of healthcare because they rarely need it while seventy-year-olds require constant medical- especially if they’ve had little or poor health care while they were younger. If you can keep the twenty-year-olds in the health care pool- then the cost goes down for everyone else.
Second: “It requires that everybody get preventive care.”
It is MUCH cheaper to prevent major medical problems than it is to treat them once they hit. Under the Edwards Plan “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”
If he keeps up like this, I might actually be able to look past his accent. Maybe.
Commentary
1. It turns out that the complete healthcare plan Edwards supports apparently allows folks to opt out of the program if they wish to manage their own healthcare without government mandates. This discovery disappoints me; when I read about the Tipton speech, I envisioned a post about Edwards declaring Patient Compliance “Mission Accomplished.” Then, I would go on to sardonically observe that “the answer to noncompliance was right in front of us – just issue a presidential proclamation that compliance was obligatory. And so on. If folks have the alternative of leaving the system, the obligatory preventive care lacks the extremity of arrogance that would otherwise render this notion an appealing target.
2. Few bloggers noted that we already have a batch of healthcare mandates on the books, including reporting and quarantine of various infectious diseases, undergoing certain vaccinations, obligating parents to follow doctor’s orders re their sick children, lest they be made wards of the state, and, more recently, restrictions on smoking and intake of some foods.
3. I have to wonder if Mr. Edwards and his advisers have considered the difficulty of monitoring, let alone enforcing patient compliance. While checking attendance records to determine who kept and didn’t keep a doctor’s appointment seems simple enough (although distinguishing between appointments missed because of traffic, scheduling snafus, and family emergencies from those missed through noncompliance may require compliance interrogations abetted by bright lights, good copy-bad cop tactics, and polygraphs), medication compliance, for example, is notoriously difficult to determine, and adherence to diet, exercise, and similar non-medication prescriptions is rarely even attempted. Enforcement methods, short of the Pill Police, are relatively easy to come by; e.g., dropping healthcare coverage for noncompliant patients or tying official authorizations such as driver’s licenses to certificates of healthcare compliance would be simple enough, but even a compliance-pusher like me recognizes that this would be a major shift in the patient-clinician relationship as well as in the role of government in this country.