Where to Start?!

by Allen Kolmes

OK, so we spent the last two posts bitchslapping the opposition. Fun!!! I can see why Rush enjoys coming to work every day.

For many blogs, that would be time to call it a day, move on to the next discussion.

But not at Epic! No sir. We will actually be dipping our toe in the pool of Constructive Debate.
Don't yawn--we'll still be dissing the naysayers, the pawns in the corporate chess game, the clingers to beliefs of convenience. But at the same time, we will also strive to be persuasive paragons of positivity.

So where to start? Need to select a topic. How about the hard one. The really reallty hard one. The really f&%$ing hard one.

Cost control.

This topic is so fraught that Rush's show is practically writing itself, and will continue to do so until he heads off into that great Oxycontin dispensary in the sky.

We have two fundamental choices to make.

Option A is attempting to control costs. While there are various places within the healthcare budget where costs can be trimmed (insurance company executive compensation comes immediately to mind), the major driver of healthcare inflation is and will continue to be increased utilization of services. So, cost control means controlling utilization which means decreasing utilization which means we can't give everybody every medical service possible.

Option B consists of providing everybody (or even not everybody, as in the current situtation, just most people) all the medical services they could ever want, need, or are told they need, and accept that eventually half our nation's income will go to that end.

Option A or option B--these are the only two possible choices. And they are mutually exclusive. For those who fail to recognize this fact (I mean you, Michael Steele and Rush Limbaugh and Sean Hannity)--your opinions can be safely ignored.

If you haven't guessed yet, this column is going to come down in favor of option A. When the choice is put this way--and I think I have expressed it an honest and straightforward manner--nearly everybody would choose option A, except, recently, for right-wing radio talk show hosts, which is really weird.

So the consensus choice being Option A, the debate needs to be about how we go about it. Do we leave it up to government? Do we leave it up to the insurance industry? Do we sponsor comparative effectiveness research? Do we push for preventive care? Do we create Death Panels (haven't ruled them out!)?

This conversation needs desperately to begin. And those whose immediate response to the initiation of this discussion is "you're pulling the plug on Grandma" are doing the country a grave disservice.

And we need to recognize that the conversation is going to be a difficult one to have, one of the most difficult we have ever engaged in.

So difficult, in fact, that I'm going to call it a night, having only offered up rules of engagement.
But more to come.