HEALTH :: APRIL 21, 2004

The Band-Aid administration: Bush and health care

The political gurus promise us that health care is going to be a big factor in this year’s presidential election. Two commentaries that appeared in the media at nearly the same time paint a petty grim picture of what we can expect if the present administration is returned to office in November. Between them the two case studies illustrate the creative use of Band-Aids.

Exhibit A is a column by Paul Krugman in The New York Times Feb. 17. He charges that the Economic Report of the President, released the previous week, “shows a remarkable indifference to the concerns of ordinary Americans” in its discussion of health care.

Take the problem of lacking health insurance. Most of us think that this would leave us in a pretty vulnerable and uncertain state, and the medical literature is full of reports that show that the uninsured get worse care and suffer worse health outcomes compared to the insured.

But the president says not to worry about this. “The uninsured are a diverse and perpetually changing group.” If I am uninsured for the first six months of the year and you are uninsured for the last six months of the year, no problem. Each of us simply needs to schedule our broken leg during the six months we happen to be covered.

Krugman’s take on this is that any serious discussion of the problem of the uninsured would look at why the United States spends so much more than every other country on health care, and why what we get in exchange is more than 40 million uninsured, plus a life expectancy that is way behind many other developed countries. That would lead to a discussion of why so much in the United States is spent, for example, on insurance company overhead and the high cost of prescription drugs. But asking those questions would be too threatening to corporate interests who contribute heavily to Republicans.

Exhibit B has to do with a concern in Congress about mounting evidence that there’s a serious racial disparity in health care in the United States – that black and Hispanic citizens routinely get less good care and routinely have more serious adverse health consequences. Congress asked a panel of the National Academy of Sciences to look into this problem. The panel reviewed the medical facts and wrote a report that said this was a real and serious problem. The report then went to the Department of Health and Human Services, which was supposed to publish the findings.

Instead, out came the Band-Aids. DHHS decided that this report looked too grim, so somebody rewrote it. The rewritten report stated that there really was no good evidence to show that blacks and Hispanics ended up worse off. Instead of listing all the problems, the editor inserted a few success stories to show that things were looking up. (The actual report held that virtually no real progress had been made in addressing this issue.)

Once the press got wind of the actual contents of the original report, DHHS Secretary Tommy Thompson said it was all a big mistake – underlings in his department decided to rewrite the report without his instructions or permission, thinking they were doing a good deed. B. Gregg Bloche, a member of the original research panel writing in the Los Angeles Times on Feb. 15) begged to differ: “According to ... internal correspondence, Thompson twice refused to approve versions containing the findings on racial disparities in health care.... Rewrites were ordered in July and again last fall.”

This Band-Aid act was too much even for a loyal Republican like Sen. Majority Leader Bill Frist, a surgeon. In February, he announced legislation to deal with the racial disparities in health car, that the DHHS said it could not find any evidence of.

Bloche’s take fits nicely with Krugman’s when he quotes Bush as saying, “Good health is an individual responsibility.” We should not worry whether we have insurance; if we are unhealthy, we can’t blame the insurance company. And we don’t want to hear evidence that says that whole classes of people suffer from inferior health care in the United States, because we want to be able to blame them one at a time if they die or end up with strokes and diabetes. So take full responsibility for your own health, and just keep on forking over large chunks of your income to corporate interests that contribute to the President’s re-election campaign.

Krugman offered the prediction that a smart Democratic presidential candidate could make something of this Band-Aid record of the Bush administration in the fall. Now, why on earth would he think that?

Howard Brody, MD, teaches family practice and medical ethics at Michigan State University. You can reach him at brody@msu.edu.

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