Leadership and Crisis (23 page)

Now imagine you are in my place again, standing in that room in Boston Children’s Hospital with your little son in your arms and the anesthesiologist standing by to take him through those doors past the point of no return. Only this time, you didn’t get the surgeon you wanted; after your painstaking work to find the best surgeon and the best treatment, your choices were denied by some far-away bureaucrat.

Let’s be clear. Government intrusion into the healthcare system creates this scenario every day. When federal or state bureaucrats who
control Medicare and Medicaid determine the rates they pay to providers based on politics, lobbyists, and federal or state-wide budgets rather than on real market-driven principles, it creates shortages of doctors who will treat those patients.

Under the Democrats’ healthcare “reform,” government intrusion is set to grow much worse.

Look at the much-vaunted Medicaid system, which will add around 16 million people under President Obama’s healthcare reform. Even now, before this huge expansion, getting a doctor is so difficult that many people simply opt to get treated in an emergency room. One example we saw was a grandmother caring for a young, autistic child. The woman, a Medicaid recipient, was struck with a brain tumor. Yet no specialists would take new Medicaid patients. Her primary care doctor told her to drive three hours to another city and go to the public hospital emergency department, tell them she has a brain tumor, and get them to find a doctor for her. In light of these kinds of horrifying situations, we are implementing some of the most sweeping reforms of our Medicaid system in Louisiana’s history.

The single most important question in healthcare is often overlooked: who do we want controlling our healthcare decisions—patients and their doctors, insurance middle-men, or government bureaucrats?

I’m passionate about healthcare because, for me, it’s personal. Before Shaan became ill, I had begun to devote my professional life to healthcare issues, having served as secretary of Health and Hospitals in Louisiana, executive director of the National Bipartisan Commission on the Future of Medicare, and as an assistant secretary of the U.S. Department of Health and Human Services. I had studied healthcare policy in both America and around the world. But no book,
study, or commission can replace the firsthand experience that comes with encountering the system yourself for your own child’s sake.

I believe everyone has a right to affordable healthcare. We are all created in God’s image, and that makes us valuable, independent of our economic worth or the contributions we make to the economy. It is a question of human dignity granted to us by our Creator.

But with equal passion I believe this goal cannot be achieved through a government-run system. Government healthcare is top-down: decisions are politicized and are indifferent to the needs of individuals. Medicare and Medicaid have proven that when there is no free marketplace with transparency and consumer engagement, we get an inflexible system that wastes money, reduces choices, and produces poor outcomes. In 2009, the federal government admits around $50 billion was wasted simply on improper payments in Medicare alone.
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When government sets prices, shortages result. Consider that in the next twenty years, the number of Americans over the age of fifty-five will double, while at the same time there is a projected shortage of more than 125,000 doctors by 2025. More doctors are already refusing to accept Medicare, and the Medicaid program is imperiled even before it enrolls millions of new patients under Obamacare.

In a government-run system, choices, either directly or indirectly, are made
for
you without your consent. America is built on choice—where we live, what we eat, what we drive, and with whom we associate. Yet oddly, when it comes to healthcare, choice is usually an afterthought. Disagree? Go online and try to find out which physicians have the best outcomes. It’s nearly impossible to find that information. If choice were paramount in our system, those data would be readily available and the public would be demanding it. But instead, we have a system where we are told what we need and expected to comply.

My view is pretty straightforward: the more important the decision, the more important it is that you have choices. This goes for the poor as well as the rich. Poor people have few healthcare choices: typically, they either get Medicaid or nothing. The poor are often criticized for neglecting their healthcare, but this is the natural result when people are automatically relegated to a poorly functioning, top-down healthcare program with few choices.

Some supporters of government-run healthcare seem to believe the poor need this kind of command and control healthcare structure because they can’t be expected to be responsible for their own care. I disagree. Poor people are poor, not stupid. In my experience in public policy, a poor woman, just like anyone else, will responsibly care for herself and her children whenever she has plenty of choices and easy access to information. I certainly trust a mom to do the right thing more than I trust a nameless, faceless bureaucrat.

There is also the question of proximity—both physical and emotional—in making decisions. The best decisions are made when the decision-maker is close enough to the problem to understand it and has a strong, personal stake in getting it fixed. But when the decision-maker is an insurance or government bureaucrat too far removed from the situation to feel the full weight of responsibility, you can bet you won’t get the compassion of a father or mother fighting for their son’s life.

Without a doubt, our lifestyle choices are the primary driving factor behind the overall poor state of health in America. But the answer is not a government diktat, which can never replace the sound judgment of an educated consumer. And not only is government control ineffective, it’s un-American. People just don’t want the government to tell them how to live their lives. I work out at the gym, but I also
eat chocolate chip cookies and the occasional McDonald’s hamburger. My health would be better off without the cookies and burgers, but it’s my choice and my right to eat them.

The government’s role should center on providing market-based incentives for sound healthcare management, especially for children. That has been the focus of my reforms in Louisiana to ensure parents get well-child checkups for their children and that people with diabetes get their blood sugar tested regularly. We also provided market-based incentives to physicians to improve immunization rates for children, which resulted in our rates jumping from 44th in the nation to 2nd, according to the Centers for Disease Control.

I’m amazed by the envy some Americans feel toward the health systems in other countries—systems that supposedly function for the overall social good, but often at a great cost to the individual. Great Britain, which has a centrally run National Health Service (NHS), is plagued with shortages and long waiting periods. British newspapers are filled with stories about babies being delivered in hospital bathrooms, parking lots, and in hallways due to a lack of nurses or beds. Individuals who need simple operations, such as for cataract surgery, have to wait years for the procedure; some have even gone blind waiting for this fifteen- to twenty-minute operation.
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The waiting list to see a dentist in Britain is so long that thousands of people resort to do-it-yourself dentistry. George Daulat of Scarborough, England, for example, contacted twenty public NHS dentist offices to have four painful teeth removed. After they all put him on a waiting list, he was forced to pull them out with pliers, using vodka to dull the pain. Don Wilson of Kent, used fishing disgorgers—the tool used to get a hook out of the back of a fish’s mouth—to pull his painful teeth. Some have attached their own crowns using superglue.
The British government estimates more than 2 million people who want treatment for mouth ailments can’t get a dentist.
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In Canada, the shortage of doctors is so severe that some doctors have held lotteries to reduce their caseload. Canadians who have been diagnosed with brain tumors need to wait up to eight months to be treated. A woman in Winnipeg with clogged arteries was put on a three-year waiting list for surgery. She died before the surgery was performed. “This tragedy could have been avoided,” her son told one newspaper. “My mother trusted the system with her life, it failed her.”
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When Canadian Karen Jepp was pregnant with quadruplets, there wasn’t one hospital in Canada with space in its neonatal unit to treat four premature babies together. She ended up being treated in Great Falls, Montana.
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Similarly, a four-year-old child in Canada was diagnosed with cancer, but when doctors wanted to check if it had spread, they faced a two-and-a-half year wait for a simple MRI scan. This is not unusual in Canada—the average wait there for an MRI scan is sixteen months.
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A Slavic immigrant living in Ontario was diagnosed with a cancerous lesion and was told he would have to wait more than fourteen weeks for surgery. He chose instead to return to his homeland to have the procedure done there within the week. “I felt very bad,” he said. “I couldn’t believe that in a rich country, you had to wait so long.”
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Anecdotes, yes. But when you see them over and over again, you begin to wonder whether this is the direction in which our own healthcare system should be going. Government-run healthcare seems free, but it’s not—it’s rationed care paid for by taxpayers. Yet Obamacare will expand bureaucratic, government-run programs like Medicaid without reforming them to make room for market mechanisms.

The Left touts the expansion of Medicaid as a way to increase “access” to healthcare, but coverage in a failed system does not equate
to access. Consider that even though Louisiana has led the nation with a 95 percent “coverage” rate for children, the majority of children in our Medicaid program still do not receive well-child checkups. Fewer than 5 percent of covered adults had a preventive visit to a doctor. These people have “coverage,” but they still don’t access the system. To fix this problem, we are overhauling our entire Medicaid program in order to ensure real healthcare access, not just access on paper. The Obama administration, unfortunately, has chosen a different course.

We should closely study foreign healthcare systems—despite their many flaws, we can still learn from the things they do well. But America offers far better treatment and has much faster innovation than any other system. There is a reason foreign monarchs, politicians, and other elites, including the sitting premier of a Canadian province,
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still come from around the world to receive medical care in America. America’s healthcare system needs reform, as discussed below. But that should not obscure the fact that at its best, American healthcare is the world’s greatest.

But sometimes, even in the best of circumstances, the system is out of reach. That was the case during the birth of our third child. Our first two kids were born without much difficulty—at least for me. Like most men, I neither comprehend nor can imagine the pain of childbirth.

Childbirth has never been easy for Supriya. I suppose any woman would respond, “No, duh.” When Selia, our first child, decided she was coming into the world, Supriya beeped me on my pager. When I found a landline she told me, “I’m on my way to the hospital. They say I’m in labor. Come home now.” I responded with perhaps the dumbest thing I’ve said in my marriage: “Are you sure you are in
labor?” I’ll leave it to your imagination how the rest of that conversation went. Thankfully, God gave us a beautiful, healthy daughter after thirty-six hours of labor and the gift of having us be together to welcome her into the world.

Our second child, Shaan, took twenty-four hours. In both these instances my job was pretty simple: let the doctor and the nurses do their work and don’t take any inappropriate pictures. However, the birth of our third child, Slade, was a little different. He only took thirty minutes, but the process was ... unusual.

Supriya went to bed that night with stomach pains, but she said she was fine. After all, she had already been to the hospital with false labor twice in the past week, and she had seen her doctor earlier in the day. But she woke me up that night and told me, “My stomach’s hurting. This isn’t right.” We quickly grabbed our clothes from the closet, and I called her parents to come watch the other two kids. But in an instant, Supriya went into full labor.

I called 911 for an ambulance and gave them all our information. I was a congressman at the time, and when the dispatcher heard my name he started laughing. He thought it was a prank call.

Supriya started screaming in pain. She had opted for the epidural route in both her previous pregnancies, thinking, “God, if you wanted me to do this naturally, you wouldn’t have made drugs.” She told our doctor before the birth of our first child, “I want the epidural in the parking lot. Is that clear?”