[Editor's Note: Just wanted to thank nick rohrhoff for his contribution. -nrb]
All indications from Washington are that the 111th Congress will soon take up healthcare reform.? To that notion, I submit this: with whom?? The mistake our elected representatives are making may be a result of the healthcare decision making process.? It is, after all, bicameral.? Sort of.? Healthcare decisions are made by patients and doctors.
The dynamics of the doctor-patient relationship are powerful and have deep meaning to both parties.? American doctors are well-trained professionals – fluent in the medical sciences and intimately familiar with the psychology of illness and wellness – constantly refining the art of empathy.? For most of us, medicine is not a career – it is a calling.? We dedicate our entire lives to pursuing the health of our patients.? We are jubilant in triumph and devastated in failure – grateful for the opportunity to be involved so intimately in the lives of our patients.? Our patients are people: CEOs and bus drivers, teachers and members of Congress, mothers and daughters, brothers and sisters, you and me.? Some are unlucky, some are reckless, all are in need of the care we are dedicated to provide.
The bicameral relationship that should be in focus is not of Republicans and Democrats but of doctors and patients.
During his abbreviated tenure as Secretary-designate Daschle, the former South Dakota Senator encouraged Americans to participate in healthcare community discussions.? This gesture showcased the keen understand that the Obama administration has regarding the failure of healthcare reform under Bill Clinton.? The people most likely to resist change are those who aren?t necessarily satisfied with the status quo but frightened that they would benefit less from the implementation of a new system.? Was that the end of our participation in the process?
Our input notwithstanding, the outline of this new system was revealed in the American Recovery and Reinvestment Act which set aside $1.1 billion dollars for comparative effectiveness research.? All physicians echo the Administration?s desire for direct comparison between medicines and treatment modalities.? Doctors want to know the most effective treatment for their patients so they can provide the best care possible.
However, the companion to efficacy research is the determination of which treatments and medicines are ?cost-effective?.? The model for this is the UK where it is done using a complex economic calculation to estimate the years and quality that a treatment would add to a patient?s life.? Dr. Meir Pugatch and Francesca Ficai of the Stockholm Network identify the potential conflict, ?Thus a decision to prioritize a less therapeutically effective medicine because of cost-based considerations over an effective, but more expensive, medicine could lead to some serious political, social and moral dilemmas.?? No kidding.
Are we ready to deny a dying patient effective treatment because bureaucrats in Washington decide it isn?t ?cost-effective??? ?This is exactly what happened in the UK last August with Sutent, a drug for kidney cancer.? The UK even acknowledged the drug?s effectiveness when they announced they would not cover it.? The panel of 10 bureaucrats who made that decision included only one doctor and no patients.? What information was provided by the other 9 panelists?
Healthcare reform is popular with the public.? We are paying too much and too many of us are uninsured.? But before we act for the sake of acting, we need to carefully examine the consequences of interfering with the doctor-patient relationship.? Elected representatives in this country are signaling that they may be ready to put a price on a human life – I suspect doctors and patients are not.? All healthcare decisions stem from the interaction between patients in need and physicians trained and dedicated to treat them.? The House and Senate should be taking up healthcare reform with us – not each other.
In the past few years, U.S. leaders ignored the growing grumble of drug related violence in Mexico because they were too focused on the stability of Middle Eastern states.? Foreign policy goals must be prioritized logically, in order of which states have the closest regional proximity and strongest economic ties.? The U.S. – Mexican border expands nearly 2,000 miles and the economic relationship between the two states is beyond vital; Mexico is the United States third largest trading partner.? Prioritization of Middle Eastern oil resources has left the United States vulnerable to serious problems festering over the border.? Mexican problems become American problems when cartels are operating out of our cities, spreading violence to small towns and large metropolis areas alike.? I outlined this clearly in an August?op-ed in The Washington Times, which apparently fell on deaf ears.? Now what do we do?
The working relationship is difficult to approach because the U.S. and Mexico have a long standing and productive alliance, one that has warranted their country to be considered part of NORTHCOM instead of SOUTHCOM in the eyes of the U.S. military.? This distinction gives Mexico a visual superiority over Latin American states because of the mutually beneficial diplomatic relationship which must be maintained at all costs.? Some have raised the notion of mobilizing the National Guard to the border, something that many of the border-state Governors support (not surprisingly, because it is a huge increase in their power).? While adding the National Guard to the border could help in the event of a very serious emergency, militarizing the Mexican border has serious diplomatic side effects that make it a very unattractive option.
Illegal immigration and narco-trafficking is a law enforcement issue and must be dealt with by CBP and ICE, both of which are doing an increasingly effective job at it over the past 7 years.? We can quell the problem by continually supporting both of those agencies while acknowledging the American end of the problem: demand for drugs and the supplying of weapons.? The shared responsibility that Hillary Clinton recently acknowledged has been missing in the past and is necessary for progress in the U.S.-Mexican relationship.? Addressing the problem on our end will be more effective in the long run than pretending to have the capability of securing such an expansive border completely and crushing the supply of drugs from Mexico.
We must support the Mexican government so that they can fight it on their end.? The challenge in combating the cartels with the legitimate Mexican government is that cartel members have infiltrated most levels of the very forces which exist to fight them.? Simply throwing money at the problem with the Merida Initiative will not fix it.? We must support trusted and dedicated leaders to rebuild Mexico and its leadership strategically, while showing their citizens and loyal sovereign leaders the respect they deserve.