Letters to the Editor

Wednesday, September 2, 2009 at 7:01pm

Nothing for what ills us

It is very difficult for me to understand what possible relevance the article by Reps. Marsha Blackburn and Phil Roe [TennCare Lessons for Health Care Reform, July 27] has to the pending national debate, except for allowing them to experience once again the joy of bashing TennCare.

There is not one positive or constructive suggestion in the entire article, and in fact the only subject that seems to interest them,  pro or con, is the possibility of a government-run health care option. The merits or demerits of this part of (some) health reform packages cannot be evaluated without an analysis of the need for reform, and for this particular component, in the context of the total package in which it is included.

Instead, the authors content themselves with a misleading and inaccurate summary of TennCare's sad history, on the apparent assumption that if TennCare was bad, then the new reform proposal (they do not say which one) must be worse even though the two have nothing to do with each other.

Blackburn and Roe characterize TennCare as "universal single payer care" and President Barack Obama's goal as "universal care," thus establishing (in their minds) that if two things sound alike they must be alike. But TennCare was not "universal," even within the small "universe" of Tennessee, and it certainly was not intended to be "single payer." Rather it was intended to lower costs and expand coverage through managed care exercised by various qualified provider organizations in competition with each other.  

But many of the providers were not qualified, there was little or no management of the care provided, and by the end any real semblance of competition had been  eliminated while virtually all risk was assumed by the State. So of course TennCare didn't work —because it was never properly implemented.

If it is true, as the authors charge, that patients with nothing more than a cold incurred high costs for doctor visits and medication when they should have just taken an over-the counter remedy, then true managed care was not occurring or these unnecessary expenditures would not have been authorized or reimbursed. 

On the other hand, of course, if people are really ill, then it is more economical (and patients are better off) if they do see a doctor instead of treating themselves and eventually winding up in an emergency room which is the most expensive option of all.

A final point:  TennCare alone simply cannot be blamed for "forcing" the then-Governor into proposing an income tax to bolster the State's chronically inadequate and unfair system for raising needed revenues.  I have read articles and papers dating back to at least the 1930s that say Tennessee's revenue structure needed to be revised so that it did not rely so heavily on an ever-increasing sales tax.  

Governor Phil Bredesen's unwillingness to acknowledge the obvious need for tax reform — along with his refusal to use the State's "rainy day" and reserve funds to help the poor and ailing — are the things that "forced" him to remove some 200,000 of our most vulnerable citizens from the protection of TennCare, thus eliminating the program in all but name. Tennessee being Tennessee, we will probably never know what happened to these people, but if we did the Governor's actions would forever stain his legacy and the reputation of the entire state.

As it is, the people cast out by Governor Bredesen are a large component of the the group which needs health care reform the most, whether through some sort of government-run plan or otherwise. People with no health coverage probably will not mind if a "government bureaucrat" is involved in the process that provides them with necessary care and treatment.  

The bugaboo that the new health care system will put another person "in the exam room" with the patient and his or her doctor should not frighten anyone anyway, since all but the most lavish current plans already place limits on costs and availability of certain procedures and require prior authorization for much if not all of the treatment provided.  

Like most opponents of reform, Blackburn and Roe give lip service to "affordable basic health care for all Americans," but they say that "creating a plan like TennCare is not the right answer." It would be more correct to say that creating a plan like TennCare is not the right question.  The question is how to meet the health care needs of all Americans, and on this subject Blackburn and Roe have nothing to offer.

Michael S. Lottman, 37082

Send comments via e-mail to letters@nashvillecitypaper.com

65 Comments on this post:

By: brrrrk on 9/3/09 at 1:58

You know chief, I know it makes you all warm and fuzzy inside to beat up on the UK's NHS but there's one thing you consistently leave out.... the fact that over the years, the NHS (thanks to the influence of Thatcherism) has become more and more privatized.

By: slacker on 9/3/09 at 2:12

Hey gdiafante, haven't imbibed yet, but will at kickoff.
I thought you were a student of history, you know that's all correct.

By: gdiafante on 9/3/09 at 2:15

I just turned down free tickets to the game tonight...

By: slacker on 9/3/09 at 2:18

Don't blame you, its not worth going up there for this deal.

By: brrrrk on 9/3/09 at 2:18

gdiafante, I'd turn down tickets to see the Vince Young show too. Who needs the aggravation.

By: dargent7 on 9/3/09 at 2:52

gd: I agree. Any "Herman Hermits" trivia?
For Christ's sake, if I have a "terminal illness", no chance of living,....well, come to think of it, it sounds like living here in Nashville. Maybe I'm actually dead and don't know it yet?

By: house_of_pain on 9/3/09 at 3:01

slacker, what, no tailgating?
As long as you're within 3 hours of kickoff, it's not considered "getting hammered".

By: gdiafante on 9/3/09 at 3:07

I'll go ahead and call the game...Packers 56 Titans -3. Jeff Fisher's mustache will get ejected when whining about a punt hitting a gust of wind.

By: shenanigan on 9/3/09 at 3:10

We the Americans public is proud of our government they are no liars in our government sence Bill Clinton so believe the Christian right and no one it that party has ever thought of lying to the American public,. look at all those WMD,and at any time we could have less than 45 min to live from those WMD.9 this stuff getting knee deep) the right have called on our fellow country men to go to war more than any other country in the last 100 years and when johnny and suize came home we have open our arms and provide him with the best health system in the world. as long as they got the money and can pay fot it.
We are proud that we give none of our taxpayers a health plan after all those other 17 countries in the industrial world give all of there citizens a health benefits,that should be easy one to figure out why . They simple do not go to war as often as we do. If that Bush had not rejected Cheney insistance on invading Iran we would have another good one going lets hope this is not to become habit forming,, just to think the World could loose if fear of the warmornger American has.

By: house_of_pain on 9/3/09 at 3:15

Tonight's game is of little importance. I'll watch the 1st quarter.
Next week is gonna rock. My calendar year officially begins.

By: dargent7 on 9/3/09 at 3:16

I think "Shenanigan" is onto something...WTF it is I have NO idea.
Note to all you celestial observers out there: The FULL MOON is tomorrow...12:06pm, Tenn. time. Tomorrows "board" should be really great.

By: dargent7 on 9/3/09 at 3:40

d'Pain: Steelers 31...Titans 12. End of story.

By: slacker on 9/3/09 at 3:42

Jeff Fishers sunglasses successfully negotiated a 2 mil. raise with Bud.

By: house_of_pain on 9/3/09 at 3:47

Two words: paper champions.

By: Loner on 9/4/09 at 8:09

Hmmmm...Friday morning and we still have Thursday's paper....no posts yet...is the NCP dying? Clint Brewer put such a hurting on this paper that it may never recover, yet some rightwing think tank has hired that dude. Hopefully he will bring them down to ruin as well.