An interesting linguistic anomaly is the idiomatic expression. Idioms are defined as a group of words whose definition — when taken together — is quite different than the meaning of the individual words themselves. We may refer to someone as “feather brained” or “hopping mad.” Though there are neither feathers nor hopping involved, we gain a more colorful understanding of someone who is not too smart or who is really ticked off.
Such is the case with the phrase “The chickens are coming home to roost.” There are no chickens involved, of course. We use this idiomatic expression to indicate that today we are experiencing the consequences of earlier decisions. In some sense, this phrase seems to have become a set of bookends for health care in the United States.
Many of the most important medical innovations and techniques used today have been invented or pioneered in this country. For years, those achievements attracted the most forward-thinking researchers and medical pioneers, all seeking to expand the future based on the promise of the present. The free market system worked well; it rewarded risk takers and penalized ideas that didn’t work. Universities vied for top talent by encouraging research and innovation. They created research centers that served a dual purpose: to raise the bar on today’s innovations and to mentor tomorrow’s scientists.
In 2003, U.S. research and development expenditures were estimated at $95 billion. In 2006, fueled by this capital investment, the United States led the world in medical innovation, whether measured in terms of revenue or the sheer number of drugs and devices introduced. The United States represented three-fourths of the world’s biotech revenues and 82% of the R&D spending in biotechnology. While none of us care for the high cost of patent drugs, those dollars helped this country maintain a position as a leader in medical advances.
Hospitals and famous clinics, such as Mayo, Cleveland and others, built world-class reputations on the tide of all of that innovation and invention. Even today, in a world where medical tourism usually connotes Americans going abroad, foreigners seek out care in our country. Earlier this year, the administration approved a visit by Yemeni president Ali Abdullah Saleh, so he could receive medical treatment here. Saleh had suffered serious injuries in a June attack on his palace in the country’s capital of Sanaa.
This practice is not confined to world leaders. According to a 2008 report by McKinsey & Co., 60,000 to 85,000 medical tourists traveled to the United States for in-patient medical care. There is enough demand for such services that Kinsey notes that several major medical centers and teaching hospitals have patient centers in other countries to serve patients who want treatment in the United States.
Yet, today, there are chickens of another variety coming home to roost. In February, the Catholic church was broadsided by the administration’s dictum that all manner of reproductive services must be provided by employers under PPACA. The church was adamant that this was an intrusion on one of its core principals as well as a violation of the First Amendment to the U.S. Constitution, which prohibits the government from impeding the free exercise of religion.
At the time of this writing, the administration’s tortuously nuanced “accommodation” (these services will be made available through the insurance company rather than through the employer directly) is being viewed by many in the religious community as a distinction without a difference. It also neglects to account for the many larger, self-insured plans where the insurance company or third-party administrator merely processes claims that are directly funded by the employer.
White House Chief of Staff Jack Lew, appearing on “Fox News Sunday” on Feb. 12, said, “I think what the president announced on Friday is a balanced approach that meets the concerns raised both in terms of access to health care and in terms of protecting religious liberties. And, you know, we think that’s the right approach.”
The White House (and to be fair, a significant number of other Americans) believes that somewhere after that First Amendment, there is a subsequent amendment that confers a right to these services for women. As Lew told Fox News’ Chris Wallace, “But let’s just be clear: every woman has a right to access all forms of preventive health, including contraception.” That’s about as unambiguous a statement as has ever been made by anyone in or around the periphery of politics.
You have to admire their consistency, though. First, they convinced themselves (and more than half of the U.S. Congress) that we have a right to health care writ large. Anything they think should be provided by government is now a right. The applicable idiomatic expression is that when it comes to actual rights, they appear to be deaf as a post.
Whether or not American women should have access to these services is not the point. What is very much the point is that, as the Wall Street Journal wrote on Feb. 8, “The country is being exposed to the raw political control that is the core of the Obama health care plan, and Americans are seeing clearly for the first time how this will violate pluralism and liberty.” What the law does, they continue, “is cement the principle that the government will decide for everyone what ‘health care’ must mean. The entire thrust of ObamaCare is to standardize benefits and how they must be paid for and provided, regardless of individual choices or ethical convictions.”
The Journal’s opinion, while harsh, does reflect basic economic principles. The government may seem to have magical powers, conjuring dollars out of the pockets of its citizens, yet the immutable fact is that no government can simultaneously cut $575 billion from Medicare while serving 78 million new enrollees while telling insurance companies that they must provide greater benefits while holding premiums steady. Something, somewhere, has to give.
In that same appearance on Fox, Wallace asked Lew, “The question — where does the president get the power to tell a private company they have to offer a product and offer it for free?” Lew’s reply: “Well Chris, just to be clear — the president has the authority under the Affordable Care Act to have these kinds of rules take effect.”
This month, the U.S. Supreme Court will hear arguments surrounding the constitutionality of the Patient Protection and Affordable Care Act. Unless the justices vitiate the law, we may be heading for more confrontations between those wishing to emulate a Western European-style social democracy and those who wish to return to the days when American health care was being forged into the best in the world.
As we have written before, there are true systemic issues that need to be solved to make the health care system in this country more efficient and more effective. More and more, few believe that PPACA will do that without requiring the government to be the authority of last resort.
Either way, an idiomatic expression from my Cuban friends in Miami is on point about the inevitable fight over this contradiction: dos narices grandes no se pueden besar, or two big noses cannot kiss.