"All that is old and already formed can continue to live only if it allows within itself the conditions of a new beginning."
On the Lamm: Thoughts on Universal Health Care
Posted 8:45 p.m., July 15, 2004
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What follows is something of an "outtake" of an interview I did this week with former Colorado Gov. Richard Lamm. The one-time Democratic governor, who was under consideration for a presidential run with the Reform Party in 1996--before Ross Perot determined the party was his personal property--has had a lot to say on the issue of healthcare over the years.
Our chat veered into the realm of universal, single-payer medical insurance for all U.S. citizens--an idea Lamm supports. Below, I present an edited Q&A with the governor, who is now co-director of the Institute for Public Policy Studies at the University of Denver.
While still a potential candidate in '96, Lamm gave several interviews with both hands firmly wrapped around the third rail of American politics--he pitched cuts to Social Security and Medicare totaling 10 times the spending cuts instituted by President Clinton. (While also pointing out that in 1996 there were 600,000 millionaires receiving Social Security checks.)
But taking from the rich, he said then, would not be enough. Sacrifices would have to be shared by everyone if the U.S., as he put it, is to leave its children a decent society.
The people that have more money, it seems to me, should put their shoulder to the wheel more. But I do think there should be some sort of equality of sacrifice. I have an offend-everybody-a-little-bit program, where I think everybody is going to have to take a little bit of a cut.
-- Richard Lamm, "The NewsHour With Jim Lehrer," June 10, 1996
Lamm hasn't really changed his tune on the theme of shared sacrifice--and in the intervening years he has often sounded off on a plan to institute single-payer, universal healthcare coverage for the United States. That is, healthcare financed--though not delivered--by the U.S. government. But only with the tacit acknowledgement that such a benefit would require care rationing as part of the bargain.
As the governor told me: "The cost of compassion is restriction."
Q&A: Lamm Talks to the Kevblog
The Kevblog: You have espoused a single-payer healthcare system. Do you still support that? Under what conditions?
Lamm: I believe that [universal healthcare] is the next step of reform. And then the question, and the one that you're asking is under what conditions. Would the U.S. find it tolerable?
Look, there's nothing magic around nonprofits anymore, because I look at the excess of nonprofit hospitals in the Denver metropolitan area. That's one of the dilemmas of having government run things.
I think there is a surplus generally of hospitals in the United States and that's cardiologists and all kinds of other things. And it seemed to me 10 years ago that the market was by far the best way to close some of the superfluous hospitals that we have. And also, if everybody would use cardiologists the same way that Kaiser uses cardiologists, we could do away with half of them.
So I'm tired of seeing million-dollar atriums in nonprofit hospitals. Or a nonprofit hospital right next to a nonprofit hospital, each of them 50 percent empty. It's lost the glamour for me to say that nonprofit is wonderful.
The Kevblog: The usual complaint is: "I don't trust the government to handle my healthcare." But that's usually said by people only too happy to receive their Medicare checks when the time comes. What's your view on that?
Lamm: Government is not very good at closing things--look at military bases. If we did get into a single-payer system, will it be able to make the hard decisions that the managed care people at least made better? At least the market can close superfluous institutions and increase the efficiency. And so this is what makes me schizophrenic.
The Kevblog: So when you're talking about the government, you're talking about whether policymakers have the stomach to buck the public outcry, even if to do so is to make a decision that is in the public's better long-term interest?
Lamm: Sure. To me, universal healthcare is a two-front war. You've got to convince the conservatives among us that we should cover everyone among with basic healthcare. That's the known one. To me, I find it just as hard, or maybe even harder, to convince the liberals that you can't do everything for everybody, that you have to set some limits.
I'm just desperately afraid, under a single-payer system that can't say no, that we're going crowd out everything else that we do in society. And of course, I'm not that big a fan that healthcare is the best way to help. I think that some of the marginal things that we're doing in healthcare are absolutely absurd in comparison to the things that we have to do to leave our kids a decent society.
So when you run a universal system in England, that comes in after a whole period of rationing after the Second World War and everything else, where everything was a bonus because it was so much better than the nothing that was before that.
But you get a universal healthcare system in America, and I fear that the expectations would drive it with the political system, it would continue to grow and grow and grow.
The fact is we spend 15 percent or almost 15 percent of our [gross domestic product] on healthcare and we're not any healthier, or less healthy, than some of the other countries that spend far less. And so I keep asking myself: OK, I'm for universal healthcare? Yes. But only if there is some [mechanism] of being able to set limits.
The Kevblog: And rationing is not just an inevitability, it's a necessity?
Lamm: Absolutely. And the question is who do we treat? We had a woman fly in here from Tanzania the other day and presented herself at Denver Health and Hospitals and wanted a transplant. And when you see a face like that and the newspapers and everything else get hold of it and everything else, how can we say no? Because we're all God's children. Part of you and I say, yes, OK.
Even in Canada--people don't realize this, we have the problem of illegal aliens in the United States. In Canada, this great system that everyone wants to cover, you've got to be legally in the country, number one. But you've also got to be legally in the country for 60 days. That's the rule. I know of no healthcare system in any other country, other than emergency care, that treats anybody that is illegally in the country.
The price of compassion is restriction. The price of compassion of a universal healthcare system is restricting both what [can be done] and who can automatically get healthcare. ... I mean, in England, you can't get some types of heart surgery until you stop smoking, common sense things like that. But at least it's a step.
The Kevblog: And in some cases, we might have to learn to say, it's too late for you, we can make you comfortable but we can't save you?
Lamm: Exactly. You look at the fact that in the United States the percentage of our hospital beds in intensive care, as a percentage of hospital beds [overall], are twice as great as in any other developed country in the world. It's really an interesting statistic, and I argue there are two reasons for this. Number one, our tort system, where we put people in [the ICU] to cover our asses. But even more, as you know, no other country would take a 92-year-old with congestive heart failure and have them die in an intensive care bed.
An intensive care bed is a salvage bed. You don't put Dick Lamm in an intensive care bed unless there is a reasonable chance that Dick's going to recover. And when you've got three fatal diseases ... You go to any intensive care unit near where you are and count the people who are likely to leave the hospital. This is a crime.
This in a place where 43 million Americans don't even have basic healthcare? We're keeping people alive for whom there is no happy outcome.
So can America do that? This is not so much the liberals. Now you're getting into the right to life movement that are saying that any step that doesn't give anybody all of the technology is the start of the holocaust.
So America is just this incredible society in which a universal care system, while it's so logical and while I still support it, it's got to be able to set some limits.
Kevblog: The sad thing about what you're describing is not unlike what Ted Halstead says: These centrist solutions won't work--will never be attempted--unless we have a revolution or a crisis of some monumental state. Is that the only avenue to a solution?
Lamm: Democracy seems to be a crisis-activiated system, I agree.
-- Kevin Featherly
- Gov. Lamm has given me permission to reproduce his essay, A New Moral Vision for Healthcare.
