Friday, February 17, 2006

Lamm (former Governor) is a Lion on Health Care Reform

I failed to reference in my blog post of Feb 15 on Governors and Health Care an extremely important pioneer again, another former Governor, Richard Lamm of the great Centennial State of Colorado-also called the “Highest State” (mountains not pot)

Gov. Lamm is former three-term governor of Colorado (1975-1987) and now serves as Co-Director of the Institute for Public Policy Studies at the University of Denver where he maintains a vigorous teaching and speaking schedule. A real maverick Lamm is a lawyer, accountant, and novelist (“1988”). Lamm demonstrated rare courage-and controversy- while as Governor in 1984 he spoke up about physician assisted suicide. He also probably was the first public figure to use the “R” word = Rationing of Health Care required by the realities of US demographics.

In 2003 Richard Lamm’s book on US Health Care was published The Brave New World of Health Care which reinforced his reputation as a recognized expert on US Health Care policy. In the book using extremely colorful but accurate language Lamm correctly concludes as many now have that our current US Health care system is unsustainable, unaffordable and inequitable. Lamm defines the problem for us including what he calls “living on the banks of the river -denial” such as huge unfunded liabilities we are leaving to future generations, and among other cogent observations the dilemma of what physicians want for their patient verses what society at large can possibly afford.(the individual good verses the common good-or "physicians serve their patients by spending other peoples money") An interesting section is “The Tale of Two Governors” where Lamm contrasts former Gov of Virginia James Gilmore who tried to intervene by requiring that a husband agree to re-insert a feeding tube to a wife in a vegetative state (Dr. Frist’s shameful game plan in the recent Schiavo case which received much national attention) verses the progressive policies of then president of Oregon’s state Senate Dr. John Kitzhaber who, in contrast to Gov. Gilmore, led the fight not to pay for excessive organ transplants under Oregon’s Medicaid law but instead use the dollars to maximize the coverage for medically indigent Oregonians.

Lamm’s Proposed solutions’ “Rebuilding the House of Health Care”

- Public Policy should pay for the statistically probable but not the clinically possible

- Managed competition geared toward correct the lack of purchaser power when individuals access the system empowering demand instead of supply side medicine

- Reducing individual expectations-overrating ourselves at the expense of others (the common good).

- Providing basic health care to all US citizens as good social policy through the legislature not through the courts as a “right”

-Expanding Health Care's Moral Universe-the imperative of rationing-tough choices between good and good

- Rethinking The Institutions of an Aging Society including rethinking entitlements, redrawing the ethics map, and controlling health care costs.

Richard Lamm closes his book by stating that the foundation of the house of health care is individual responsibility! (One would say almost a “republican sentiment”) He talks about ethics and duties of the doctor-patient relationship, the ethics and duties of the health insurance plan and the ethics and duties of the state and nation . And he makes the strong case that we do not necessarily maximize health by maximizing health care.

In my view Richard Lamm’s greatest contribution to this growing national debate was his early recognition of the imperative of rationing, intergenerational competition for health care resources, and the need for the nation to confront death and dying. In short, Lamm demonstrated enormous courage sometimes at great personal and political expense. Some call it backbone-I call it sheer courage- that of a lion!


Post a Comment

<< Home