I am about to speak ill of the dead. So naturally, the subject of this blog is health care reform, otherwise known as the “Graveyard of Politicians.”

One must admire the audacity of Congress. The bill they’ve come up with achieves universal healthcare by requiring everyone to purchase health insurance. Problem solved. In the words of Georges Jacques Danton, one of the leaders of one of the French revolutions “…audacity, more audacity, always audacity.” For that, he got le Guillotine. Families failing to obtain coverage will be fined a maximum of $3,800 if they don’t buy…not that Congress should be selling.

We were recently on holiday in France, which is my excuse for not posting a blog for awhile. France has couverture maladie universelle (universal health care coverage). But honestly, the only phrase I was able to master in French was l’addition, s’il vous plaît, which is what Congress should be asking. Countries such as Denmark, pay higher rates of taxes in order to provide universal health care. Alas poor Yorick! It is not a cheap undertaking. The Canadian government is curtailing some of the services covered by its public health care system due to rising costs, which seems anathema to the concept of universal coverage (see US neighbor swallows private sector medicine in the Financial Times).

Comparing the quality of health systems is difficult. An article in The Economist (Healthier than thou ) notes that life expectancy in Britain is 79.1 years as compared with 77.8 years in America. Does this mean Britain’s National Health Service is superior to America’s system of private insurers? The Economist goes on to state that Britain does worse than America in five-year survival rates for cancer. Part of the reason for this is that America has more “high-tech diagnostic equipment” per million people than Britain. And, “expensive new drugs generally become widely available sooner in America…”

Perhaps this is why America’s health care system is the most expensive in the world in terms of economic output. The United States spends 16% of GDP on health care (see “Heading for the Emergency Room” in The Economist ). “However, a few might be surprised to learn that Americans spend more than twice as much per person on health care as Swedes do. And many may be shocked to be told that in Miami people pay twice as much as in Minnesota, even for far worse care.” What do Sweden and Minnesota know that Miami doesn’t? Is health care cheaper in colder climates? Under what system are you better off?

I think the answer very much depends on what ails you. For instance, you are possibly better off with certain types of cancer, those that respond well to chemotherapy and radiation treatment, in America. Although consider what Robert Martensen states in A Life Worth Living – “most Americans die in hospitals these days…older Americans dying in hospitals experience an extended and agonizing process.” Our health system may extend our lives, but are we living better as a result? Can our World Wrestling Federation style of debate (sometimes called a “town hall meeting”) tease out these nuances of health care reform?

This is the appropriate place for the “speaking ill of the dead.” I found the recent HBO special on Ted Kennedy perplexing. A 1974 clip shows a young Bill Clinton introducing Ted Kennedy who gives a speech on health care reform remarkably similar to those we are hearing today. Which makes me wonder if it will take another 35 years for any kind of health care reform (at which time I won’t need it).

In 1971, Richard Nixon advocated a national health care system that would have required all employers to provide health care to employees. A subsidized government insurance program would have been available for those who were not employed. Ted Kennedy was in favor of a government insurance scheme for everyone and helped to defeat Nixon’s proposals. A comparison of the tenor of the debate between now and then is illuminating. Apparently, Americans were as alarmed then as now over the rising costs of health care.  Of course, the annual cost of the nation’s health care in 1974 was a mere $100 billion annually, or a couple of Merrill Lynch bonuses.

If we are to avoid the fate of the Red Queen over the next 35 years, what is the solution? You’ll recall Lewis Carroll’s Red Queen who tells Alice, “‘A slow sort of country!’ said the Queen. ‘Now, here, you see, it takes all the running you can do, just to keep in the same place.’”

Perhaps the only way to approach this is to recall the old joke about a physicist, a chemist and an economist lost on a deserted island. They are surrounded by cans of beans, and what not, and the said physicist and chemist have been unable to pry them open. The economist conjures up the answer – “assume we have a can opener…” So let’s assume we have “universal health care.” What does this look like to you?

I’ll close with this thought. Was Macbeth talking about health care reform before he met his end?

Tomorrow, and tomorrow, and tomorrow,

Creeps in this petty pace from day to day,

To the last syllable of recorded time;

And all our yesterdays have lighted fools

The way to dusty death. Out, out, brief candle!

Life’s but a walking shadow, a poor player

That struts and frets his hour upon the stage,

And then is heard no more; it is a tale

Told by an idiot, full of sound and fury,

Signifying nothing.

(Macbeth, William Shakespeare, Act V, Scene V)