Attacks on Sen. Barack Obama’s health care plan during the 2008 election were a common occurrence, and these attacks often included at least some mention of “socialism” or “socialized medicine” coined during Truman's reform failure in the '50s.
American’s deep-rooted fear at the mere mention of socialism is no accident. The “Red Scare” of the 1940’s and '50s defined American culture. With a universally held enemy in the Soviet Union, concepts such as welfare, universal health care or nationalized insurance were seen as overtly communist or socialist.
To be American was to be strong, independent, a believer in individual freedoms and wary of big government.
The impact of this mindset is felt today just as strongly as it was in the '50s. As the only industrialized country without a universal health care system, the United States is at a cultural crossroads. Obama is attempting to succeed where no other president before him could—efficient and comprehensive reform in the health care arena.
However, American culture is firmly blocking Obama's path. The culture gap between the U.S. and other regions, specifically Western Europe, is large, Parente explained. The difference is how citizens view government intervention and action. Just as with socialism, Americans (and Republicans) fear big government in a way unlike their European counterparts.
Both attitudes were adopted over the past century. The “Red Scare” and escalating Cold War defined American thoughts on universal health care while the Europeans relied on their governments to rebuild after the destruction of World War II and to provide just about every service.
“Countries like the England and Germany are much more open to and even expectant on the government doing things like providing comprehensive health care,” Parente said. “In the United States, we openly reject that thought and see the government as the enemy.”
A deeply held resentment of government intervention is one reason why campaign rhetoric against health care reform often concedes to using such buzzwords as socialism or big government—their use is extremely effective in building coalitions and public support against health care reform.
Still another major cultural obstacle to effective cost reform is the consumer culture of the American people.
Americans like the shiny, the new, and the expensive. Abundance is always seen as better. In terms of health care, this means the newest drug, the newest device, the newest treatment always looks better—even if the old treatment was less expensive and just as effective.
Sullivan said that the conventional wisdom that newer is better is one of the biggest factors in escalating health care costs. The United States government literally has no effective way to gauge the effectiveness of new treatments, drugs or medical devices.
“Everywhere else in the world, the state says no.” Sullivan said.
The United Kingdom's National Institute for Comparative Effectiveness (NICE) is an example of a government agency with the capability to deliver comparative assessments to new drugs, treatments or devices. Proponents are likening the newly formed U.S. Federal Commission on Comparative Effectiveness Research (FCCER) to NICE. However, critics suspect the FCCER will have no ability to enforce its findings and prevent certain products from entering the market.
The health industry lobby takes advantage of American adoration of technology and drugs, aggressively lobbying the public whenever politicians attempt to stem health care costs. When coverage of a new drug or product is threatened, cries of “health care rationing” immediately flood the country from coast to coast.
In 2002, controversy surrounded Xigris, a drug approved by the FDA for the treatment of severe sepsis. With costs approaching $7,000 per patient, per treatment, many hospitals and medical professionals openly doubted its use. Severe bleeding and serious side effects can follow its application. Lingering concerns still exist over the drug’s value in effectively treating sepsis.
To combat the risk of loosing sales on one of its biggest drugs, Eli Lilly hired an advertising firm to create a campaign raising ethical awareness about not using the drug. The campaign, called “The Ethics, the Urgency and the Potential” failed to include any studies on its cost effectiveness. Instead, it aggressively lobbied the public and accused the government and hospitals of rationing new, revolutionary and life saving drugs.
At $6,800 per patient per treatment with no clear benefit, the drug is hardly cost effective.
Sullivan is skeptical that the government will ever have the ammunition to shake the stigma of health care rationing.
“You're not going to be able to address costs without changing public opinion,” he said.
Experts disagree whether Obama has the ability to do so. “Obama has an instinct about the American people,” Sen. Durenberger said. He thinks Obama can frame the conversation to appeal to the American people.
Sullivan approached it from a different perspective. People can witness the failures of the health care system in their own lives, but not the effect that all these factors have on the country’s overall well-being. He likened it to the global warming/climate change debate. When the potentials harms are long down the road, the public is less concerned.
Sullivan openly doubts Obama's ability to change public opinion. “People tell me this guy is transformative,” he said, “I've seen no evidence that he was A. Passionate or B. working really hard for something.”
Parente also shared doubts. “If he really wants it, he should just barrel through and just get the coverage determination down. Because you’re not going to fix the cost element of it. The only way you’re going to fix the cost is to ration technology and to say no to people to get care,” he said.
“We’re on a boat where we’re an aging society that’s fairly well to do that loves technology.”
Not a good combination.
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