Dr. Michael Cousineau qualified for Rarefied American status when he announced at last night’s monthly meeting of the Culver City Democratic Club he has read, and absorbed, all 2,074 pages of President Obama’s revolutionary healthcare reform law.
And he orders his medical students at USC to digest the new rules in their entirety.
This places Dr. Cousineau ahead of every member of Congress who voted for and against it 15 months ago. No member read the whole document or much of it.
During a compelling, lucid and learned half-hour presentation — where he was constantly interrupted by comments and questions — he provided seldom-heard perspectives. While he intellectually but not necessarily emotionally approves of the still-new, still-vulnerable legislation, he delivered a cool, objective accounting of where the law stands.
“I worked hard to get this bill approved,” he said, speaking dispassionately, “and nobody likes everything that is in it. Passing this bill is an extremely important policy step, and it takes a long step toward universal coverage.”
For context, he said that 20 percent of Americans, about 48 million, are not presently covered. When the Obama law is fully activated, the expansion will subtract 33 million persons from the uninsured list.
While there is plenty to applaud about the American healthcare system, Dr. Cousineau said, “it is primarily based on treatment rather than prevention — and that is a problem.”
Facing a primarily senior audience, Dr. Cousineau knew that a central interest, and hurdle, was costs.
“A second problem,” he said, “is that our system is very expensive, the most expensive anywhere. In our country, we spend $7,500 per person per year on healthcare, more than twice what Canada does, at $3,200. In spite of all the money we spend, we are not the best healthcare country in the world. In 1988, healthcare accounted for 11 percent of the Gross National Product, and today it is nearly 20 percent. What’s driving the increase? Healthcare costs have, of course, risen, while wages have remained flat or gone up much more slowly.”
Meaningless
When an audience question arose about where the U.S. ranks globally, Dr. Cousineau sought to scotch such thinking. He said he attaches scant significance to such indices.
Assessing the quality of the American system, he said, is a mixed bag. The U.S. rates at or near the top of the world in cancer treatment, but notably lower in preventative care, pre-natal and cardiovascular treatment.
“We have a good healthcare system, but the benefits are not distributed equitably.”
Dr. Cousineau cited “three major problems” with the system:
• Costs
• Access
• Quality.
Don’t Celebrate Yet
He said it is not yet clear what proportion of those three stumbles that the Obama law will help to resolve.
Perhaps his most fascinating insight was the answer to Hank Shapiro’s question about why healthcare costs are soaring.
Dr. Cousineau identified three reasons that are almost never mentioned:
• Increased use of technology
• Oversupply of hospitals
• Oversupply of technology.
He said that one of the most welcome clauses of the new law, that more or less does not fully start until ’14, is to eliminate the prohibition of healthcare seekers with a pre-existing condition.
De. Cousineau is confident the law will markedly improve the quality of life and healthcare, but it is still premature to celebrate, he cautioned.
“There is a lot in this complex bill that still can be tripped up politically,” he warned.
