- - Monday, August 11, 2014

During my twenty-nine years directing pediatric neurosurgery at Johns Hopkins Children’s Center, I oversaw and personally performed thousands of critical and delicate operations. Never did I walk into a surgery with anything but the best of intentions and hopes for the outcome. But in every instance, waiting outside the operating room were parents, friends and loved ones. My prayer was to always return their child or loved one after each operation in a better physical and mental condition.

Above all, they were focused on one thing: the outcome. Would their loved one survive? Would they have the chance to live a long, healthy life?

Like any other physician, I had a tremendous responsibility. Whether the outcome was miraculous or sad, it was my job to deliver the news in person, face to face. There are few human interactions more personal and emotional than that.

When I criticize the left’s vision for government-directed healthcare, and Obamacare in particular, it is this experience I draw upon.

I don’t doubt that our elected officials want to help people. I believe that most of them mean well and have good intentions. But in my field, outcomes, not intentions, are what matter.

We must judge our representatives and the programs they create by the same standard: based not upon their promises but the results they deliver.

There is an old saying that if you don’t have your health, you don’t have anything. Our health is the most personal and important thing we possess, and its care should be entrusted first and foremost to our family, our doctor and ourselves. Every time we cede control to large, centralized bureaucracies, we encourage inefficiency and abuse, and we discourage the personalization so integral to quality medicine.

One of the most unfortunate examples of this disconnect between intentions and outcomes is Medicaid, and its signal failure to significantly improve our nation’s appalling racial and ethnic health disparities.

Created in the 1960s, the goal of Medicaid was to provide healthcare for low-income individuals and families who could not afford it on their own.

Today, Medicaid enrollees are disproportionately ethnic minorities. And how has Medicaid improved their health? Let’s take a look.

A range of measurements, from infant mortality rates to life expectancy, indicate that ethnic minorities are generally less healthy, and have less access to quality healthcare, than whites. This is particularly true of African-Americans. For example, according to the American Health Association, African-Americans are nearly twice as likely to have a first stroke and much more likely to die from one than whites.

Having been raised in poverty by a single mother in inner-city Detroit, I understand why minority communities are often mired in poverty. But should we not wonder why a class of our fellow Americans so disproportionately enrolled in Medicaid also happen to be the least healthy? Every American, but African-Americans in particular, should demand answers. More importantly, we should demand changes.

Every election cycle, when social welfare programs like Medicaid and Medicare become political footballs, we hear the same arguments and accusations. Often reasonable calls for reform are met with charges of heartlessness, and the parties run into their respective corners and ultimately change nothing.

Since the 1960’s, federal spending on Medicaid has increased well over 10 percent annually, and in 2012 total Medicaid spending was $415 billion: This is not a funding problem. More money would not necessarily help those it is meant to help.

For example, the Government Accountability Office has issued dozens of reports over the course of two decades that have designated Medicaid at “high risk” for its “greater vulnerability to fraud, waste and abuse.” Tens of billions of dollars every year are literally stolen or wasted from incompetence.

I don’t share this because of any deep desire to harshly criticize Medicaid. But we can’t heal the ailment until we diagnose it.

For instance, a new report by the American Heart Association notes that Massachusetts’ health reform, a template for Obamacare, has done little to impact racial, gender and socioeconomic disparities in heart health. According to lead author Michelle Albert, a professor of cardiovascular medicine at Howard University College of Medicine, “Despite health care reform, which mandates health insurance coverage in Massachusetts, disparities persist in an important area of cardiac care, such as performance of potentially life-saving coronary interventions in certain vulnerable groups, including blacks, Hispanics and women.”

As a responsible, caring and just society, we must ensure that every American has access to our healthcare system. Rather than entrusting the health of our most vulnerable citizens to fraud-ridden bureaucracies, we must empower those closest to patients and their doctors. This means less power in Washington, D.C. and more flexibility for governors and state legislatures, who better understand the needs of their local communities.

Rather than trying to prop up archaic processes and bureaucracies, we must embrace the merging of communications technology with medical science, such as telemedicine, which holds particular promise for Americans in rural areas.

Rather than allowing our elected officials to argue about process and the proper amount of funding for our healthcare programs, we must demand a focus on outcomes, and hold our representatives accountable for the results of the programs they create.

In my career as a physician for almost four decades, there was no better moment than telling a family that their loved one would be OK; that he or she would have the blessing of living a long, healthy and independent life. With real reform, maybe we can give the same prognosis for our health care system as a whole.


Ben S. Carson is professor emeritus of neurosurgery at Johns Hopkins University, a columnist with The Washington Times and author of the new book “One Nation: What We Can All Do To Save America’s Future.”

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