Where I Stand — Brian Greenspun: Let states deal with it

Friday, Jan. 17, 2003 | 9:24 a.m.

WE HAVE a problem in some of the 50 states of this union. No problem, let the federal government handle it.

Now we're talking. That's the kind of language, though, that Rush Limbaugh climbs all over his "liberal" friends for using to solve our problems. And that's the kind of language that the Republicans in Congress like to assail as practically un-American, especially when they are uttered by a political enemy. And that's the kind of language that contains fighting words to George Bush's White House, which prides itself on the issue of states' rights and damned be he who tries to step on them! (Unless, of course, states' rights has anything to do with Nevada's desire to keep nuclear waste out of our back yard, and then it is President George who will do all the stepping)!

Some things you can just count on in life, and President Bush's opposition to using the federal government in any way to fix an issue most properly left to the states is one of those things. You will never hear him saying that Washington can do a better job fixing a local problem. Nosiree!

Unless, of course, you just happened to be listening to his speech in Pennsylvania Thursday in front of a room full of health professionals. It's a good thing the audience knew what was coming and knew how to avoid going into shock. As for the rest of us, the president's about-face on states' rights took us by surprise -- almost. We knew that when he had a chance to hammer the lawyers he would do it. And all the people who hold that group in low esteem would love it, too.

I am not going to pick apart President Bush's plan to solve the medical-malpractice crises that threaten health care delivery in some of these United States. There are plenty of more knowledgeable people who can do that. It is fair, however, to point out a few glaring items that were left untouched by Bush's global solution to the problem of rising malpractice insurance rates.

For one, he forgot to mention the insurance companies and their complicity in the problem. I am sure that was just an oversight. For another, the president told us that he wanted to put the doctor back in touch with the patient without the middleman. He was referring to a doctor having his words used against him if a lawsuit ensued and how the doc would, therefore, be reluctant to speak freely, knowing a lawyer might use his words to do the doctor's case harm. I don't know about the president's doctors, but I expect my medical advisers to always speak frankly and tell me the truth. What's the concern there about what may be used in court?

So, let's assume for a moment that the lawyers are kicked out, so to speak, of the examining room. The biggest culprit I see is the very insurance companies that don't exist as part of the president's problem-solving and the HMOs, both of whom practically dictate the quality and quantity of care that a doctor feels comfortable providing his patient. I am not sure who I would want least in the room with me, a lawyer, an insurance clerk or an HMO agent who is most comfortable saying "no." The doctor-patient relationship has no room for any of those people, if you ask me.

But back to the point at hand. President Bush must have curdled the blood of his Republican base when he told the world that yes, indeed, there are some problems the national government can better resolve than the local governments, which are closest to the people. Heck, even most of the Democrats I know have become convinced of late that local problems are best dealt with at the local level.

So what gives and how do we square what George Bush is saying now with what he preached yesterday? If the federal government can take 50 disparate problems of varying degrees with different root causes and fix them all in one fell swoop of federal legislation, then who can ever argue that our overwhelming problem with the public school system should not be resolved at the federal level?

If teaching math and English is a local issue then, clearly the jury systems, insurance premiums, types of doctors and hospital care provided, quality of HMO and PPO systems available, medical mores and other matters that have always been local concerns should continue to stay that way. If one goes national so should the other, right? Don't let school boards across this country hear you spout that nonsense!

The fact is that when it comes to the very complicated issue of the quality and delivery of medical care in the thousands of communities across this country, one size does not fit all or even very many. The Congress can pass laws dealing with the lawyers' part of this multi-act play, but until there is a global solution fashioned that includes all the players, the problem will not get fixed. All that will happen is that some in the system -- you can read that to include HMOs and insurance companies, not doctors, lawyers, patients or anyone else for that matter -- will get richer while the best system in the world gets poorer.

Some things, Mr. President, lend themselves to federal solutions. Others don't. You had it closer to right before you decided to whack the lawyers and help your friends in corporate America. Let the states deal with this matter. We will get it right eventually, which is far better than getting it wrong from the start.