Monday, September 21, 2009

Flour, Coffee, LBJ and the Cost of Health Care

The September 20 issue of the Sunday New York Times carried a collection of quotations from President Lyndon Johnson. All were related to LBJ’s successful effort to enact Medicare.

LBJ had a colorful way of speaking and all of the quotations were interesting, but one in particular caught my eye. It was taken from a conversation with his Vice President, Hubert Humphrey.

“Don’t ever argue with me [about health]. I’ll go a hundred million or a billion on health or education. I don’t argue any more about that than I argue with Lady Bird [Mrs. Johnson] buying flour. You got to have flour and coffee in your house. Education and health. I’ll spend the goddam money. I may cut back some tanks. But not on health.”

Those remarks go far to explain the problems we are having with the cost of health care. The LBJ quotation cited eloquently encapsulates the way we have thought about the relationship between health care and money. The idea that we might spend too much money for health care – so much as to endanger the financial stability of government itself – not only had not occurred to anybody, but would have been, and to considerable extent still is, in violation of a deeply and widely held value.

When dealing with health care, the basic instinct both then and now is to spend more money on it. Our health care delivery system can be counted on to use every penny and ask for more. All of that is clear from the way the health care reform debate is going.

It is an issue of culture and we’ll not deal successfully with our health care cost problem until we face up to it.

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