Obama, Health Care Summit

(Chop Suey, Edward Hopper)


Does anyone have patience for the health care deniers any more?

President Obama, either out of obtuseness or shrewdness--it remains to be seen--invited the likes of Big John Boehner and Mitch McConnell and their nattering nabobs to "discuss" health care reform and he got the party line of generalities which form, as far as I can tell, the entirety of their objections to new legislation.

The Just Say No crowd has no specific objections or plans, only deep seated anxieties that a new approach will violate some holy tenets of conservatism. These talking points have been repeated ad nauseum with conservatives/Republicans portraying themselves as the only hope, the right minded people to prevent change, read change as catastrophe.

You can read them in the New York Times (Feb 22) or on any of their websites, but the clue is they stick to generalities, and abhor specifics. Which is to say, they like to stick to their imagings and their own illusions, which need no specific substantiation, rather than dealing with the tangled woof of reality, where one has to govern, where the auto mechanic, the electrician, the plumber and the medical doctor have to operate.

Here are the tenets of belief:
1/ Government health care is ipso facto bad healthcare. Never you mind Medicare and the VA -- if it's government it's part of the problem; cannot be part of the solution. The fact is, as Congressman Weiner from New York recently observed: "If you ask 100 fifty year old citizens whether or not they'd sign on for Medicare, if they had the choice. How many do you think would do it?" Answer, we're betting about one hundred and one.

2/ Government solutions mean we will be stripped of all choice and left only one choice, the government run health care. During the election one good tag line was, "All I'm asking for Senator, is the same health insurance you get." And the fact is, the federal government workers have more than a few choices and seem happy with what they choose.

3/ Choice among a wide range of private (commercial) options has got to be better than whatever choices the government run program could offer; shopping in a competitive marketplace is want people want to be able to do (Mark McCellan) The fact is, the people I see every day, really would rather one or two good choices, Medicare or one other option than a hundred choices which have so much fine print they cannot hope to be able to be smart buyers. This was the philosphy which gave us the infamous Medicare part D, which paid for drugs, some of the time, through a welter of different insurance plans, all of which had different provisions and left the average citizen hopelessly confused. When Mark McCellan, who oversaw this Bush program was asked if the program was made so complicated to discourage anyone from actually using it, he acted as if it was the simplest thing imaginable. Think again, Dr. McCellan.

4/ The people do not want health care legislation. This is the mantra which every Republican seems to be chanting in hopes that if they say it often enough, it will come true. It probably is true, if you ask people whether they want an uncertain future vs an imperfect present, many will go with what they know. If you ask people whether they want the thousand page healthcare bill now in Congress do they want that? Well, no, it's scares me. But do you want inexpensive healthcare which cannot be cancelled when you finally need it, which cannot be withdrawn on the claim you failed to reveal a pre existing condition, which can be owned by you no matter who employs you, which is as solid as the US government, well then maybe you get a different asnwer from John Q Public.

5/ Government run, centrallly organized health care systems are "Top down" organizations,(Bill Frist) and such organizations always fail, as the experiment with Soviet style government showed. It will lead to rationing, death panels, Big Brother, "Kafkaeseque" (James Pinkerton) totalitarianism. Okay, then let's just throw out Social Security.

6/ All we need to control costs is to reign in the lawyers, frivilous lawsuits and liability law. Doctors tell us that 25% of health spending is spent on unnecessary care, which means doctors are spending patients' and insurance company money doing tests to avoid lawsuits (Newt Gingrich) Anyone who has ever become involved directly with the medical jurisprudence system knows its essential corruption, based as it is on what you can sell an uncomprehending jury rather than on what is possible in medical practice. The malpractice system is so outrageous it belongs on The Wire as one more dysfunctional institution which is only concerned about money and power but not about patients or justice. Having said all that, if you eliminated it tomorrow, it would do nothing substantial to the overall balance sheet of medical costs. You can make up any number you want, "25% of health spending is unnecessary," is a fiction. Nobody knows what goes through the minds of 500,000 physicians; certainly not Newt Gingrich.

7/ Paying for preventative medical practices will save the system substantially over time (Mark McCellan) and this can be done by less expensive practitioners ( Nurse practitioners, pharmacists, wellness programs). Here's another fantasy, one shared by Peter Orszag and liberals as well as conservatives. I wish it were true, I really do, but if you actually deal with patients, in the trenches, you listen to the histories of people who supersize every drink, every meal, smoke, drink and consider heaven a week spent in a recliner in front of the TV with a domestic brew in one hand and a supersized soda in the other. Not going to happen folks; wish it weren't so.

8/ Medicare is a terrible system because it is fee for service, rewarding volume and is inherently inflationary (Charles Kolb) I was once asked on Cleveland television, what I thought about Dr. Crile's assertion every doctor in this country ought to be on salary, the way docs at the Cleveland Clinic and Mayo Clinic are. Get that profit motive out of medicine and focus doctors on taking care of patients. All I could say is I certainly would be happy with Dr. Crile's salary. And putting everyone on salary sure would change who applies to medical school and that might be a good thing. But not even the Democrats are talking about that. Dr. Crile was a demi god in Cleveland, revered, and so mainstream they were naming babies and streets after him. But what he's talking about is real revolution, not the tidal changes whcih the Democrats are trying to push through.

9/ Current legistlation being considered will create a catostrophic bureaucracy which will banrupt the country and result in loss of therapy and care for the average citizen.
Fact is, neither the Republicans nor the Democrats know whether or not this is true. What Washington has done, when it does anything at all, is to try something and see how it works, always prepared to beat a hasty retreat, never blowing up the bridges.

What the Republican party has presented is the same old objections based on conservative theory without specifically saying what we can do to address:
1/ People denied health insurance because of pre existing conditions.
2/ People being tied to bad jobs to keep health insurance.
3/ Companies failing because they carry overhead costs, mainly health insurance, with which their competitors in other countries are not burdened.
4/ The roughly 1/3 of American citizens who are either uninsured or underinsured place a burden on local and federal government by using emergency rooms as their primary care.

At least the Democrats are proposing to address these problems. Trouble is, the institution. None of these lawmakers want to pack up their offices into cardboard boxes and hire moving vans and pull their kids out of schools and move back to Peoria and have to find a real job. (Except for the senator from Indiana.) So the Democrats, who are more nervous because they are actually being asked to say, "Yes," to something, are suffering from the knocking knees syndrome.

One thing the Republicans have got correct: The Democrats are wusses. Their leadership is tepid, Casper Milquetoast. The Democrats simply do not have the guts to lead or to govern. The only visible exception to this may be President Obama himself, who is not a strong leader in the sense Roosevelt or Churchill were strong--he cannot rally the troops and embarrass the cowardly. Roosevelt excoriated the greedy and Churchill lacinated the timid. They made their citizens stronger. Obama, thus far, has not.