For all those Obama-ites confident that they won’t make the same
mistakes pushing health care reform that the Clinton administration
did, might I suggest a trip back home?
Just a few minutes into the Second City comedy troupe’s latest show, America: All Better!,
the usual japes about the Jesus-like hopes projected onto our 44th
president gave way to a quick bit about health care reform. A doctor
was telling a woman that her diagnosis gave her only three months to
live. When she pleaded for help, he told her that the good news was
that Obama’s health reform plan meant she was scheduled for her next
visit just six months from now.
Bad news for Obama — the audience laughed.
Conventional wisdom says that the shopworn distortions and
deceptions that killed health care reform in the past have lost their
sting due to combination of middle-class economic worries and soothing
on-message reassurances. Perhaps. But comedy works only when it
connects with real anxieties. The fact that Second City comics in the
heart of Chicago are successfully playing to GOP-fueled fears of
rationing should raise a bright red warning flag at the White House.
Here’s another warning sign: I was talking with a liberal physician
friend who’s spent his career serving people in the kinds of Chicago
neighborhoods where Obama worked as a community organizer. But my
friend’s instant reaction to my optimism about reform was concern: “I
hope Obama doesn’t just open up the government’s checkbook.” This from
a primary care physician whose patients are overwhelming poorly insured
or have no insurance at all! But he’s also a middle-class guy with
taxes to pay and kids to put through college.
A similar warning sign flashed on the recent ABC News special
featuring questions for the president. Pastor David Hattenfield of
Cornerstone Baptist Church in Cumberland, Maryland rose to address
President Obama . He did not ask about the 46 million without health
insurance or the estimated 20,000 men and women who die every year —
roughly 55 people every single day — as a result. Instead, he was
concerned about government “taking over” health care and his taxes
going up.
In answering the good pastor, Obama, no doubt on autopilot, provided
fiscal reassurance, citing his plan to cap itemized deductions for
those making over $250,000 a year. Conspicuous by its absence was any
reference to morality, Christian principles or the common good.
Yes, I know the administration is constantly rolling out stories
featuring average Americans hurting because of inadequate health care.
But are the 85 percent of Americans with health insurance listening?
There is nothing Republican opponents would like better than for the
debate over health care to devolve into a discussion about taxes.
Finally, there is the balancing act of when to roll out specifics.
At some point, supporters of reform like myself need specific
legislative language we can use to debunk the overarching sense of
danger and dread opponents are seeking to instill. Yes, specifics are
supposedly on their way, and yes, the upcoming full-court press by the
administration to sell reform to Congress and the public may indeed
culminate in America, All Better!
But right now, that’s going to take one heck of a second act.
Michael Millenson is a writer, consultant and frequent speaker on healthcare topics. His work appears frequently in these pages and on other blogs, including the Huffington Post, where this post first appeared.
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Squashing ambulatory surgery centers and doctor hospitals in the end raises costs for everyone. By killing the efficient providers, will that cut any of the bloat in hospital/bureaucracy run medical care?
Laughter is the first sign of fear.
To get any kind of reform you are going to need three important things:
1. Find a few Senate votes. Byrd and Kennedy may not be able to be present at a vote role call due to health reasons. Additionally, there are at least 4 Democratic Senators who won’t sign on to a national public plan option. Basically makes that 60 number much harder to obtain with Franken in the Senate now as Democrats are several votes short of a 60 vote majority needed.
They could use the Byrd rule and try for 50 but that really twisting the intention of that rule. Republicans rightly would decry such a tactical maneuver to stuff through a massive piece of legislation.
2. Baucus buying off healthcare constituencies –
Pharma companies have backed off because the House Democrats are backing off their issue of being much more aggressive federal pricing on pharmaceuticals for former Medicaid enrollees now in Medicare.
AMA and the physician lobby only want $250B to deal with the potential Medicare cuts that have kept getting rolled back due to the BBA of 1997 and a reform of the payment formula (as we know doctors always put the lives of patients ahead of their own incomes).
Hospital got bought off yesterday by swallowing some a bunch of cuts in exchange to severely limit the ability of physicians to open future ambulatory surgical centers and other sources of competition to hospitals.
Last two major groups that need to be bought or haggled with are employers (particularly small employers) and the insurance companies.
3. Overcoming the tax argument – The sun setting of the 2001 & 2003 Bush tax cuts is looming ever more large on the domestic agenda starting early next year. Republicans are disorganized and looking for national leadership but the “no new taxes” mantra still rallies the troops and get votes out. Plus, groups like the Americans for Tax Reform (Norquist’s political minions) and the Club for Growth are still very effective at organizing important players in DC and galvanizing public opinion.
Additionally, it is no small matter about the tax increase the likes of Rengel and other House Democrats are proposing either. They are talking about a 4% hike on households making $200k/year. Nevermind that fact that that really isn’t most Americans (only 4.2% of households last year) or that fact that these same households almost typically enjoy a subsidy now in the form of no-taxation on employer-based health insurance premiums. That’s irrevelant.
If I am a Republican strategist, I am hoping this 4% tax increase goes through. That’s huge and would be a message I would use as a Republican strategist to bury a Democrat who would vote for that increase along with other notable spending/tax increases in a swing district in 2010.
Every morning I check the health care blogs to see the latest. The post from Michael Millenson is most disturbing. It appears true health care reform won’t happen – again. Not because of the republican or democrat congress critters but because our culture has raised individualism, I’ve got mine, you get yours philosophy to be the driving force. If I’ve got health insurance then I don’t care about anyone else.
That’s the American way and it’s too bad.
I guess it’s part of the evolutionary process of the decline of civilization. I’ve given up on seeing any legislation coming out of Washington that really helps the middle class, working stiff. Washington needs reforming before any meaningful legislation is passed.
It is not merely that the Messiah pontificates on building a radical departures from a care system that has evolved over decades.
He is establishing a cracked foundation by using flawed, defective, and dangerous HIT products as the cornerstone, having been duped by the self-promoting and manipulative HIT industry.
In my second city, the patient’s anxious family was told that she died because her potassium was 7.5; and bragged that the newly deployed HIT system got the result to the nursing unit computer 5 minutes after the blood was drawn; but what they were not told is that the result was resting in the results silo for 2 hours before anyone happened to log on.
Dr. Sucher is unfortunately right. No-one is going to read the entire 1200 page bill (except for Peter Orszag and Nancy Ann DeParle) before the President signs it. Deadlines, like firing squads, do concentrate the mind, but they also lead to “death march” type exhaustion and sloppiness.
What caused the problem with the stimulus bill was the lethal combination of a very great hurry and too little Presidential oversight/influence over a Congress predisposed to make no difficult choices. The result was an embarrassing porkfest, only $80 billion of which will be actually in the economic system by the end of FY10 in Sept!
I don’t think there is a single “open the checkbook” person on the President’s health reform team. Unfortunately, the tactical decision on timing and pushing the drafting process onto Congress puts the President in a very awkward position: relying on the thin reed of the Congressional Budget Office to impose fiscal sanity.
The fact, as Michael suggested, that LIBERALS are concerned about the cost should tell you something about Congress’s abject lack of fiscal credibility. After what Bob Reischauer did (correctly and responsibly) to the Clintons, you can bet that CBO is going to get rolled flat this time. That Second City audience is core Obama constituency, and if they’re laughing at this stuff, it makes me nervous as well
It’s just too easy to hurl money from helicopters just now. Health reform is very important, but not at any price. . .
“At some point, supporters of reform like myself need specific legislative language we can use to debunk the overarching sense of danger and dread opponents are seeking to instill. Yes, specifics are supposedly on their way”
I’m glad you remain a “supporter of reform”. It is more than clear that health care needs to be managed better, but it remains very unclear if this administration is just talking about change, or if they are truly creating meaningful pathways for improvement.
The consistent problem with this administration is the ongoing mantra of “reform” without substance. This was true of the obnoxious “stimulus” bill and remains true with the concepts espoused to reform health care. Based on past behaviors, I have little faith that we will see the specifics that even you say are “supposedly on their way”. I remain concerned that we will see a repeat of pushing through a bill that goes unread because the President creates such a sense of urgency that no-one will know what they are voting for. So I ask that you and others stop acting like co-dependents and start requiring delivery of substance.
JFS
That is the problem we face. Without going on a long describe, I have seen so many comments about how our system might become like Canadian where you have to wait for months, and how governemnt system is badly run, and we do not have money to fix….
here is worth noting:
1) Candian system is better than American. I have used it and the wait was no more than here
2) Government systems are not always bad. Look at post office. They do a damn cheap job for you. Is there anyone who will send letter for 50 cents
3) We do not need more money…the money is already there more than we need. We just need to reallocate smartly,
One of the idea of saving which helps all – physicians, insurers, patient and hospitals is about reduction of license canellation. It sounds like a small problem on the surface but it is huge. We wrote a white paper and it is on our blog in the signature posted in last 2 weeks. Those are the kind of things we need to do to cut cost and become better.
rgds
ravi
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