Sunday, November 14, 2010

Health Care ‘Reform’ Reforms Legislature

Thank you, Obamacare.

The GOP, demoralized and frustrated, as they endured the Obama liberal juggernaut that trampled across the country these past 2 years, has been resuscitated. It’s more fun to be in the majority, as Nancy Pelosi can recall. Democratic hubris and rising public disapproval provided not just a strong wind, but a tornado, behind the GOP’s backs. Obviously, there’s nothing revolutionary here, as midterm elections tend to favor the minority, with rare exceptions. What is noteworthy here is the depth of disapproval with the current administration’s policies, affecting every demographic. The gains that the Republicans achieved, particularly in the House, have left Democrats numb and glum.

Whistleblower readers will not be shocked to learn that I did not vote for Obama in 2008, but I was inspired by him. I wanted to believe that he would be the transformational figure that his campaign promised and that the country desperately needed. In particular, I was moved by his speech on race relations that he gave at Constitution Center in Philadelphia in March 2008, as a candidate. He certainly has the intellect and the vigor to serve as our chief executive. Additionally, he accomplished a political feat that I thought no living human could perform. He vanquished the Clinton political machine that assumed that Hillary’s campaign was a mere formality that would precede her coronation. As the president-elect, he spoke of collaboration, reaching out and reconciliation. Then, he was inaugurated.

What happened to the idealism and the abandonment of partisanship? There was plenty of audacity, but not the type we were promised.

The public would only allow Obama to blame George Bush for so long. At some point, the president must assume ownership of the nation’s challenges. We expect, of course, that newly elected officials always state after they take office that they didn’t realize how serious and deep our problems are. This strategy is an attempt to transfer blame to their predecessors, but the public will not provide an indefinite grace period for this buck passing The gaziillons of dollars of Obama stimulus hasn’t dented unemployment, and the public is not persuaded by arguments of ‘imagine how much worse we would have been without our bail outs’. We physicians often use this specious reasoning also.

Doctor, Granny has been on the medicine for a year, and I don’t think her dementia has improved at all.


Well, she would have been much worse without it.

Even many of Obama’s stalwart supporters have turned away. Independents and women defected to the GOP. He managed to alienate both the right and left political wings of the country, no easy feat. Our economy may be mired for years, China’s currency devaluation is costing us jobs, no progress thus far on immigration reform, Iran closing in on a nuke, cap and trade policy that many Democrats oppose and a war in Afghanistan that does not seem to be following a soaring trajectory toward victory. (Watch for the definition of victory to change.)

While the economy is the proximate cause of this electoral reversal, Obamacare receives Best Supporting Actor in the Election Day performance. Obamacare is a symptom of arrogant overreaching by Democrats to give the public what the government prescribes. This political paternalism lit the Tea Party fuse and caused rising suspicion and discontent among ordinary folks and businesses that came to realize that they were being force fed medicine they didn’t want or need. The reason that most Americans oppose Obamacare is not because the administration hasn’t communicated its message well. To the contrary, the more the public understands what Obamacare will mean for them and their families, the more vigorously they oppose it. This was a colossal misfire that helped to retire Nancy Pelosi’s gavel.

Leadership is convincing folks that they should follow a new path. It is not herding them over a cliff. Both of these tactics bring folks to new destinations, but isn’t one of these 2 methods the preferred strategy?

The public does not believe that Obamacare will save money or improve medical quality. They believe – and with good reason – that this plan will break the bank, ration care, micromanage health care delivery and create a pathway toward government control. They do not want our health care system, despite its flaws, to be dismantled.

The repudiation of Obamacare is symbolic of why Obama’s shining veneer has faded so quickly. He didn’t care what the GOP or the public thought. He was determined to force his plan through to earn a legacy for accomplishing what no president since Harry Truman could accomplish. I think health care reform will earn him a place in history, but not the one that he seeks. He will join list of American presidents who served only one term. When this happens, he won’t be able to blame it on George Bush.

This election could allow the president to have a more successful end to his first term. He will likely decide to take turn toward the center and work with Republicans and independents. Can Obama leave the left behind, or will he be left behind?

As always, your comments are welcome.

11 comments:

A. Bailey said...

What we have here is a crisis of leadership.

Our status is not unlike the trench soldier of WWI. We have given the diplomats and generals credit for being "experts" in their fields, and we end up getting slaughtered.

Our leaders in finance, journalism and government have been collectively guilty of "malpractice" and if there were any justice, they would all have to sit in the docket and listen while the plaintiffs' attorney makes the case that they should be found negligent to the tune of $50 million, including pain and suffering.

Instead they get golden parachutes and generous government pensions at worst, and some, like Barney Frank, Barbara Boxer and Harry Reid get re-elected.

Anonymous said...

Government never retreats, only advances. Whether one is willing to recognize it or not, Obamacare was the massive leap forward that single payer advocates have long wanted.

This battle is now over, physicians. So continue pouring money into tort reform, or begging for an SGR "fix" if you want, but you're pissin' in the wind.

Joel said...

Excellent analysis.

BobbyG said...

Interesting blog. Just added you to my "Blogroll" at my independent REC blog.

BobbyG said...

"The public does not believe that Obamacare will save money or improve medical quality."
___

The public DOES believe, however, to an execrable idiocracy degree, that the President is a Radical Communist Muslim from Keyna. So...

A. Bailey said...

Yep, and some believe that 911 was an inside job or that Bush got into a war only so Cheney could make a lot of money through Halliburton.

A lot of people believe in a lot of foolish things, don't they?

Michael Kirsch, M.D. said...

@BobbyG, thanks for the blogroll link. Welcome to the blog. For those of us who have been deep skeptics of Obamacare, brighter days are ahead.

Anonymous said...

The reason the polls show that 70% of Americans dissaprove of the healthcare bill is because 40% of them (myself included) wanted something more radical. I will be promptly removing you off my rss feed

John said...

Hi, Dr. Kirsch! Long time, no see. I am another of many Obama supporters down in the dumps from what seems to have been a wholesale sellout. But I'm a paleo-Liberal going back fifty years. What should I have expected?

Nevertheless, my take on PPACA and the future of health care is not the same as yours. There is no way in hell government will break the bank, ration care, micromanage health care delivery and create a pathway toward government control. At least not in the manner you suggest.

The bank will break, alright, but it will happen as the result of health care inflation if IPAB and the rest of PPACA fails to move quickly enough. Left unmolested our current system is guaranteed to sink the national financial boat in the near future.

And yes, there will be rationing. But it will have to be done by Medicare in the same manner it is already being done by Medicaid and the VA. The result will be a federally subsidized safety net under-girding the private sector, much like it is now, but means testing, multiple eligibility and tiered reimbursement schedules will be part of the landscape.

More individual doctors, clinics and other providers will pull out of the system -- just as they already do -- and take their chances with a real competitive environment which will compete for actually wealthy patients able to afford concierge medicine along with whatever lifestyle trappings go along with solid net worth. (But the market will no longer be flooded with those who cannot afford that measure of care, government vouchers in hand. They will be cared for by more pedestrian, government supported places.)

I say let a thousand private concierge practices bloom, but not flourishing at the expense of taxpayers. Let them flourish the old fashioned way: earn it. Looks like those at the top can well afford anything they want.

But for everyday people like my parents and others who have ended up in the Medicaid safety net ("spending down" you know, so there will be nothing left of any nest egg for their heirs) there will be a national safety net. In fact, I look for what we now call Medicare to deteriorate into what will eventually become Medicaid at the federal level.

Perhaps then the complaining will stop.

Michael Kirsch, M.D. said...

Welcome back, John! We are learning that the president's health care plan has a new and formidable adversary - the judiicary. It is definitely going to be interesting.

John said...

You're right.

I won't be surprised if the Roberts Court (already famous for Citizens United) takes the side of those who want to dismantle the whole mess. As an old saying goes, be careful what you pray for; you may get it.

I was hoping not to follow my parents sad example (both fell into the Medicaid safety net) and leave something to my children, but at the rate things are going it's just a matter of time until my wife and/or I start "spending down" ourselves in the aftermath of large medical expenses.

Interesting, indeed.

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