He put the cart before the horse, expecting Americans to buy into a massive, loosely defined concept – healthcare reform – and offer support without being told exactly what it would mean for them and their families. The ink wasn't even dry on the various bills back in July and the president was already giving the country the hard sell. by Matthew Bastian
(conservative)
Friday, August 21, 2009
It's too early to tell if the wheels have completely fallen off ObamaCare, but it's certainly running on a wobbly axle or two. Failing to pass legislation before the August recess, members of Congress have returned to their home districts only to be greeted by raucous, if occasionally nasty, town hall meetings. Sensing that the "angry mob" may not be entirely made up of Brooks Brothers-clad corporate shills, the White House has backtracked somewhat, indicating that a government health care option may be negotiable. This, in turn, has drawn ire from the president's left flank.
Indeed, it's been a long, hot August. How did Obama and his handlers let it get to this point?
At a fundamental level, they lost site of the most important question: there's a popular, if hackneyed, saying in the business world, "what problem are we trying to solve here?" The president has been trying to regain the initiative recent weeks to answer that question, but he has yet to offer a concise, Cliff's Notes version of his plan that everyone can understand: he's offering the Physician's Desk Reference when we need Healthcare for Dummies.
And "fixing a broken healthcare system" or "reforming health insurance" doesn't cut it. Those make for nice slogans, and may be the ultimate goals, but don't specify a problem to be solved along the way. Those have become umbrella terms that cover a broad spectrum of ideological mush, with both sides of the political aisle defining them as they see fit: socializing medicine; instituting a single-payer system; reining in private insurance companies; and offering quality, affordable care to every American.
Again, the focus has to be on a problem are we trying to fix.
If the goal is to bring down the cost of health care, any serious discussion must include tort reform. According to Towers Perrin, a professional services firm, the tab for malpractice litigation runs $30 billion a year. As a result, a neurosurgeon can easily shell out $300,000 per year in insurance premiums - and that's just to hang out a shingle, before he or she can even treat a single patient. Those costs don't just evaporate and have to be borne out in the system somehow, usually by consumers. Beyond insurance and litigation costs, the mere threat of being sued forces doctors into performing additional, often unnecessary, tests and procedures (a practice euphemistically called "defensive medicine" but perhaps best filed under "I-hope-they-don't-sue-my-stethoscope-off").
Democrats, of course, have been mostly silent on the issue of tort reform, hoping we won't notice that the camel with its nose under their tent looks suspiciously like the trial lawyers' lobby; as long as they get their pound of flesh in the deal, Democratic campaign coffers will benefit.
If the problem is access to healthcare - bringing in the 48 million uninsured Americans we so often hear about - then how are we going to address the supply side? One can't dump millions of new patients into a system with limited resources without considering who is going to treat them. Indeed, many specialty doctors, especially obstetricians and gynecologists, are leaving for states with friendlier tort climates or giving up their practices outright. On top of that, we are faced with a chronic nursing shortage that is years in the making. In the July/August issue of Health Affairs, one report estimated that 260,000 RN positions will be vacant by 2025. In such an environment, the notion of rationed care isn't some right-wing talking point - it's a legitimate concern.
President Obama may have ideas to address these issues, but his voice was lost amid the din of a debate spun out of control. Much of this was his own doing: he put the cart before the horse, expecting Americans to buy into a massive, loosely defined concept - healthcare reform - and offer support without being told exactly what it would mean for them and their families. The ink wasn't even dry on the various bills back in July and the president was already giving the country the hard sell.
Which may be a case of the White House going to the old playbook one too many times - it's a theme, after all, that helped Obama win the election. While not entirely bereft of specifics, his campaign last year was stunning its ability to keep voters focused on the big, shiny objects: hope, change, and a new way of doing things in Washington. For an electorate weary of George Bush and an increasingly rancorous partisanship inside the Beltway, Obama's grand themes, however vague, resonated. He became the political equivalent of a Choose Your Own Adventure book and many people were willing to take a flyer on him, with the new president reserving the right to define "change" as he went along.
And so it was with the healthcare debate in which Obama assumed that the country would rally around his urgent call to "fix healthcare" before the calendar flipped to August, allowing him and his congressional allies to flesh out the details later.
But the mood has changed since November and "buy now, I'll explain later!" isn't having the same effect. Americans don't seem so keen on dutifully swallowing another murky and expensive government plan, certainly one with the personal implications of health care. With the $787 billion stimulus, the slipshod cash-for-clunkers program, and the abomination that is cap-and trade, we've seen how carelessly this Congress will grind out the legislative sausage if left to their own devices and put under artificial deadlines. However, there is still time for Obama to recover and the smart money is he will get something called "health care reform" by year's end.
But his White House seems stuck in a campaign mentality that serves neither his agenda nor the country well.
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Posted By: Jahfre Fire Eater
Date: 2009-08-21 14:04:48
Hi Matthew,
Good article.
 Supporters and promoters of any "reform" that doesn't include ending government competition with private businesses and charities are willing to ignore the likely disastrous consequences for the glory of the political victory. Yet they claim to do so out of compassion for uninsured or outrage against the insurance companies. Its just plain ugly and petty as far as I'm concerned.
Sure the insurance companies benefited from the government involvement. Incrementally, the progressives lured the insurance industry into the role of the greedy villian. No doubt they were willing but now the end-game is afoot. The government that has ensured their villian status is now going to save the day by stabbing the villian in the heart. Rah, rah.
The funny thing is that this theater has been played in so many podunk towns and villages that everyone knows the ending. Constant cuts in coverage, constant decrease in quality and quantity of care, constant drain of top talent toward better opportunities, citizens become viewed as liabilities rather than as assets and partners in prosperity, etc. these things are the consequences of government competition with private enterprise and charity. Call it socialism, call it fascism, call it whatever feels right on your tongue...the consequences don't change.
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