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  • Yeah, I’m not really feeling it Mr. President

    Posted by onparkstreet on September 11th, 2009 (All posts by )

    Our dear President recently delivered an important speech on health care. Sample excerpts are provided below (in italics) with select commentary by yours truly – a busy working physician with no real expertise in health care policy. I do, however, have a keen sense of  ‘so, this is probably gonna hurt, and hurt bad, right?’

    There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

    That’s a nice summary of the issues, Mr. President. So, what do you think?

    While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

    I’m keenly interested in those significant ‘details to be ironed out,’ sir. Is it okay if I remain skeptical about your plan until you, and related House and Senate committees, are done with the ironing? Although, I may not be too pleased with the cuffs-and-collars once that crew is through…..

    And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

    Hey, it’s nice to call me a friend (although, I’m not really feeling it for the GOP these days, either), but I sense a problem with your logic. If someone is making a wild claim, what legitimate concerns would that person have?

    Second, we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse.

    Oh, so that’s where we’ll find my legitimate concerns. Most of the plan will be payed for by savings within the existing health care system, you say? I’m sure that will happen. Also, I might be Angelina Jolie. That’s about as likely, sir.

    So, to review: the left and the right disagree, the plan ain’t all worked out, quit complaining about it anyway, Republicans, and pixie dust will pay for everything. Got it! Not making wild claims, sir, just kidding around. Because, this is gonna hurt, and hurt bad, isn’t it?

     

    10 Responses to “Yeah, I’m not really feeling it Mr. President”

    1. Andrew_M_Garland Says:

      The government demands detailed, researched Environmental Impact Statements before starting a building. We should have Official Policy Impact Statements before our representatives change our society.

      We need proposed results, expected evolution, methods, justifications, comparative studies, past successes of similar policy, funding sources, expected difficulties, the works. What has worked, not what might work.

      I hope people of all parties and positions could agree that this is fundamental. It is non-partisan to demand that the President and all politicians show how they have carefully researched their proposals.

      No company can run without books of account. No government can write legislation without a plan in the background. The plan is there. Let’s see Obama’s written plan. Then, he can talk about it.

      The Congress and Obama should proudly present their careful research that supports their proposed rearrangement of healthcare. Obama is a Harvard trained law professor. He should be up to it.

      Where is the policy paper, Obama’s research on healthcare reform?

    2. elf is healthy Says:

      @A Garland,

      Re: Policy Impact Statements

      Dude, if they did that (even if they could) we’d run them all out of town. The closest we got was the CBO Trillion dollar bill projection of cost. That just gets poo poo’d. A wild Republican lie, doncha know.

    3. Andrew_M_Garland Says:

      @elf is healthy,

      If there is a carefully researched policy, we can discuss it.

      If there is a sloppy, contrived policy, we can criticize it.

      If there is no policy document, we can laugh at them.

      So far, no one with a following (press or blog) has asked our politicians for the document that “must” be there. And, this is something that most people can understand is basic to a good government.

    4. onparkstreet Says:

      Thanks, both, for the comments.

      @ Andrew M. Garland –
      “We need proposed results, expected evolution, methods, justifications, comparative studies, past successes of similar policy, funding sources, expected difficulties, the works. What has worked, not what might work.”

      I had thought reading HR3200 (several online groups set up pages where you could read and comment on various features of the proposed bill), and the comparisons to Medicare/Medicaid, the Massachusetts health plan, and various failed state plans, sort of did this? Can you give me a specific example of what you mean? Has this been done before for any previous legislation in the way you ask? It all sounds very intriguing. Thanks.

    5. Andrew_M_Garland Says:

      To Onparkstreet,

      Our political debate is confused by a lack of accountability. What is the President’s or Congress’s plan?

      A bill specifies a collection of actions. We can try to infer why those actions are specified. Because of the complexity, we even have to infer what actions are specified. This leads to public confusion and distraction.

      A bill doesn’t present the investigation or thought, the “why” behind those actions. You and I may regard Obama’s plan to be similar to Medicare or Massachusetts’ plan, but we can’t pin down any politician. That is only our inference. We can claim that Obama’s plan will be expensive and rigid similar to Massachusett’s plan, but we have no statement that it is intended to be similar.

      What do they see as similar to their proposals? What do they intend and why, in readable form? What are the justifications for the choices made? What successful programs are being emulated? If they are going to save money, then exactly how will they do this, and how much will be saved? On what do they base their estimates? Where is the spreadsheet? Is this a bright idea proposed for the first time, or does it follow successful action on more limited scales or in other places or countries?

      They are proposing the new laws, so they should justify the details of why they are a good idea. Obama has not pointed to any justifications of his “plan”, whatever plan that may be. We have heard politicians say that they don’t know what is in the bills being written, so they can’t comment.

      What are the bills being written from? What is the basis for writing anything?

      An analogy is building a house. The architect investigates the client’s desires and documents what the client wants, how that can be expressed in the building, and what the tradeoffs are. The production of blueprints follows from this requirement specification. Drawings are produced to illustrate the blueprints. Otherwise, the customer can not understand or visualize what he is getting. The blueprints (the bill) are not enough for understanding.

      Has this been done before? I don’t know of the government formally doing this for legislation. The government asks for a lot of this, as in environmental impact statements for construction projects.

      However, can anyone imagine writing a complicated bill without such a policy document in the background. As I say above, if Obama is changing healthcare without a careful investigation and justification for the proposed changes, then we must laugh at him. If there has been such a justification, then let’s see it. Will he say that the government researched the problem but didn’t write down the facts?

      I see this as a way to pin down the government. Did they do research or not? Maybe the research is convincing, and at least they have to point at a written document and say “we believe in this”. If there is no research, we have a basis for laughing at them. It is about accountability.

      Thanks for asking.

    6. Dr. Value Says:

      Thus far our government has done suck a splendid job of managing the 50% of health care they pay for and regulating the other 50% that I have grave misgivings about turning over the whole thing. Some of the biggest fundamental problems they have are as follows:

      One

      They pay large amounts of money for behaviors they do not want and then seem surprised they are getting those behaviors. They totally fail to reimburse for beneficial behaviors and then bemoan the fact people are not exhibiting these behaviors. There are many examples but perhaps my favorite is the $50,000 per case for coronary artery bypass surgery. There is no evidence it prolongs the life of most recipients while there is ample evidence linking the procedure to cognitive impairment, disability and depression. There is no reimbursement for management of an exercise, diet and counseling program when the evidence shows that such programs not only work better than bypass but also that they have no side effects and numerous additional beneficial effects.

      Two

      The government has nearly succeeded in regulating competition from the health care system and driving consolidation into a few large fixed cost systems in each metropolitan area. Any fixed cost business (Hospital costs are 84% fixed) survives by keeping as full as possible. A recent example of how the government is driving out competition is the 2010 reimbursement schedule for services. There you will find that a cath lab owned by a cardiology group will get just at $500 for performing a cardiac catherization, while a hospital cath lab receives $3,000 for the same service. Is it any wonder that cardiologists all over the US are selling their practices to hospitals and getting large raises from the $2,500 difference.

      There is more lunacy, but this should give you a flavor for what it is like in my industry.

    7. Ginny Says:

      Off topic but curious: I am surrounded by people who’ve undergone bypass. Some of them had heart attacks in their forties or fifties and now are dying in their eighties. I’d thought the surgery was part of the reason they stayed around another thirty or forty years. Of course, my mother had one and died of a heart attack a couple of years later – it didn’t seem to demonstrably lengthen her life. I’m just asking – where can I see (preferably in easy to read layman’s terms) some simple description of what experience, statistics, research, whatever, has shown? (I would not be surprised if such decisions might not be in the future since about everyone in both my husband’s and my family died from heart attacks – ranging from his father at 47 to my grandparents in their late eighties.)

    8. Shannon Love Says:

      Ginny,

      I don’t think Dr. Value is correct about the usefulness of coronary artery bypass surgery. From my reading, once major plaques have formed in an artery, diet and exercise will do little to remove them (at least in a time span of under 5 years.) Since it takes only on thick plaque in the exact wrong place to kill a person, not routing the blood supply around the blocked region is very dangerous.

      There really aren’t any magic bullets. IIRC, roughly 60% of us will die of something related to the failure or our heart or circulation system.

    9. onparkstreet Says:

      Ginny, I’ll ask some of the people I know, but fair warning, they often take quite a bit of time to get back to me :)

    10. Ginny Says:

      Thanks to both of you and sorry about high-jacking the thread.