Wednesday, December 30, 2009

Obama Health Reform Grade - Obama: A to C- On Health Reform

President Obama, in a recent Oprah Winfrey interview, gave himself a “solid B+” for his overall performance for his first year in office.

Frankly, it is beyond my pay grade or competence to judge Obama’s overall performance. I will leave that to the American people, who will have their first chance to register their opinion in the November 2010 off-year elections.

I give Obama a weak C- on health reform. This puts me somewhere in the middle of the opinion spectrum.

• Uwe Rinehart, the Princeton health care economist, gives Obama an A- in a Health Affairs blog.

• David Brooks, the New York Times columnist, gives him a B.

• Jeffrey Flier, MD. Dean of the Harvard Medical School, gives Obama a “failing grade” in a November 17 Wall Street Journal Op-Ed piece.

Flier’s article, coming out the rarified pro-Obama atmosphere of Boston, surprised me. Flier reasons, “There are no provisions to substantially control the growth of costs of quality of discussions with dozens of health-care leaders and economists, I find near unanimity of opinion, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending, rather than restrain it...In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system– now with many more participants. This will make an eventual solution even more difficult. Ultimately our capacity to innovate and develop new therapies would suffer most of all.”

Flier cites the Massachusetts example, where coverage was expanded and costs exploded over the last three years of a universal coverage plan. In Massachusetts, a “Special Commission” has decided capitation will be needed to replace fee-for-service to control costs. :Unfortunately," Flier says, "The details of such a massive change are completely unspecified...We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.”

Which brings me to my C- grade.

I like certain things about reform proposals- expanding coverage to 31 million uninsured and covering those with pre-existing illnesses. I dislike others - not allowing consumers to shop for plans across state lines. limiting tax deductions for HSAs, taking no real action on tort reform.

Obama and the Democrats are telling us government knows what is best and they are not the slightest bit interested in what people or doctors think. They are not interested in what dissenting authoritative experts have to say; they are not interested in holding hearings on the final proposals; they are not going to let Republicans contribute to the negotiations; they do not give a damn what others thinks.

They ignore overwhelming and exploding public opposition. They believe a new Medicare Commission ought to have the power to overrule doctors, and government has the right to choose cheaper alternatives to expensive care.

Democrats are simply obsessed with making “history,” even in the face of countervailing opinions and empirical evidence that what they propose might not work.

I find such “top-down” power brokering arrogant and ignorant. It is arrogant in that it thinks it knows best while the public and doctors know least and in that it practices financial sleight-of-hand, such as taxing immediately and delaying benefits for 4 to 6 years.

It is ignorant in ignoring such fundamentals as the growing doctors shortage, which grows worse by the day; in believing that all Medicare payments ought to be equal for all regions of the country, no matter what the poverty levels in those regions; in preaching the gospel that EMRs, preventive care, and coordinating care will somehow save more towards the end of the decade, despite evidence to the contrary; in believing you can cut $500 billion out Medicare without cutting benefits; in finessing and hiding such issues as market and consumer-driven care, which has been shown to control costs and enhance quality through competition; and in failing to acknowledge that American medical technologies are the best in the world and that the health care sector is one of the few economic growth sectors.

1 comment:

Richard L. Reece, MD said...

A self-correction. I have learned President Obama said if health care passes he will deserve an A- for this first year in office. Academic grade inflation, alas, has extended to government.