Friday, January 22, 2010

Doctor Shortage - Health Reform - Hindsight and Foresight

A health care reform prophet must be something of a contortionist. He must have one eye on the horizon, one eye in the rear view mirror, his nose in the air, his ear to the ground, and his finger in the wind.

He may claim selective 20/20 hindsight, but his foresight is more likely to be 20/200.

In hindsight, my book OBAMA, DOCTORS, AND HEALTH REFORM, written in the Spring of 2009 and published in June 2009, possessed some 20/20 insights. I predicted, among other things, that President Obama would,

• get only about one-third of what he wanted in health care: I did not say which third but I did say the changes would be incremental rather than monumental;

• underestimate the complexity and adaptability of the system ( I called the system a “whirling Rubik’s Cube with interchangeable moving parts, each with its own agenda, axes to grind, and oxen to gore.”);

• overestimate the power of electronic medical records and their “meaningful use,” indeed that the $20 billion devoted to IT might be an unprecedented boondoogle or boongoogle;

• overlook the realities of the looming physician shortage which will be the next health care crisis, which will be all about lack of access to doctors;

• misunderstand the American culture’s center-right nature and its proclivity for access to technologies, its impatience with waiting for care, its desire for personal private choice, its distrust of government bureaucracy

• sign something into law rather than allow nothing happen and claim an historic legislative victory.

• Not achieve simultaneous restructuring of the health, financial, automobile, energy, and educational sectors because it is simply too much too soon and costs too much.

But I did not foresee,

• Persistent unemployment, officially 10% but effectively 17%.

• Dropping of Obama approval ratings from 70% to 50% or less.

• Decline of public approval of health reform bills to the 32% level.

• The rise and potency of the Tea Party Movement.

• The Scott heard around the world, viz. Republican Scott Brown’s astonishing Senate victory in Massachusetts, the bluest of the blue states.

I have no idea of what will evolve with health reform. The political dynamics are uncertain. President Obama has indicated Senator Scott Brown must be part of the process, and House Leader Pelosi says she does not have the votes in the House to approve the Senate Bill. I expect a pared-back, deliberative, bipartisan bill to arrive over a greater time span. That may be more of a hope than a prediction.

But to get an educated guess of what might happen, next Tuesday, January 26, I will interview Senator Tom Coburn, Republican of Oklahoma. In addition to being a Senator, Coburn is a practicing physician ( he spends 3 hours each early morning see Ob-Gyn patients) and possesses deep insights into the implications of the Scott Brown factor and what it portends for physicians and patients and the health care industry.
We shall see how his views jibe with those of President Obama, who, on January 27, will deliver his first State of the Union address.

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