Friday, February 26, 2010

Do-or-Die - health summit - mpression of Health Summit

My impression of the health care summit was that it was unlikely to change anybody’s mind. It did not change mine. Those who believe government is the answer will continue to think so. Those who advocate market solutions will remain firm in their beliefs.

The President deserves praise for bringing partisans together. It was the right thing to do. The conference aired clear differences and strategies.

The summit was not, to use President Obama’s favorite expression, a “game changer.”Yet it was a long overdue meeting. It should have been held long ago, at the beginning, not the end of the reform process.

One Republican stratagem was to use the hefty 2700 page bill with Obama’s 11 page summary on top as a prop. They then read aloud selections from it. Through the use of Democrats’ own words, this technique scored points.

The Obama rejoinder to criticisms for excluding Republican views from the bill was to say everything you’ve mentioned is already in the bill, and we’ve thought of it before. I found this approach vague and less than edifying or electrifying.

My conclusion? President Obama will continue to lecture Republicans, and Republicans will continue to hector Democrats. Democrats will try to “ram” or “jam” a bill through by a simple majority using “reconciliation” – a misnomer for literate laymen.

Republicans will accuse Democrats of defying the will of the American people. If reconciliation succeeds in March, Blue Dogs will fall in November.

Democrats maintained their bill controls costs, overhauls insurers, reduces deficits, and expands coverage. Nonsense, said Republicans, the bill does not control costs, raises premiums, expands deficits, and pushes more people into Medicaid.

The most effective speakers were,

• Republican Senator Lamar Alexander of Tennessee , who laid out the case for tort reform, marketing across state lines, and health savings accounts;

• Republican Senator Tom Coburn of Oklahoma, who bluntly explained why fraud and abuse are the real culprits;

• Democratic Senator Tom Harkins of Iowa, who said we must stop “segregation” on the basis of disease, just was we stopped segregation on the basis of color;

• Democratic Senator Kent Conrad of North Dakota, who said 5% of people with chronic disease consume 50% of costs and called for disease “coordination “or Medicare will collapse;

• Representative Paul Ryan of Wisconsin, who explained the true cost of the bill, was $2.5 billion, not $ 1 billion, mostly because of “smoke and mirrors.”

As for President Obama, he was defensive and less than convincing about “bridging the gap” and “reaching broad areas of agreement.” He seemed particularly hung up about the unfairness of Medicare Advantage plans. He returned to that subject again and again. I found his crack at Senator McCain for continuing to campaign demeaning.

Reform is likely to be settled by an up and down vote. President Obama may choose to “go small” rather than getting “nothing at all,” an intolerable political defeat.

One thing missing was a more vivid highlighting of why the American people resist Obamacare. After all, an average of seven recent nationwide polls indicates only 40% of Americans favor the Obama plan while 51% oppose it.

What do the people want other than lower costs? It was not clear from the summit, but according to Rob Lambert, a physician in the Southeastern United States, in a letter to President Obama, entitled “Dear Mr. President” and appearing in today’s The Health Care Blog,

1. People want things to get simpler.

2. People want access to their medical records.

3. People are very suspicious of big health organizations and big government.

4. People want a less secretive system.

5. People think the President it out of touch with them, should stop playing with their lives and money, and should stop acting like he is part of an elite ruling class.

As for me, I think the country is too big, too diverse, and too complicated for a one-size-fits-all bill to be directed from above.

The President should level with Americans about what is necessary and possible and take incremental steps to do what needs to be done. Government has neither the resources nor the wisdom to solve every problem with one bill.

No matter how many experts it consults or how many pages of legislation it writes, it cannot anticipate all consequences.

What succeeds in reforming the system will depend on how individuals, patients, doctors, employers, and others respond to incentives.

Government cannot dictate, it can only catalyze results. Achieving health and productive lives rests with responsible individuals, not with government bureaucrats.

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