The “We-They” “Do It Our Way, Now” ”We’ll Tell You Later What’s In It ,” “It’ll be Great” Approach to Health Reform

Theirs not to reason why. Theirs but to do and die.

Alfred North Tennyson, Charge of the Light Brigade

Why is Obamacare floundering? Why do Americans oppose it? Why have 20 state attorney generals brought a lawsuit challenging its constitutionality? Why, if they regain control of the House, are Republicans threatening to hold hearings designed to dismantle it one piece at a time, defund it, and even repeal it?

The reasons why may lie in narcissistic attitudes. These attitudes include: It is We against They. It is Our Way or the Highway. Our Way is the better way. Only Our historic legacy counts. Do it now when We have the majority. Pass it now, read it later. We have a mandate. The American people will believe whatever We say. The Devil with the details, the details will take care of themselves.

Overconfidence, when mixed with intellectual arrogance, a feeling of moral superiority, and ignorance of how what you do impacts people on the ground, in this case, doctors and patients, can be a dangerous thing. So can ramming legislation through under questionable circumstances.

Revenge can be a powerful emotion.

Details can be important. So can unexpected adverse consequences, such as soaring costs and millions of people losing their present health plans. Reform is costing more than thought. Insurers are raising premiums and dropping out of the market. Employers are dropping coverage because they regard it as unaffordable. Let the government take the hit.

Insured Americans are screaming foul for fear of losing their present plans , and seeing costs elevate and benefits shrink as they face the mother of all open enrollments seasons (“What’s Happening to Your Health Plan, WSJ, October 9).

The States, who will bear the costs of Medicaid expansion, implementing health-insurance exchange, and reorganizing their insurance markets , are dragging their feet as they contemplate paying for millions more Medicaid recipients and installing health exchanges ( “How to Reform Obamacare Starting Now: States should steer the mandated health-insurance exchanges in a pro-market direction and dare Washington to stop them,” October 14, WSJ).

The lawsuit of States against Obamacare may proceed (“Challenging Health Law, Suit Advances,” NYT, October 14).

Physicians believe they will be negatively affected and are threatening to drop or refuse to accept new Medicare patients (“Obamacare and Its Impact on Doctors, “WSJ, July 19, 2010.

Expected-to-be Republican Majority leader John Boehner announces plans for hearings on Obamacare (“Today's Opinions: Broken Promises, Boehner's Plan B And Implementing Reform”, Kaiser Health News, October 14).

Promises may be hard to keep when you have two years to go and a determined political opposition, maybe soon to be in the majority, and bent on payback.