Ask Not: Health Reform Propositions

And so, my fellow Americans, ask not what your country can do for you: ask what you can do for your country.

John F. Kennedy, Inaugural Speech, January, 1961

The best book title I have run across recently is Ask Not. The book’s author is Thurston Clarke. Clarke is the author of eleven books, the most recent of which is The Last Campaign: Robert F. Kennedy and 82 Days That Inspired America (2008).

Clarke’s present book’s title is short. It is precise. And it evokes the image of President John F. Kennedy’s famous inaugural address. The book’s subtitle is The Inauguration of John F. Kennedy and the Speech That Changed America.

Kennedy's proposition is powerful and masterful as a speech theme. It is direct. It is personal. It provokes and inspires the listener. And it mobilizes the mind. What can you do for your country? It galvanized the Peace Corps, Civil Rights movement. It helped win the race to the moon.

Ask Not got me thinking. Perhaps a similar proposition could be applied about health reform. It might go like this:

And so, my fellow American politicians, ask not what you can do for yourselves, ask what you can do for your fellow Americans.

These propositions logically follow.

Ask not what the health reform law can do for you, ask what it has done after its passage 10 months ago. One chamber of Congress has voted for repeal by a margin greater than passed it. More than half of the states have challenged the constitutionality of its individual mandate. The law remains unpopular by 55% to 40% among Americans. Health spending and premiums are soaring at a 10% clip. Claims that it will allow you to keep your health plan have proven false.

Ask not what the health reform law can do for you: ask what it does and does not do for your fellow citizens. What it does in the short term, between now and 2014, is provide poll-proven popular benefits for 12.4% of Americans – coverage for children with pre-existing illness, young adults under their parents’ plan; reduced prescription costs for seniors in the Donut Hole. What it does not do is provide cost relief for the other 87.6% of Americans; offer any tangible or believable cost controls; or provide any hope that Americans will be able to keep their current coverage.

Ask not what the health reform can do for you: ask what it will do to the nation’s growing deficit. Ask who is more honest, those who fed the CBO figures leading to an estimate that the reform bill would save $230 billion between 2014 and 2020; or those who say the true costs will be $2.3 trillion between 2014 and 2024. Charles Krauthammer,MD, puts it this way: "Suppose someone - say, the president of United States - proposed the following: We are drowning in debt. More than $14 trillion right now. I've got a great idea for deficit reduction. It will yield a savings of $230 billion over the next 10 years: We increase spending by $540 billion while we increase taxes by $770 billion. He'd be laughed out of town."

Ask not what health reform can do for you and for Inside-The-Beltway experts: ask who should control health care decision-making – bureaucrats or doctors and patients. Britain has made its decision; its 42,000 general practitioners, not National Health Center bureaucrats, will decide how the money is disbursed. Where will be the U.S. government come down on clinical decision making? Will it be experts inside CMS and HHS, with their protocols, guidelines, checklists, algorithms , outcomes analyses, and exchanges who decide, or will it be patients and doctors at the point of care.

Ask not what government health reform can do for you: ask what enterprising and innovative markets can do for your fellow citizens. Do you believe that top-down government has more wisdom than people on the ground: physicians, entrepreneurs, patients and people themselves? Do you believe government has the capacity for disruptive innovations that will lengthen lives, restore health and life style, and bring medical breakthroughs to bear? You may be right. but history is not on your side.