Saturday, May 19, 2012

Obama – The Health Care Amateur
It is true that  you may fool all the people some of the time; you can even fool some of the people all of the time; but you can’t fool all of the people all the time.
President Abraham Lincoln (1809-1965), to a caller at the White House
Barack Obama is an amateur!
President Bill Clinton (1946    )quoted in The Amateur: Barack Obama in the White House (Regnery Publishing, Inc,  2012)
May 18, 2012 -  I’ve been reading Edward Klein’s The Amateur: Barack Obama in the White House (2012).  Klein harshly portrays President Obama as a political amateur. 
Too harshly in my opinion -  as a failed black Abraham Lincoln want-to-be,  as an arrogant know-it-all, smartest-guy-in-the room, who ignores advisors, alienates allies, and angers enemies;  as someone who sought universal health reform at any cost; and who shunned the advice  of Emanuel Rahm,  his chief of staff, who told  him to go slow on health reform.  

Still, as president, you can''t please all the people all of the time.  Campaigning and governing are different kettles of fish.
As a physician,  I see some truth in the thesis of the book: that Obama is an amateur in politics.  

When it comes to health reform,  incremental health reform: pleasing some of the people some of the time is the way to go.  Some reform is needed, but not at the cost of totally excluding and alienating Republicans, who with the Independents represent 60% of the population.  
That was, and is, formula for fatally poisoning the political process.  But Obama offers no compromise.  It is his way, the Obama,Pelosi, Reid  way, or the highway.
But Obama's pure, unilateral,  ideological  stance came at a tremendous cost – it poisons his relationship with Rebuplicans and broad swathes of the medical industrial complex but seniors as well.  Older voters do not buy the notion that you could cut $575 billion out of Medicare,  end Medicare Advantage,  shift $500 billion or so to Medicaid,   while  saving money and increasing benefits through greater government “efficiencies.”
From the onset of Obama reform, it was clear Obama was a rank amateur on nealth care matters. 
Obama   did not  seem to  comprehend that:

·       More than 4 of 5 Americans liked their health plans.

·       Americans expect immediate access to high-tech life and life-enhancing technologies.

·       Americans do not like to be told what to do by government experts.

·       Americans prefer to pick their own specialists rather than going through gatekeepers.

·       Americans, according to Gallup,  trust doctors more than government or health plans.

·       Americans are emotionally and personally driven rather than data driven when it comes to picking doctors and hospitals.

·       Americans are more impressed by results – lower costs, more choice of providers,  greater access, and higher quality – than promises on those issues which never seem to materialize.
Above all, you do not turn around an employer-based  health system – which has been evolving since World War II  and which covers 200 billion Americans -  on a dime,  And you do not do it by creating uncertainty and by  driving up taxes and costs for the business community which finances that care.  It is best  not to  anger business in a capitalistic society, for business hires workers and creates prosperity.
Tweet: On matters of delivering health care with greater access, lower costs, and better quality - President Obama is looking like an amateur.

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