Thursday, December 20, 2012

Political Partisanship and Physician Leadership
The partisan, when he is engaged in a dispute, cares nothing about the rights of the question, but is anxious to convince his hearers of his own assertions.
Plato (c.426-348 B.C), Dialogues

There is nothing which I dread so much as a division of the republic into two great parties, each arranged under its leader, and concerting measures in opposition to each other. This, in my humble apprehension, is to be dreaded as the greatest political evil under our Constitution.

John Adams (1735-1826), Second President of the United States
Leadership and learning are indispensable to one another.
John F. Kennedy (1917-1963), Remarks prepared for delivered at the Trade Mart in Dallas, November 22, 1963
December 20, 2012 -  Physician leaders are slowly learning to deal with political partisanship.  This is apparent in dealing with Obamacare, passed in March 2010, by a Democratic Congress without a single Republican vote, an unprecedented political act for a law affecting every American in a country governed by two political parties.  In effect, this power grab of the health system,  which has never been popular with the American people, poisoned the political well and deepened the political divide between Democrats and Republicans.
The partisan composition of Congress, Governorships, and the Presidency is now.
·         U.S. Senate – 53 Democrats, 45 Republicans, 1 Independents

·         U.S. House of Representatives – 199 Democrats, 234 Republicans

·         Governors,  20 Democrats, 30 Republicans

·         Presidency (popular vote)m  50.6% Obama,  47.8% Romney
Obamacare is now in the process of being implemented.  A Democratic President and Senate iare in control, but are blocked by a Republican House and Republican Governors, most of whom do not approve of Obamacare and make its implementation difficult because of budgetary overruns and fear of loss of state sovereignty.
Surveys indicate physicians  disapprove of Obamacare by about 2:1 to 3:1 margins, and polls of the public reflect a 60% disapproval.  Yet physicians depend on Medicare for their levels of reimbursement, and government this year will spend 50% of total health care dollars.  

In this partisan  environment,  physicians, who generally prefer a competitive market environment to government control,  feel powerless and demoralized to change things,  as reflected in a recent Physician Foundation survey of 630,000 physicians. Furthermore, the AMA, which backed Obamacare,  has lost much of its credibility among physicians. Only 15% of physicians now belong to the AMA.   American physicians feel leaderless.   This is aggravated by the fact that the Obama administration tends to dismiss physician suggestions for reform – HSAs, market competition, tort reform – with a wave of the federal wand,  and a curt dismissal of teh opposition. .
Exit polls after the November election compound the sense physician helplessness. The  polls clearly indicate the public expects government, not market competition, to “fix"health care its  high health costs, limited access, and runaway entitlement costs. 

This is evident in these poll numbers of voters about National Health Policy issues (“Implications of the 2012 Election – The Voters’ Perspective,” New England Journal of Medicine, December 20. 2012)
·         What should happen to the 2012 Health Law?

Obama voters, expand 49%, repeal 2%

Romney voters, expand 3%m repeal 48%

·         Favor government efforts to make sure most Americans receive care.

Obama voters, 92%

Romney votes,33%

·         Favor government fixing the health system.

Obama voters, 85%

Romney votes, 53%

·         Medicare should continue as is.

Obama voters, 83%

Romney voters, 43%

·         Medicaid should continue as it, with feds and states jointly paying

Obama voters, 78%

Romney voters, 30%

·         The government should increase regulations on insurance companies doctors, and hospitals to control costs

Obama voters, 41%

Romney voters, 20%

·         Government should make large cuts in Medicare to cut federal budget deficit

Obama voters, 57% oppose

Romney voters, 41% oppose

·         Government should make large cuts in Medicaid to cut budget deficits

Obama voters, 77% oppose

Romney voters, 56% oppose

·         Raise taxes on those making$250,000 to raise revenue

Obama voters, 88%

Romney voters 35%

These partisan differences create problems for physician leaders, for the differences make it difficult to change the political dynamics.   If you advocate market-driven changes or changes favoring the”rich” (many physicians make over $250,000), you are perceived to be  a Republican partisan, acting against the best interests of the old and the poor and the sick.

Consequently, physician leaders are often split or muted  in their health reform views.  Not all. Dr. Donald Palmisano, a widely respected physician leader and author of “On Leadership,”  feels physicians should take a courageous and bold stand by advocating free enterprise, entrepreneurship, and patient choice over government control. 

Yet the political odds seem stacked against physician autonomy. In a Wall Street Journal interview yesterday “Cleveland Clinic Diagnoses Health-Care Act, “ Delos “Toby” Cosgrove, MD, a heart surgeon and  Cleveland Clinic CEO concludes  of Obamacare, “it’s going to be a faster move towards one payer. Increasingly people think that in 10 years you’re going to have 75% of the health-care costs paid by the federal government.”

I hope not.  This week Wall Street analysts predicted a 20% to 30% increase in health care premiums and costs because of Obamacare.  I’m afraid we’ll see more of the same  cost escalation in Obama’s second term.

The American creed is: One, the majority rules,  Two; equality opporunity but not equal results for all.

The questions are - Does the majority rule for you?  Or does it rule to make itself bigger and more powerful? Does it provide equal health care opportunies for all, or just  for these it favors?
Tweet:   For controlling health costs,  Obamacare may be the problem and not the solution, but voters remain unconvinced of this reality.


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