Saturday, May 3, 2014

The Enormity of the ObamaCare Whale

Strong against the tide the enormous whale
Emerges as he goes.

Christopher Smart (1722-1791), English religious poet, in  Song to David

What follows is a talk I gave before a small group of hospital chaplains.  As I was giving it, the enormity of what President Obama is trying to accomplish hit me – to deliver  10 “essential “ comprehensive health benefits to the entire population without questioning the health risk of those covered or the financial risk to the insurance industry or the national budget. The enormity of the task was heightened by the fact that I was talking in Hartford.    Hartford deems itself the  “insurance capitol.”  Hartford is home of Aetna, the nation’s 3rd largest health insurer.  Aetna’s CEO,  Mark Bertoli,  is a reluctant participant in ObamaCare health exchanges and says ObamaCare premiums, to be announced in late May or early June,  “may double.”  If this doubling should occur for Aetna and other plans, it will enormously increase the stakes for the November midterm elections.

Co-Presentation with my Son, Spencer Reece to the Hospital Chaplains at Hartford Hospital

Poetry and Health Reform Readings
The art of reading is to skip judiciously.


Richard L. Reece, MD, Rotating Intern, Hartford Hospital, 1960-61, Resident in Pathology,  1961-1965, Editor, Hartford Hospital Bulletin,  1964-1965

It’s good to be back at Hartford Hospital.  

 I trained here. I met my wife here.  My son, Spencer, was born here. I started my professional and writing career here. I edited the Hartford Hospital Bulletin here. I was here in the great Hartford Hospital fire of 1964.  I have given two talks here, one on the automated medical laboratory of the future and another a roast for Doctor Ronald Beckett, a pathologist, a wonderful human being, and my mentor.  I was here when I had hair.  Oh well, here today, or hair today,  gone tomorrow.

It is an honor to be back, this time on the same podium with my son, a priest and a poet.  Spencer will give you a poet’s view of the world. I shall share with you a physician’s view, mostly in prose with a smattering of poetry.  I do not fall far from my son’s tree, nor he from mine.   

Think of  this as a Father, Son, and Holy Smoke presentation.   I will supply the smoke and Spencer will either bless it or blow it away with his beautiful lyrical poems.

Five Readings

I shall do five readings about health reform. Some are serious, others less so.  
I have written 12 books and 3450 blogs on medical innovation and health reform.  Expression, as  you can plainly see,  is the need of my soul.  

Writing Credo

I believe in  creativity, clarity, brevity and levity.   I have sought to achieve these goals in my writings.

My writing credo is:
Seek brevity,
With a touch of levity,
In short
Be terse

For nothing
Is worse
Than verbal
To this verse, I  would add this maxim, which I learned from surgeons:
“When in doubt, take it out.”

Before I begin my five readings, let me make it crystal clear that I regard health reform as the most serious, personal, emotional,  profoundly human, deeply moral issue of our time.    There are no easy answers. 

Participants in the health reform debate tend to be full of gloom and doom if the other side prevails.  Yet we all agree there must be a social safety net. I hope to show  it is possible to be serious without being delirious or deleterious  , to disagree without being disagreeable  or foreseeing the inconceivable., while keeping this epigram in mind:   one man’s verse is another man’s curse.   If one is a poet, sometimes one must take the ode less travelled, even if one is a bad poet, as I am.   Bad poetry is better than no poetry at all.  There is always gloom for improvement.

This will take 15 minutes, with an average of 3 minutes per reading.
First Reading
The first reading is from a blog called the “Cookie Monster.”

Me want cookies? Me eat cookies! Me eat anything and everything!

The Cookie Monster, Sesame Street

“The new health reform law's cookie monster will always be eating. Its appetite is insatiable. It will eat in broad daylight. It will eat at night. It will eat behind closed doors. It will eat your breakfast and lunch. It will eat your dinner. It will eat your assets. It will eat the national budget. It will eat 24 hours a day, 365 days a year. It will always be raiding your cookie jar. It will eat things you are not even aware of. It will even eat your money.

• Starting in 2013, if you earn more than $200,000 as an individual or $250,000 as a couple, it will eat 1.45% to 2.35% of Medicare Part A.

• That same year in that same group, it will start eating 3.8% of your “unearned income” – investment proceeds from partnerships, royalties, and rents.

• Between now and 2018, if you are an insurance plan bogeyman, it will eat $47.5 billion. After that it will eat $14.3 billion a year. Along the way, you will be emptying your cookie jar to pay more for premiums.

• Through 2019, it will eat $16.7 billion out of drug company proceeds, and $2.8 billion a year thereafter, causing you to take more out of your cookie jar to pay for drugs.

• It will eat $2 billion a year out of the profits of sales of medical devices- pacemakers, prosthetic limbs, and insulin pumps - more out of your cookie jar if you need these things.

• On July 1, 2010, it began eating 10% out of the profits of tanning salons.

• In 2018, it will tax and eat 40% of the costs of Cadillac health plans.

• It says it will even eat its own entitlement, though it has never eaten an entitlement before. Federal cannibalism is unknown. Yet from 2010 to 2020, it says it plans to eat $716 billion out of Medicare by eating away at Medicare Advantage plans and payments to doctors and hospitals.

• From 2014 to 2024, it will eat $2.5 trillion out of the federal budget.

What a cookie monster is health reform! 

He  is like a big baby- an alimentary canal with a huge and growing appetite at one end and no end in sight at the other.  He keeps saying,”Me want cookies!” The trouble is: its cookies are your cookies too.  "
Second Reading
The second reading is from my 1988 book:  And Who Shall Care for the Sick?   The Corporate Transformation of Medicine in Minnesota.  

In that book,  I predicted a doctor shortage and a public backlash against managed care.
“I shall discuss the struggle now going on for control of health care.   The struggle is mainly between the management of corporations and physicians. It is a struggle for power. ..The government, economists, and leaders of large organizations favor the corporate strategy because it is way of making physicians behave economically.”

Managed care and large corporations have set a agenda for health reform, which concentrates on managing costs and  inproving  outcomes while cutting hospital rates, reducing doctor incomes, and herding doctors, hospitals,  and patients into ever larger organizations, where doctors are easier to monitor and control.  Individualism is out.  Group control is in.

Among Americans, there is now a  backlash  against ObamaCare, with those opposing it outnumbering those  favoring  it  by 12- 15 percentage points.  In 458 ObamaCare polls since 2009, 433 or 95.5% of Americans have opposed the law, 65% by double digit margins.    
This backlash exists among  physicians as well:  90% of them are advising their children not to enter the profession.

The public and doctors  are saying.  There must be a better way, let us keep our doctor and our health plan.  Fix it.  Don’t repeal it.  Keep the good. Throw out the bad.  Shall we listen to the proponents or critics of the poll, or to American voters?  I am with the voters.

I worry about the physician backlash.  Although a widespread doctor shortage exists, in the neighborhood of 50,000, and is growing every day, 100,000 doctors have opted out of health insurance plans, including Medicare and Medicaid, which cover 110 million Americans.  
After all is said and done, who shall care for the sick? What good is health coverage without doctors?   Is corporate care delivered by corporate teams preferable to care delivered by a personal physician? And where will sick patients be cared for,  as hospitals continue to close because of low reimbursements and burdensome regulations..
Third  Reading

The third reading is from The Health Reform Maze: A Blueprint for Physician Practices

The book  concerns Obamacare. Its opening quote is from that  18th century man who created the first modern dictionary,  Samuel Johnson (1709-1784).  

Said Sam,  “The road to hell is paved with good intentions.” 

The ObamaCare reform cause of universal coverage is noble,  having one heart in the right place matters,   but it may be torn into tatters.  The  road to reform is strewn with big  boulders- broken promises, cancelled health policies,  decreased business hiring,  economic stagnation, and unaffordable premiums and  $6000 deductibles.  

These obstacles raise questions: People are asking: Why have health insurance at all with unaffordable premiums? And doctors are asking: Why accept patients with health insurance when I can provide it cheaper on a cash-basis?  That is why 100,000 of America’s 900,000 doctors have switched to direct-pay practices.

The book contained this terse verse.

Government may think it knoweth,
What is best for most of us.
But the market often bestoweth,
What is good for the rest of us.

There are two ways of looking at  health care reform  – from  top –down government or  bottom-up markets.  

As Winston Churchill observed, “The chief vice of capitalism is the unequal sharing of blessings; the chief virtue of socialism is the equal sharing of miseries.” 

It’s  a hard choice.  How does one strike the balance between what lifts all boats, a growth economy; and  socialism,  which historically  has left  people  equally  miserable  in stagnant economic waters?
Fourth Reading

The fourth reading is from my E-book, just published this week, Understanding ObamaCare.    This book is the first of 3 E-books on ObamaCare. The second E-book will be titled ObamaCare Revealed,  and the third, ObamaCare: Dead or Alive?

 This blog post from the book was written to explain why everyone is so angry,  so partisan, so bitterly divided about  the Patient Protection and Affordability Act.

“Looking Back in Anger

Look Back in Anger.

John Osborne (1929-1994), title of play (1956)

Many people, especially the American public, are angry about ObamaCare .
ObamaCare is, when push comes to shove,  about anger:
·         Anger over 50 million uninsured

·         Anger over high health costs

·          Anger over health law’s unilateral unipartisan  passage

·         Anger over its mounting seemingly uncontrollable  expense

·          Anger over its broken promises about keeping your doctor and health plan

·         Anger over failure to reduce costs of premiums

·         Anger over its unanticipated consequences

·         Anger over its negative effect on the full-time economy

·         Anger over misinformation and lack of information

·          Anger over failure of political parties to compromise and reach a consensus.
Sources of Anger
This anger dates back to parliamentary chicanery surrounding the health law’s passage without a single GOP vote. Indeed, without even consulting Republicans. 
Anger over the health law was responsible for the Tea Party rise and Democratic loss of the House of Representatives in 2010.   

Anger boiled over into the 2012 Presidential campaign. 

Anger fueled use of words like “anarchists,” “terrorists,” “extremists,” and “right wing nuts” to describe the Tea Party. 

Anger culminated in the House-Senate-Presidential-Red State standoff, partial government shutdown, and threat of government default.

Momentary Insanity
Anger is momentary insanity. What began as anger has ended in hurt for many us. Shame on  both political parties. 
In the case of ObamaCare, the remedy for anger may be delay, it should be negotiation.

Fifth and Last Reading

My fifth and final reading is deemed, “Rube Goldberg Bus Nears the Cliff.” 

You’re either on the bus or off the bus.

Tom Wolfe (born,1931), author of  Electric Kool-Aid Acid Kit

Lots of people want to rid with you in the limo, but what you want is someone who will take the bus with when the limo breaks down.

Oprah Winfrey (born 1954), TV host, TV network owner

“It’s a fine bus.  It has a famous driver, driven by a transformative vision, to give free seats to the poor and have other passengers pay for them.  

It has famous designer,  “Rube” Goldberg (1883-1970), an American cartoonist and engineer who  perfected the art of designing complex machines that does simple tasks in overly complex ways, like build a bus that could carry a busload of free-loading passengers for free without anybody sacrificing anything for anybody else.

The bus’s massive fuel tank, once filled to overflowing with federal funds.  

But now the tank is running on empty. 

How to refill it?  

Should the driver lighten the bus load to get more miles per gallon, more bang for the buck?  

Should he charge paying customers more?

His bus has a powerful engine, equipped with computer-aided technologies.  It even has a website.  Future riders, the driver says,  can easily  go to a website to find a seat, correct deficiencies,  tune up the carbonator,  clear the gas lines, even refill the gas tank.  

But what to do if the website malfunctions?  What if customers can’t get on the website? What if they can't even get on the bus?

The bus rides on four big overblown wheels, built to raise the main chassis. The bus driver calls these tires the individual, employer, regulatory and religious mandates.  The word “mandate” means passengers have to follow the driver’s instructions, get off the bus, or pay more to ride the bus.  

The bus has a full -load  of loyal passengers, riding for free.  Word is out, and more free riders are coming on board every day.  Some may even be able to pay for a ride with food stamps.

The bus owners and its driver are popular with the press, who are spreading word far and wide that its seats are free for those who need a ride.   

Its only problem is that all the features of the bus and the dreams of the driver are not interconnected or widely known, nor are they appreciated  by  the public at large, who have their own ideas and who are weary of supporting the vision of the driver and bearing the expense of the bus.   

Furthermore, some are being displaced from their seats and forced to abandon seats they have chosen for themselves.   They are angry.  They are threatening to fire the driver and hire a driver friendlier with their desire to be free to choose a seat.

Consequently, the bus is approaching a cliff, a chasm between its free riders and future passengers.   

What can the bus driver do?     

Tell his free riders things are going to be OK, that he can swerve and miss the cliff?  

Change direction?  

Open the doors to other passengers?    

Let them in and tell them to go to the back of the bus? 

Have the young give up their seats to older riders?  

Tell limo owners to give up their cars and pay to ride the bus?

The End

Thank you for inviting Spencer and me and listening to us.  As hospital chaplains, keep on with your moral work. My son is one of you.  You and he are doing God’s work – consoling the sick.   

As Saint Francis of Assisi said,” O divine Master, grant that I may not so much seek to be consoled as to console; to be understood as to understand; to be loved as to love.”

Let voters decide how to best protect the sick.  We are a nation where the majority rules, and where belief in equal opportunity still occupies the center ground. We are grounded in morality, but we recognize  reality.

I now yield the floor to the next poet laureate of the United States.

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