Saturday, March 28, 2009

Obama strategies - Obamanation - Prospects for an American European-Like Health System

While researching Obama, Doctors, and Health Reform; The Health System, from Top-Down to Bottom-Up, As Seen Through Lens of Cultural Complexity, now at the publishers, I ran across a number of articles speculating on whether Obama-care will lead to a top-down centralized European-type system.

Mindset Hopes

If you’re from the Democratic-left, you probably hope so. That would be a long sought-after crowning achievement of the Democratic Party – a signal that government really cares about the American people. If you’re a right-wing Republican, you hope not. That would herald that Socialism, European style, has arrived and will end individual liberties, freedom of choice, an usher in rationing.

Health Reform - Incremental or Sweeping?

Will we have health reform under Obama? Yes, but in my opinion, it will be incremental reform played out over ten years, not universal reform in the next four, or eight years. Here’s what I have to say about the issue in the foreword to my book. It’s important to distinguish what kind of reform you’re talking about.
In any event, here’s what I have to say about reform in the foreword to my book.

“Although President Obama strikes a determined, even combative tone, when advocating health reform, I place odds for sweeping reform at 30/70 in his first term, but as near slam dunks for immediate incremental changes such as coverage for children, stem cell financing, funding for electronic records, setting in motion a Comparative Effectiveness Institute, and extended Medicaid unemployment benefits. “
The obstacles to sweeping reform, i.e, universal coverage, single-payer, or Medicare and Medicaid for-all, are these.

President Obama faces four major reform obstacles. I call them the four “Cs.”

Culture, American style, abhors the word “rationing.” Our health care culture cherishes unlimited choice, quick access to the latest and best in medical “cures,” and proven lifestyle restoring technologies. These traits conflict with a centralized, command-and-control, federal expansion of health care.

Complexities, American health care is a whirling Rubik’s Cube, with millions of interrelated moving parts, institutions, and people, each with agendas, axes to grind, and oxen to gore.

Costs, Obama says prevention, electronic medical records, and paying only for what works, as established through comparative research, will save billions of dollars, yet scant evidence exists that these measures work. Proposed savings remain hypothetical.

Consequences, of curtailing health costs, may be worse than the cure, because health care institutions and private practices in many communities are the biggest and fastest growing employer in town. Collectively, health care profoundly impacts most communities’ economies . Health care’s building blocks can’t be downsized quickly or dramatically.

I find myself agreeing with Michael Barone, who, in an article “Not Yet Ready for Welfare State," in Real Clear Politics , has this to day.

“The problem on health care, as on cap-and-trade and card check, is that this is a big and complicated country. America doesn't have one energy system, one employee relations system, one health care insurance and delivery system -- it has many. Members of Congress from different states and congressional districts have constituents who are very differently situated, and those differences cut across party lines. “

“Setting up a welfare state is easier in European political systems, with their centralized governments and rigid parliamentary party discipline. American welfare state programs like Social Security and Medicare were set up and expanded step by step by very shrewd strategists operating over many years. Obama has the audacity to hope that he can jam things through with sizeable Democratic majorities at a time of economic crisis and uncertainty. But he has quickly encountered some roadblocks -- and may yet encounter some more.”

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