Thursday, September 3, 2009

When Great Expectations Are Not Met

The American people have great expectations of their health system. They know the system, flawed as it may be, has the world’s greatest technologies and among the finest doctors and medical centers. They expect it to perform miracles – to cure them of disease ans restore full function.

Failed expectations may be responsible for many frivolous lawsuits. Overzealous pursuit to meet expectations to cure disease and restore health may lead to hospital marketing wars to acquire the most expensive of technologies, like PET scans and gamma knives. We want the best, and we expect to get it. Nothing wrong with that, We are a very optimistic people.

Great expectations apply to politics as well. When candidate Obama promised “hope” and “change,” he was laying down great expectations. When the “hope” of economic recovery has not yet been met, and when the “change" of health care oe“affordability” and “ choice” now looks remote, he is encountering political difficulties, with his popularity dropping from an initial high of 70% to a current level of 49%, with his handling of health care dipping to 42%.

One of the best analyses I have read of the dangers of failed expectations appears in today’s September 3 WSJ “Wrong Turns : How Obama’s Health Care Push Went Astray,.”

Here is a sampling,

“Two overarching problems have bedeviled the Democrats' health-care push. One is the difficulty of persuading people who already have health insurance that the plan offers something for them. Polls suggest many Americans are happy with the coverage they have.”

“The other is the cost, estimated at $1 trillion over a decade. While Democrats say the plan will be budget-neutral, Republicans say the cost savings and tax increases being used to fund new programs would better go toward reducing the fast-growing federal budget deficit.”

“Mr. Obama has had trouble making the case that his health push would carry teeth to eliminate the waste that he blames for driving up costs. A key moment in the debate came July 16, when Congressional Budget Office director Douglas Elmendorf told a congressional committee, "We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."

“A look back suggests the president and his allies may have "overlearned" the lessons of President Bill Clinton's 1993-1994 health-care defeat. They expended great effort to line up the support of health-care insurers, pharmaceutical makers and care providers, believing that by keeping them around the table, they could win over Republicans and stop the kind of industry-led attacks that helped sink the Clinton plan. But this strategy left out the wooing of public opinion, which was being affected by broader events, including the economic crisis and anger over bank bailouts.”

President Obama’s chief problem right now, in my opinion, is defending a health care reform proposal which does not exist and which he has not articulated.

The solution is quite simple: Simplify, simplify, simplify. Specify, specify, specify. Tell us exactly what is on our mind, and what to expect from your plan

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