Monday, December 28, 2009

Ideology, -Notes of An Ideological Pragmatist

I’m an ideological pragmatist. I believe in what works and what suits the temperament of American people, rather than what is politically correct or what passes some moral litmus test.

Public-Private Mix

Whatever reform measure passes, It will be a public-private mix, it will superimpose more government regulations on our private system. It will have uneven effects. It will cost more than the status quo. And it will expose the reality, that when it comes to health reform, Democrats and Republicans have their ideological blinders on.

All developed nations have a mix of public and private systems. The United Kingdom has the NHS (National Health Service) and BUPA (British United Provident Association and other private plans); Canada has its Medicare and private insurance plans to help citizens escape waiting lines .

It comes donw to questions of the socialist-capitalist mix, how much goverment consumes of a nation's GDP, what citizens are willing to cough up in taxes, what choices they are willing to give up, how long they are willing to wait for life-saving and function-restoring technologies, how free they want to be in their personal decision making , and how economically secure they want to be in health care matters.

Everybody in all countries knows if you have money and connections, you can jump the public queue to get care. In the U.S. Medicare and Medicaid cover about 105 million of our 310 million citizens at a cost of about $1 trillion, while private plans care for the rest for roughly $1.5 trillion. Then, of course, there are those “cadillac plans,” which offer rich benefits, mostly of members of powerful unions.

Health Reform as an “Ideological Exercise

Democrats harbor the illusion of a high moral duty to care for all by expanding federal regulations to care for all. It may be more about political power than moral obligation. Nolan Finley, reporting in today’s Detroit News, says the “most tangible fallout of the electorate single-powerful rule in Washington is that public policy making has become an ideological exercise, rather than a pragmatic one.” Translated, this means, by God we Demoorats have unlimited power, and we’re going to exercise it, no matter what the consequences.

Meanwhile Republicans seem to think Democratic power leads to serfdom, and the only solution is freeing the market from federal regulations, letting entrepreneurs innovate , and having consumers pay their money and make their choices. This isn't going to happen, given embedded liberal ideologies of equity and equal outcomes and current political power.

Connections and Ideology

One’s connections shape one’s ideology. I am no exception. I work closely with The Physicians’ Foundation, a nonprofit organization representing some 650,000 practicing physicians in state and local medical societies, and for the last 10 years, I have been on the MedicaL Advisory Board of Castle Connolly’s Top Doctors, which is closely linked to the nation’s top academic medical centers.

From the Foundation, I’ve learned most physicians cherish independence and direct relationships with patients without 3rd party interference. These physicians, contrary to what you might hear about AMA support of current health reform, tend to be profoundly skeptical of House-Senate bills because of their intrusiveness into doctor-patient relationships and constant lowering of reimbursements.

From the Top Doctor organization, made up mostly of more 3000 physicians practicing in America’s 125 academic hospitals, I’ve learned academics are skeptical as well. They are especially leery of the proposed $500 billion Medicare cuts proposed over the next ten years. High tech care of Medicare patients is often the life-blood of these institutions.

The American People

From recent public polls, I’ve learned 60 percent to 70 percent of the public do not believe reform will lower costs or improve care, or change their overall care for the better. At this stage, because of unemployment of over 10 percent, the perceived ineffectiveness of the massive stimulus bill, and soaring federal deficits, public belief in government intervention is at an all time low.

Because of these various factors, I remain pragmatic and skeptical about the ultimate outcome of reform and its political and practical consequences. To me talk of successful reform as “historic” remains mostly political histrionics. Time will tell how reform shakes out and whether criticism from the sidelines is factual or simply political jealousy. We do not yet know the impact or implications of this partisan party line bill, or how its final version will evolve.

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