Friday, December 4, 2009

The Prisoners of Ideology and Health Reform

No one is genuinely free from political bias.

George Orwell

George Orwell, of Big Brother is Watching You fame, said we are all prisoners of our political ideology because we want to push the world in the political direction we favor.

I am no exception. I want to push the world in the direction of free health care markets, personal financial responsibility, and reliance on patient-doctor decision making rather than on government control.

I am a prisoner of my ideology.

I believe America’s best health care future lies in relying,

• on small financially responsible government with balanced budgets rather than a financially proliferate government with huge deficits,

• on the common sense of the people rather than the power of central government;

• in offering universal tax credits to all people rather than having government tax all people to achieve universal coverage;

• in having people pay for their health care through higher deductibles rather than pretending care is “free” through government paternalism;

• in extending choice of health plans across all state lines rather than having people choose between a state plan and a government option;

• in giving people a choice between basic plans to fit their needs rather than government sanctioned comprehensive “community-rated plans” with the same plans for the young and old;

• in listening to doctors in the clinical trenches who are taking care of people and trying to meet the bottom lines of paying for their staff, installing new equipment.

I suppose I am naïve in believing in trusting the judgment of people and doctors rather than government.

I suppose I am naïve in believing that the continuing growth of health sector job growth of 3.6% while overall unemployment has fallen 4.7% is good for the American economy.

I suppose I am naïve in believing that mandates on individuals to provide coverage, to dictate benefit contents of health plans, to control physician quality, case management, care coordination, disease management, and use of health care information technologies make prisoners of all of us to government.

And lastly, I suppose I am naïve that the best way to stimulate job growth is to cut marginal taxes, death taxes, capital gain taxes of small businesses, which is where 80% of the job growth is.

And I suppose I am partisan in believing President Obama is a prisoner of his ideology – that only big government,with its supposed collective and collectivism wisdom, and big taxes on the wealthy, health plans, device makers, drug firms, and providers can provide the wherewithal to simultaneously cover all, prod job growth, and provide economic security for everyone.

Because Obama is a prisoner of his ideology, it may be politically impossible for him to take the necessary steps to cut health costs or stimulate the economy. For that reason, the only reasonable solution may be for the rest of us to disencumber ourselves from political incumbents.

Forgive me for believing in the common sense of common people. Forgive me for believing small business and small physician practices will respond to incentives that set them free from the shackles of Big Government.

I am a prisoner of my ideology.


Michael Kirsch, M.D. said...

Richard, I have read enough of your blog to know that you are sans naivete. Your current post, however is a fantasy, a reverie of a thoughtful physician who sees common sense being suffocated by political quicksand. After the battle, will the medical profession be limping off the field? Who will be left standing?

Richard L. Reece, MD said...

Look. Michael, the nation needs doctors to provide care. And Congress knows it will lose doctors if the bill passes in its present form. It also knows if doctors refuse to see Medicare patients at 20% to 30% lower rates, Congress will have a major access problem and a first-order political crisis on its hands. So I am optimistic some sort of compromise is at hand.

Michael Kirsch, M.D. said...

Yes, Richard, it appears that Reid is having trouble keeping 60 votes together. I think that the public option will emerge, but as a shadow of what the political left had hoped for. Interesting times.