Tuesday, April 6, 2010

Reaction to Health Reform – The Sounds of One Hand Clapping and Two Hands Clapping

Reactions to passing of Obamacare is reminiscent of a Zen philosophical riddle – What is the sound of one hand clapping? The answer depends on who you are, what you are, or what you know, or what you believe, which is what you get.

The Zen riddle leads to a second question: What is the sound of two hands clapping? We do not know, for we have yet to know what the bill forbodes or promises.

Americans are divided on health reform and are waiting to see how it affects them. We may not know until 2014 when most reform provisions kick in. And maybe not even then, if Republicans win big in 2012 and take over the House and even the Senate.


• If you are the American public in this still largely middle-class nation, you may not be clapping with either hand, which is why 60% of you oppose the bill.

• If you are the uninsured or underinsured or have a pre-existing illness and do not have coverage, you may be clapping with both hands.

• If you are a progressive Democrat, you may be clapping with your left hand, for you believe government is the solution for health problems.

• If you are an unimpressed Republican, you may not be clapping at all, for you believe Obamacare is a step towards national bankruptcy and a step away from true market reforms.

• If you are a Tea Party member, you are not clapping, for you believe in individual freedom from an overreaching and ever growing government.

• If you are a primary care physician, who comprise 1/3 of American physicians, you may be clapping with both hands for the uninsured, for your government has promised you a 10% raise each year for five years.

• If you are a high tech specialist, such as an imaging radiologist or an invasive cardiologist, you may not be clapping, for your government is already cutting your Medicare reimbursements by 40%.

• If you are a Medicare recipient, you may be withholding applause because you know $500 billion cuts in Medicare and the gutting of Medicare Advantage plans for 10 million of you does not bid well for your future.

• If you are a medical student, you may sitting on your hands, not knowing whether to clap for coverage for all, or leery about low Medicare and Medicaid reimbursements, which will make it difficult to pay off your education debts of up to $200,000.

• If you are part of the group, Physicians for National Health Program, you are not clapping because the bill did not rid the health system of “ the profit-driven, private health insurance industry. This costly new legislation will enrich and further entrench these firms. The bill would require millions of Americans to buy private insurers’ defective products, and turn over to them vast amounts of public money.”

• If you are William Flemming, MD, president of of the Texas Medical Association, you are not clapping because “ the bill’s unaffordable health system reforms, piled on top of a crumbling Medicare foundation, will create even more dire consequences for all. We now urge Congress to take swift action to stop the implosion of our Medicare system.”

• If you are William Rohack, MD, president of the AMA, you may be clapping with both hands for Obamacre covers more of the uninsured , but with your right hand, you are not clapping, for you are “ relentless in pursuit of permanent repeal of the Medicare physician payment formula, corrections to Independent Physician Advisory Board, medical liability reform and other important actions.”

• If you are Regina Herzlinger, a Harvard Business School Professor widely regarded as the Queen Mother of the consumer-driven health movement, you are not clapping because “the present bill will inevitably increase costs, further weakening our economy. Tragically, although it will expand insurance coverage, it will ultimately result in rationed medical care for its beneficiaries.”