Wednesday, July 7, 2010

In Health Care, As Massachusetts and Harvard Go, So Goes the Country

I have more than a passing acquaintship of Harvard thought processes.

I spent 8 weeks at Harvard Business School learning how Harvard public health authorities planned to manage the health system, my son graduated from Harvard Divinity School, and I regularly read the Harvard Business School Alumni magazine from cover to cover.

None of this makes me a Harvard man, but it makes me aware of Harvard sensibilities. The political class at Harvard thinks it knows what’s good for the country whether the country knows it or not.

A Harvard man, Barack Obama, is president. He is our leader. He directs the apparatus of the federal government. This directorship gives him certain privileges.

• He can point health care reform in the direction he chooses. He has said that his health care bill is “essentially identical “to the Massachusetts universal coverage plan signed into law in 2006.

• He can choose to ignore the consequences of the Massachusetts law – capping health plan rates and forcing plans to sell their products at a loss; helping raise costs so much that Massachusetts now has the highest average premiums in the United States; introducing an individual mandate that causes people to buy insurance only when about to incur medical costs then dumping coverage; restricting the diffusion of medical technologies like MRI and linear accelerator machines; curtailing the rates charged by hospitals, physicians, and specialty providers; and making physician participation in federal programs as a condition for licensure, thereby converting all Massachusetts physicians into public employers (Joseph Rago, “The Massachusetts Health-Care ‘Train Wreck, “ WSJ, July 7, 2010. That is his choice.

• He can rely on political subterfuge and federal pay offs to senators to get his health bill passed though the majority of American oppose it. That is his prerogative.

• He can make recess appointment to finesse political opponents and to get another Harvard man, Donald Berwick, MD, appointed as head of the Centers of Medicare and Medicaid services appointed to avoid Senate scrutiny. He can appoint Jon Kingsdale, former director of the Massachusetts “connector, “ the Bay State version of Obamacare’s “insurance exchanges, “ as his regulator-n-chief. Those are within his sphere of influence.

• He can overrule actions of state governments, even though more than 70% of the residents of that state and the nation as a whole approve of a new law. I refer to the Arizona immigration law, a veiled cry for federal help to stem the flow of immigrants. Caring for these immigrants strain state welfare and state health system budgets. No matter. For Obama, the future Hispanic vote is what it’s all about.

Some may call these political actions “arrogance.” I call them "politically savvy.” None of these Presidential actions are illegal. They may be sneaky. They may be morally edgy.

But never mind. As I said in the beginning, being President has its privileges. So does being a Harvard man.

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