Sunday, December 5, 2010

A Premature Autopsy on Obamacare

In the tumultuous history of postwar American liberalism, there has been a slow but steady decline of which liberals have been steadfastly oblivious. The heirs of the New Deal are down to around 20% of the electorate, according to recent Gallup polls. Conservatives account for 42% of the vote, and in the recent election the independents, the second most numerous group at 29% of the electorate, broke the conservatives' way. They were alarmed by the deficit. They will be alarmed for a long time.

Liberalism: An Autopsy, Wall Street Journal, December 4, 2010

Liberalism may be a candidate for autopsy, but Obamacare is not.

For the next two years at least, the new health reform law will be alive and kicking. If it is not repealed, which is unlikely, its major provisions will begin in earnest in 2014.

As a pathologist, I know there is no such thing as a premature autopsy. Either you are dead, or you are not. Yes, the midterm election results deeply wounded the health care law. And yes, Republicans have vowed to repeal it, or pieces of it. But there is no such thing as a partial autopsy either.

We await the process and outcome of the next legislation session, 2010 to 2012, the run-up to the Presidential election. to see if Accountable Care Act will be repealed and if President Obama will be re-elected. Until then, the President can wield the veto pen over any repeal of his most cherished signature domestic program. If it goes down, so does he.

As the debate proceeds, keep in mind the liberal dream – universal coverage given credit to, paid for, and controlled by the federal government. This, progressives say, is the morally imperative hope for America, a change that would make us morally equivalent to other progressive nations. That's what "hope" and "change" in health reform is all about, as viewed from the left.

In this week’s New England Journal of Medicine is a piece entitled “Government Payment for Health Care – Causes and Effects,” Victor R. Fuchs, PhD, professor emeritus of health economics at Stanford, articulates and justifies the dream.

Fuchs argues:

• Eight European nations provide wider access to health care at lower costs with better outcomes than the U.S. These nations pay for 70% to 90% of health costs, We spend 50% and more per capita yet have lower average life expectancies.

• This increased government financial clout allows these nations to constrain costs through controlling the number and specialty mix of physicians, limits on facilities and acquisition of expensive technologies, hard bargaining over prices charged to medical suppliers, and restraints over physician fees and incomes. The Fuchs agenda does not engender enthusiasm among physicians. They do not like being tools for government policies.

But certain quirks of U.S. culture, Fuchs maintains, stand in the way: our cumbersome political system, the influence of “special interests,” our insistence on quick access to diagnostic and therapeutic procedures, our desire to have these procedures close to home, our superior health care amenities, the heterogeneity and diversity of our population, our individualism, our dedication to “life, liberty, and pursuit of happiness,” and our lack of sacrifice for the common good .

Wouldn’t it be better, Fuchs asks, to redistribute a “greater equality of access and sharing of costs through taxes on income or payroll, value-added tax or sales tax?”

Fuchs is worth listening to. Since his seminal 1974 book Who Shall Live? Health, Economics, and Social Choice (Basic Books), he has emerged at the dean of academic, bicoastal elites on health care issues.

What he and his followers seem to forget is that this is America, not Europe.

To judge from the midterm election, most Americans, rightly or wrongly, think of the U.S. as an exceptional nation, as a haven from an intrusive, centralized, debt-producing, arrogant government.

It is too early for an autopsy on Obamacare, but it is not too late to evaluate and debate its impact on the American dream versus the liberal dream.

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