Saturday, November 30, 2013

My Perspective on Obamacare
You can never understand a person until you understand his point of view.
Harper Lee ( born 1926 ), American novelist and author of  To Kill a Mockingbird

Everybody we do is an opinion not a fact.  Everything we see is a perspective not a truth.
Marcus Aurelius (121 AD -180 AD), Mediations, a book on how  to lead a life of duty and service while achieving equanimity and minimizing conflicts

Today ObamaCare with its promises “improvement.” moved out of the shadows of theory  into the real world as it seeks to convince the world  that its website and its policies will  level the health care  playing fields between the have’s and the have-not’s.   The trouble is that every promise is a fudge, a hedge, or a prayer, How well ObamaCare will succeed depends on one’s perspective.
In my E-book , Understanding Obamacare, due out January 2014,  I try  to present a balanced perspective. 
Not so successfully, I fear.   I sent out copies of the manuscript to colleagues for perspective and a blurb. 
One of these colleagues,  William Fore, MD,  who has had a distinguished career as internist specializing in diabetes,  a medical group leader at Johns Hopkins, an inspector  for the Joint Commission,  and a physician who treats the uninsured and underinsured in a “free clinic “ in North Carolina,  called yesterday  to point out differences in our points of view.
Bill hovers on the left of center while I dangle on the right.  
In reading my manuscript,  Bill  found two gaping deficiencies  - One, lack of any substantial discussion in my book on the plight  of  America’s uninsured, who now number about 50 million. 
Two, a failure to address or praise Obama’s effort  to  cover those with pre-existing conditions.  
Bill is right, and I plan to right these deficiencies (right is not the right word, but it will do for now) either by adding either a corrective paragraph in the preface to the manuscript or discussing these problems in a subsequent book on the twin rollout disasters.
Meanwhile,  I harbor these concerns over ObamaCare:
One, the flawed, avoidable website, in response to which only 50,000 have enrolled and paid their first premium,
Two,  the 5 million people  insurers have dropped from their existing plans in order to comply with ObamaCare standards, which are too broad, too unrelealtic, and too expensive.
From my perspective what disturbs me about these developments are:  
One, the Obama administration’s incompetence in failing to anticipate or to prepare for the website crash when it was repeatedly forewarned what might happen by its own IT experts.
Two,  the failure to see the faulty   trade-offs  between insuring  50 million of the uninsured while  uninsuring 5 million of the insured, which may grow to 80 million to 100 million if employers stick to the letter of the law, which flatly states that all future plans must include ten essential benefits.
Three, and more fundamentally,  Obama’s lack of understanding of the essence of American culture.  We are not an imperialistic nation bent on keeping the have-nots down.  We are not a socialistic society intent on pushing the rich down while raising the poor up.  We are a freedom-seeking capitalist country bent on  elevating  rich and poor by allowing them to exploit their dreams and opportunities in the belief that a rising tide raises all boats.
From Bill’s perspective,  something must be done to provide care for the uninsured and underinsured,   even though this “something” may be disruptive for the medical industrial complex and for the rest of us. On the othr hand,   Bill feels it  is only fair and moral  for insurers the business community, and American society  in general to bite the profit bullet by covering those with pre-existing illnesses,  over which most patients have no control, and for specialists to forego some or income and devote more of their time to caring for the disenfranchised.
It comes down to this:  One man’s meat is another man’s poison.  One man’s tradeoffs are another man’s turnoffs.  The important thing it to appreciate the other man’s perspective.
As the late great Steve Jobs (1955-2011), the Apple of  the Internet’s Eye, eloquently put it, “A lot of  people haven’t had very diverse experiences.  So they don’t have enough dots to connect, and they end up without a broad experience on the problem, The broader one’s understanding of the human experience, the better design  we will have.”
Tweet: One’s experience shapes one’s perspective. One may be partly right or partly wrong when  one  fails to connect the dots.

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