Wednesday, December 23, 2015


Ordinary health, remember, is highly gambit prone.

Stephen Potter,  One-Upsmanship

The  health reform movement  is essentially a game of one-upsmanship,  involving those on both sides of the issue who seek to  gain an advantage  by deploying certain gambits. 
The Obama administration has been particularly adroit at the game through the use of the following gambits.

·         Big Brother Gambit  -   This also called the Big Government  Ploy. This is a highly effective gambit.   Through sheer bulk,   after all,  Big Brother represents  330,000 million people,  controls the biggest chunk of the health care population with 150 million in Medicare, Medicaid, and health exchanges,  and spends roughly $1.5 trillion a year on health care.  The Big Guy is not only the Big gest Donkey but the 800 pound Gorilla in the room.  Not only that, Big Brother (and possibly Big Sister to be)  has the most managerial talent and health policy experts at its beck and call.  Through what the Office of Management and Budget (OMB),  the Congressional Business Office (CBO)   Centers of Medicare and Medicaid ( CMS), and  those occupying or representing the Bully Pulpit say, Big Brother  proclaims government gospel,   and  the Ruling Class gospel,  ooften goes  without fear of being contradicted.


·         The  Guilt Trip-  ObamaCare is also a guilt gambit.  Its partisans maintain  that market-driven care suffers from   woeful ack of compassion among  hard hearted conservatives,  who wrongfully complain that   Obama  is  covering more of the population using  OPM (Other People’s Money).    Everybody knows that nobody, left or right, wants to see people dying in the streets for want of money to pay for medical care.    The gambit here is to show that those opposing  ObamaCare  have no heart and are only concerned about making profits for their special interests, not the public’s interest.   The is best done by repeatedly saying that the United States is the only developed nation on the planet without universal coverage, that the U.S. has the widest income inequality gap in the universe,  and that the poor,  the bereft, and the needy are falling through unseemly  cracks in the safety net.

·         The Humpty Dumpty -   This is perhaps the cleverest gambit.   Its proponents assert that if ObamaCare falls off the wall,  all the GOP’s men and all the GOP’s elephants won’t be able to put ObamaCare together again, and the people’s  health will suffer thousands of unnecessary deaths and millions of economic indignities.

·         The Full Continuum -   Life is a continuum.   We are born, we live, and we die.   At each stage,  we see a doctor.   Ergo,  health care and each disease  must be a continuum provided by a continuum of services provided by government,   physicians,  nurses, other caregivers, and health care professionals.   Therefore,  it follows that the only way to pay for this continuum is through one lump sum from one source. Guess who?

·         The Absent  Alternative -   A favorite and irrefutable gambit among  Obamanites is to ask – What’s the alternative? – and then to assert -  The opposing party has no alternative!  And of course it doesn’t.    Republicans are split into competing factions – each with its own alternative,  none with enough  authority or a sufficient  majority   to present one single coherent plan to overcome ObamaCare. And none of this silent majority has yet to articulate  alternative of  how to cover those new  20 million formerly uninsured now insured  and  now subsidized under ObamaCare  health exchanges and Medicaid. How does one disentangle those now entangled in the federal safety net without appearing cruel and heartless?

·         The Complexity, the MetaData, MegaMandates,  MegaTaxes, and MegaRegulations Gambits-   These gambits are best considered together.    Their underlying theme is this:  ObamaCare is hopelessly, bewilderingly, fiendishly   complex.  It affects different people at different times in different ways and involves billions,  even trillions of health care transactions.    Consequently  ObamaCare will take 10 to 15 years to understand and  implement and cannot be interrupted lest it disrupt  the chain of events leading to universal coverage,   greater choice of doctors and health plans,  and  lower premiums for consumers and free care for all.   Monitoring this process will require megamandates, megataxes  for  individuals and businesses to fund  it all and metadata and megaregulation compiling and analyzing all those transactions to  monitor it all and prevent private fraud.

Once you execute all of these gambits,   you will effectively defuse the anti-Obama establishment and their complaints about broken Obama promises,  inability to keep their doctors and health plans,   skyrocketing premiums and deductibles, and an unpaybackable  national debt. 

At last,  the public will know and appreciate  the health law is for its own good and the common  good. We are all on the Titanic together.  And the public  will no longer heed   conservative propaganda proclaiming that Obama’s legacy can be erased ( Phil Gramm and Michael Solon, “Cheer Up,  Obama’s Legacy Can Be Erased,"  WSJ, December 20),  or the Heritage Foundation’s e-book,  A Guide to a Better Alternative to ObamaCare, now available  at, for they  will realize there is no better,  viable, reasonable,  rational, empathetic , compassionate  alternative to ObamaCare.

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