Stanley Feld M.D., FACP, MACE Menu


Are The Wheels Coming Off?


Stanley Feld M.D.,FACP,MACE

During the past week the healthcare debate has increased in intensity. President Obama has drawn a line in the sand. He wants a bill on his desk by August 1, 2009.

It also looks as if his healthcare reform plan is being derailed not by Republicans but by his own party.

President Obama has also given the AMA a glimpse of where he stands on malpractice reform. He received boos from members of the AMA.

He has set out the fundament principles of his healthcare reform.

1. Universal coverage

2. Affordable cost

3. Increase in quality of care.

President Obama then asked key committees in both houses to craft a bill compatible with his goals. He is very smart.

“What the president wisely assessed, looking at what did not happen in the early ’90s, was that unless there was some real ownership, unless members of Congress owned drafting and crafting and did some heavy lifting and then owned the final work product, it wasn’t going to work.”

This is clever but it could be the down fall of any healthcare reform. Max Bacchus has presented Tom Daschle’s plan. Ted Kennedy has presented a plan that is fiscally irresponsible according to the congressional budget office. His healthcare reform plan completely ignores the warning of the congressional budget office. The House of Representatives released the Conyer healthcare reform plan that would create an even larger deficit than Ted Kennedy’s plan.

None of the plans from either side of the aisle are focused on the real problems in the healthcare system.

Kathleen Sebelius, secretary of health and human services, summarized the mood that is motivating the country to move forward. The country feels government needs to do something. She disregards the fact that what is done needs to be constructive and must repair the healthcare system.

“ I think the underlying factor is that the status quo is not sustainable and it’s not acceptable. And in many ways the economic downturn has shaken the status quo.”

Economically, emotionally, and morally the status quo is not sustainable. Everyone agrees. The debate is getting very confusing while focusing on the wrong issues.

In the early ’90s, there was a sense that doing nothing was an O.K. alternative. For some people it was better than doing something that they felt would lead us in a wrong direction. I really don’t know of a single stakeholder group or party in this discussion who is willing to say out loud doing nothing is O.K.

Everyone agrees something must be done. The momentum for healthcare reform is compatible with Heidi Klein’s “Shock Doctrine.”

If people are frightened enough about an issue they will accept any policy. She says this is the method politicians use to gain power over the people.

All the healthcare reform proposals are confusing and difficult to follow. At this point citizens are so frightened and disgusted that they relinquish their power to elected officials who they hope understand the problem. They assume these politicians will look after their vested interests.

I think the weight of inertia is always more powerful often than the forces of change. But in this case there’s an underlying turmoil, whether it’s people looking at the moral imperative, people looking at the financial imperative, and people frankly looking at what’s happening to our country in terms of health outcomes. Nobody feels this is acceptable

Kathleen Sebelius explained the legislative confusion away by saying this is how legislation works. The people want a bill.

President Obama is going to prove to congress that the people are demanding a change through his house parties and blogs calling for support of his healthcare plan. The Democrat controlled congress will have no choice but to give them a bill. The problem is the plan will make things worse as proven in Massachusetts.

When Secretary Sebelius was asked the question;So are you not concerned about the Congressional Budget Office release on the HELP bill? Do you think it doesn’t really pose problems? (The office “scored” the bill produced by Sen. Edward M. Kennedy’s committee as costing at least $1 trillion over 10 years, while leaving 36 million people uninsured).”

She said don’t worry. Whenever you see a big price tag and the notion that lots of people are not covered it will raise questions.

“ What I’ve been told is that we shouldn’t spend a lot of time and energy on that because it( Kennedy’s plan) is a partial hit on a partial bill.

I think the American people are tired of these general responses to some positive data by impartial sources. The administration believes all it has to be do is to respond by repeating President Obama’s generally accepted idealistic principles. The people will believe everything will be alright.

I’m still optimistic at the end of the day that a bill that meets what the president said all along, some fundamental principles — cover every American who lacks health insurance right now, build on what is working in the health system, so people who have coverage and a health provider that they like and they feel is good for their family keep it, that we have a new system in place to really lower costs over all for everybody and that we begin to drive quality, which is now available to some Americans some of the time depending on where you enter the system. So around those principles I’m convinced we’re going to have a proposal.

What are the details of President Obama’s program? What is the cost to the tax payers going be? Is the congressional budget office wrong about the 1 trillion dollars over ten years? Is Senator Kennedy wrong about 36 million uninsured because the government cannot afford it? How is the quality of care going to improve with the bills on the table when quality medical care is not defined properly? Is a board of experts’ going to be able to define and enforce its definition of quality medical care?

This is not the time to give in or give up!

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