President Obama’s Poor Salesmanship Of Health Care Reform
As much as I am not a fan of President Barack Obama–I’m kind of neutral on him so far–I’ve long been impressed by his salesmanship of ideas and programs, even where I sharply disagree with him. The President can literally sell snow to the Eskimos. That’s why I am more than a little surprised at his halting, half-formed attempts to sell his health care reform plan to the public and yesterday’s speech before the American Medical Association was a clear indication–to me at least–that President Obama might need to run his plan (it’s really just a grab bag of ideas and goals at this point) through the typewriter once again because he’s continuing to fail to address several key issues and what he is talking about so far fails to impress me. He’s not doing really well with doctors either and was briefly booed during his speech for saying he was against malpractice award caps (I might have cheered him on that point).
In fact, I am even beginning to wonder how well thought out President Obama’s plan is (or if he’s just mouthing things various policy wonks have whispered to him) or if this is going to be a replay of his attempt to close Gitmo (I have a hunch that he won’t be able to close the place because there are some detainees there who are so evil that they are in the right place already) and the torture photos back-and-forth that’s frankly become an embarrassment and a pointless distraction. I’d like to see him do better on health care reform since I am one of 47 million Americans without health insurance of any kind. And that’s why I am being critical of his plan to date and asking a few tough questions. I’d actually like to see it work.
Several points in his AMA speech troubled me (an AP account is here). President Obama seems much enamored of the potential for electronic medical records (time savings, cost savings, less duplication of effort) to the point where I wonder if he knows how medicine is done and what huge privacy concerns are at-play. I for one don’t want my medical records on a computer network anywhere (totally hackable) and if we do get such a system I will find a way to opt out of it. I simply don’t trust it and know I am not alone in that. What’s more, my own experience with computerized medical records has not been positive. Several years ago, I used to see a psychiatrist here in Seattle (one my insurance company picked out for me, always dangerous) who had all his patient records and notes on a computer. The trouble with this was that it created a situation where my doctor could be lazy, not listen to me and most of the time didn’t even seem to know who I was (this was the doc who messed me up on Lexapro even though I repeatedly insisted to him that SSRIs had messed me up in the past. I went along with him because he was a very convincing salesman for Lexapro). I’m much more in favor of old school approaches such as doctors actively listening to patients instead of relying on electronic notes tapped into the system by some other doc who wasn’t listening to the patient either. (I could see where electronic records might be useful for ER and surgical situations and ICU cases, but for general medicine and psychiatry…not so much.)
President Obama also made it clear that his health care reform would include a provision requiring–read: forcing–every American without health insurance to participate in his new, ill-defined program whether they like it or not. (There would be an out for hardship cases who cannot afford his plan.) Hate to be a contrarian here, but what if someone doesn’t want health insurance? The government is going to force it down their throats? For what reason? On what Constitutional grounds?
Look, there’s been way too much forcing going on with President Obama and the Congress: we’ve just spent God knows how much on a so-called stimulus package and various bailouts (and in GM’s and Chrysler’s cases they were both failures and epic wastes of tax monies) and you, me and everyone is going to be forced to pay that off for years to come. I’ve simply had it up to my neck with this kind of thing and I think President Obama ought to work on drumming up some incentives for everyone to participate in the new system instead of jamming them against a wall. Call it compassionate progressive-liberalism.
While more specifics about how health care reform might be paid for are trickling out of the Obama Administration, I am not convinced that he can pull off $1 trillion-plus in costs by shifting around various Medicare/Medicaid payments and cutting payments to hospitals without instituting a new tax of some kind. And from the AP’s coverage of his AMA speech, here comes a hint of new taxes:
“Aides had said previously that the administration wants to keep the cost around $1 trillion, while also acknowledging it might go higher.
“Obama has taken steps in recent days to outline where money could be found.
“He wants to cut federal payments to hospitals by about $200 billion and cut $313 billion from Medicare and Medicaid over 10 years. He also is proposing a $635 billion in tax increases and spending cuts in the health care system as a ‘down payment’ for his plan.”
I think that new taxes of almost any kind will at this point cause big problems for the American economy. I’ll leave it at that and await more details of what’s going on here.
And now let me repeat several questions I first posed last week about the President’s health care reform proposal, ones that he continues to avoid providing details on.
“How are we going to keep employers from cutting off their employees in order to shunt them onto the public system and save themselves money? [The President really needs to address this one, especially if he wants to beat down conservatives' accusations that he's engineering a government takeover of health care.]
“How can we add 40 million to 50 million people to whatever health insurance system we wind up with while utilizing roughly the same number of doctors, nurses, etc. and expect to provide the same level of access to care and services?
“How are we going to drive down costs in the health care system? The President and his people keep insisting they will make this happen, but how? [Does anyone seriously think that pharma companies and health care systems will accept smaller profits?]
“What services are going to be covered under the public component of the ill-specified plan and at what price? And for that matter, beyond general PCP types of things, will naturopaths, chiropractors and other alternative medicine providers be covered?”
These questions deserve serious answers if President Obama expects people like me to support his health care reform push.
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