Obama Health Care, etc.
By Doctor Tom on September 10, 2009 at 12:00 PM in Current Affairs
From a Cardiologist who practices in the midwest and, sadly, is Larry’s Brother-in-Law (sad for Tom because he has to put up with me, LJ):
To me, the ‘big speech was just as scary as it has been these past weeks. Virtually all of the criticisms (from both sides of the aisle) continue to be unanswered, especially for those of us who actually work in this hobbled system.
To begin with, he made a statement that he wouldn’t sign any bill that would add to the debt….but then, throughout the entire speech was unable or refused to say how this thing will be paid for. He made some reference to insuring another 5% of the persons not now insured and how their premiums would help, but that issue has already been analyzed and that increase in premiums would not pay for much of anything. In short, during the entire 45 minutes there was no explanation how this would be paid for. His own advisors have suggested that it will cost a trillion dollars…and he didn’t refer to that information in any way.
Regarding ‘end of life’ issues, he suggested that the government would pay certain doctors to discuss this with patients….a bit insulting to me since we talk end of life issues with our patients already; the government must believe that we are inadequate. This is not just a small insult.
He didn’t support encouraging or requiring insurance comptetition across state lines even though he mentioned the problem.
He suggested a ‘fine’ for companies who didn’t provide insurance options for their employees…this fine would amount (according to him) to 8% of revenues. What he didn’t acknowledge is that health care coverage averages far greater than this for companies that provide it….thus a company could and economically should just pay the fine; to provide coverage often amounts to 10-15% of revenues…in other words, there would be an incentive for just paying the fine and dodging the health care coverage entirely.
He completely dodged the issue of reducing health care excesses. He made a comment about defensive medicine, but implied that it ‘may’ be responsible for increased costs…yet went only so far as endorsing what Bush proposed…a ‘study’ to see if this were really true when we all know it IS true and has been analyzed already. In other words as far as tort-reform…nada.
Obama totally dodged the fact that government controlled health care does NOT improve outcomes. There exists NO believable data that government control of any program, anywhere in the world, improves outcomes. Specifically, he did not note that those countries who have government health care are NOT leaders in the major killers and problems of today, namely heart disease, cancer, pre and post natal care, and diseases/disabilities of seniors. While he mentioned bureaucratic decisions regarding health care, he offered no explanation how this system would work; in fact, the bill itself suggests that triage and therapeutic decisions will be made by committees of appointed persons. There is no explanation regarding the qualifications of these individuals and there is no guarantee that, even if they are doctors, that they will be qualified. Medicare and insurance companies are loaded with totally unqualified ‘doctors’ who don’t even understand the basics of medical care. We deal with this on a daily basis. They seem totally incapable of keeping abreast of current practice. This is especially true in heart disease and utilization of specialized diagnostic procedures designed to improve diagnostic and hence, therapeutic decision-making. Coventry would be a prime example of the incompetence of the triage system of these insurance companies who appear to desire medical practice ‘on the cheap’ without regard to quality. Imagine the results should the government hook up with that company.
There was no explanation how increased coverage and supposed increased quality of care is accomplished without increased cost….without curbs on the manufacturers and their profit margins. Improved technology has never, in any industry, come with the gift of decrease in expenditure. The same is true of the pharmaceutical companies. In fact there was no explanation in the entire speech how there were to be any savings. There has never been any….ANY…government program of any kind that saved any money! In fact it appears to me that some or much of the money earmarked for this program will come from the social security chest which is already jeopardized. After that…it’s taxes. When taxes go up…spending goes down. When spending goes down in the private sector, businesses suffer and terminate their operations. The government already owns the largest part of the automotive industry. How much more do we wish to see under government control. Look up the definition of Fascism and Communism. We seem to be not even pausing at the Socialism rest-stop, but continuing to the more radical without even realizing it. And if we protest, we are labeled as ‘stupid’ by ‘important’ persons such as Bill Mahr, Kieth Obermann, Pelosi, and the media.
All his comments regarding our health care system were negative. He seems to think that all of us would rather allow a disease to progress to the most expensive of options and therefore we are all dishonest. I recollect he recently accused doctors of ignoring diabetes so they could amputate a limb (he was so ill-informed that he suggested that a doc could make $30,000-50,000 from a limb amputation and would ignore treatment or education of the patient to accomplish this bonus….the real figure is about $500-700 with a reimbursement only after an average of 120 days). Yet, he made no comment about the exhorbitant profits realized by the pharmaceutical companies. Over the past decade the largest increase in health care costs to the individual consumer have been in the realm of pharmaceutical costs…not hospitalizations or operations or catheterizations, etc….but the drugs with which we need to treat these people. Take a look at all the patent medicines we give people…on average they cost between $50 and $120 per month for the individual medications….and they are all marked up about 50-60 fold compared to their eventual generic cost to pharmacies.
Obama promised….yes…repeatedly promised…that discussions regarding health care costs would not be back-room deals and that they would be broadcast on C-span. The reality is that there were NO broadcasts on C-Span regarding the pharmaceutical discussions. In the end, those companies gave up nearly nothing as their contribution to the problem. The number quoted is impressive, but represents absolutely NO concession by those companies at all….and Obama considers it a victory even when he had his original paltry number was almost cut in half and spread out over nearly a decade instead of any immediate contribution. This is despite obscene profits by those industries over 2-3 decades. It is a fact that the pharmaceutical companies and the medical device companies’ greed is so great that one of their responses already is the elimination of thousands of mid and low-level white-collar jobs (sales representatives and educational directors) in anticipation of a depressed market. So, a loss-of-jobs result is already rampant in that industry. There can be no reason other than maintenance of a very high profit margin which, although acceptable in a capitalistic market, shows very little concern for the economy in general. In my personal experience, knowing many of these persons, most have not yet re-entered the job market after nearly 6 months. This represents a significant and potentially damaging loss of talent and training….yet the cost to the patient for consumption of these devices and drugs has not diminished!
This bill is off target, is too far-reaching, and is dangerous in that it turns over control of the issue to the government which has been unable through the course of history to avoid screwing up every program it has embarked upon…there has never been a government program that has failed to exceed it’s predicted costs. This bill is not even understood in detail by those who support it. It does not clearly solve the problems which are basic to the solution. Take a poll of the legislators who support the bill….how many earmarks are in the bill? Has anyone counted? Are there none? Are there a dozen? Are there more than a hundred? The most profitable solutions in big business and small business are small, simple, and unencumbered. I don’t believe this bill satisfies any of those stipulations. In fact, I believe that this bill confers unlimited powers on the government regarding the most important of all decisions for those who participate in programs designed to protect their health care costs. I believe this bill makes those who take responsibility for their own health care, responsible for the cost of those who choose to have someone else pay for their care. While, in a certain respect that is the way things are now, this bill ensures that those of us who take responsibility will pay more and have less personal directive.
Obama is a good speaker. He touches all the emotional issues well. But he does so without substance. And, so far, he has failed to deliver on any single campaign promise. He is dismantling our intelligence community so we’ll have to just take a guess as to our enemies’ plans. He is cheapening space exploration and that will result in a loss of science. He has tagged onto things he knows nothing about such as ‘global warming’…an occurrance which simply isn’t supported by science. He has hired ‘czars’ rather than appointees for his cabinet so that they will not have to undergo congressional scrutiny….and now one of them has been found out and has resigned under pressure. He hasn’t supported any energy policy yet. He has ordered the closing of Guantanamo terrorist prison….and hasn’t figured out where he’s going to put the prisoners. He has increased the debt incredibly…more than any other president in history…and just passes that by….while pardoning guilty parties. He appears to be racing to be the most ineffectual president since Carter and the difference is that he has none of the good qualities of Carter.
Seems to me he was elected not because he has done anything (in fact he hasn’t done anything even before he was elected…non-military, no record of scholarship, no confirmation of success in business, no record of financial or economic prowess, no experience even near the level of CEO in anything, a literal non-attendance record as an elected official) was elected on a ‘hope’ emotion…and appears to be wishing things rather than coming up with realistic, constructive, and well designed programs. In fact…in now nearly 9 months in office….with a Democratic congress and senate…he hasn’t done anything of significance. He has taken a lot of vacations and bought a dog. Why does it not bother liberals that we know nothing about this president? He was close friends with persons who hate our country…this doesn’t seem to bother democrats. Why doesn’t that raise a little bit of concern? He acquired a great deal of money without explanation. Why doesn’t that raise an eyebrow?
In the past 9 months our position in the Afghan war has deteriorated immensely. He appears to be uninvolved. I haven’t read anything indicating he is concentrating on that issue. How many military bases has he visited? In his campaign he asserted that the reclamation and rebuilding of the gulf coast destroyed by Katrina would be a priority on a daily basis in his administration. After 9 months there hasn’t been any relief on this issue….nothing.
So, this amounts to some of my concerns. I don’t know who this guy is. He hasn’t done anything and the health care bill is so flawed and so little studied with so little data to support it’s implementation that I just can’t believe anybody in either party is taking it seriously. It’s like the brand-new college grad who want’s the loan for the million dollar house when he doesn’t even have a job yet….and because he’s a good speech-giver, someone is going to give him the loan…not realizing that the payments will be spread out on the rest of the community. Who is Obama? Do you really know? You knew exactly who McCain was. We don’t even know Obama yet he was voted into the presidency knowing he comes from the most corrupt areas of the country politically and did nothing of consequence in the Senate. He even had the chair of a committee and (it was noted repeatedly on this blog during the campaign) never called a meeting. He was absent the majority of his voting opportunities….and people put him in the presidency! It seems incredible to me….a bad dream! He doesn’t even have the experience of running even a small company!….and he was elected. To me something is terribly wrong.
In summary, this health care bill is strikingly inept….as Obama’s presidency has been. Passage of this bill will be the most confusing and poorly planned program in the history of the country.
To make the statements above labels me as ‘stupid’. I guess I am, but I happen to work in this healthcare industry and I see nothing but increased bureaucracy telling me, as a clinician, what to do.
/TDS
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