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Mr. President, there are better ideas, if only you’d listen to them.

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Obama’s Healthcare Rhetoric Means Little Reform

Mr. President, there are better ideas, if only you’d listen to them.

Much to the surprise of the political prognosticators, President Obama devoted a good bit of his State of the Union address to his struggling healthcare initiative. Unfortunately, the surprises ended there.  

Despite the fact that this plan is on life support in the Congress and with the voting public, the president chose to defend his proposal with the same claims “you can keep your doctor or your insurance if you like them” or “this plan will bring down the deficit” that have so imperiled his and Congress’ credibility on the issue.  

As with his earlier promises that the health care debate will be transparent and aired on C-Span or that the bill will be posted 72 hours in advance for all to read, or that no special deals will be permitted, the president showed virtually no recognition  that such claims are now dismissed out of hand by not only vocal critics on the left and right but  the public itself, which opposes his proposal sometimes by as much as a twenty-point margin.

Nor were the President’s many calls for leadership and bipartisanship any more credible or reassuring. As he challenged the GOP — stating that leadership does not mean holding up legislation with 41 votes — President Obama seemed to be suggesting that bipartisanship means the minority should simply acquiesce  to the majority even when that congressional majority pushes a plan that the American people — most recently and notably at the ballot box in Massachusetts — have loudly rejected.  

The president made not the slightest rhetorical nod in the direction of acknowledging the widespread feeling that he is the one who squandered the chance to show leadership and bipartisanship when he refused to firmly tell his party’s leaders in Congress they needed to cooperate with Republicans and allowed instead  his party’s  ideologues to write a bill that became a formula for a federal takeover of 16% of the economy.

Nor did the president acknowledge his claims that the lack of new legislation would devastate the economy or his new openness to other ideas would sound hollow to many now that the President’s majority in Congress is no longer insurmountable. In short, President Obama sounded political not presidential — a partisan leader who had decided an unpopular healthcare bill was still very much in play because too much political capital has been expended to let it get away.

A way does exist though for the president and congress to get past the rhetoric and ideology and find common ground. And, again, the president’s own State of the Union rhetoric is revealing here. Having previously contended that most doctors were behind his plan, especially the AMA, the best the president could do before Congress Wednesday night was to say that many doctors were in support of his bill. The reality is that MOST doctors do not support him and that the heralded AMA only represents 17% of the doctors in America.  

A way then to “reset” the health care debate and reopen the way to legislation is to bring into the discussion those who — unlike members of Congress — don’t just occasionally study  the health care system’s problems but deal with them everyday:  doctors.  If doctors are heard from they will tell the president and the Congress the status quo in the health care system is unacceptable and that reform is badly needed. But the needed reforms are those that leaves healthcare decisions with patients and their doctors and not the  boards and panels of bureaucrats that are simply inevitable with any government-driven plan.

Such patient-doctor oriented plans and market-driven ideas are out there. The pathway, for example, to ending the problem faced by Americans who are uninsured because of pre-existing conditions is not with mandates to insurance companies which would simply result in higher insurance premiums for everyone but  incentives that would allow individuals to receive the same tax treatment as corporations. This lets people purchase their own insurance, thereby making it portable and not tying them to a job they don’t want.

Establishing “high risk pools” in every state would help with those who are uninsurable as well as supplement regular insurance in the event of a catastrophic illness. So too, Health Savings Accounts places medical spending decisions in the hands of patients and avoids the endless paperwork and unnecessary tests and procedures that a federal “third party payment” system always encourages. Making insurance more available by ending the antitrust exemption that insurance companies have been allowed to operate under since the 1940s as well as permitting sale of insurance across state lines and on the internet would do much to thin the ranks of the uninsured.  

Finally, no talk of bringing down costs in the health care system is credible without considering the reform that has dramatically driven down costs in state after state – a willingness to take on the powerful trial lawyers lobby  and pass medical liability reform.

Sadly, the president mentioned none of these concepts in his State of the Union speech. So one way, then, for Mr. Obama to restore the relevance and credibility of his pledges of “hope” and “change” — invocations also missing from his address —  is to  show an openness to health care reforms that are about not extending the reach and power of Washington politicians but offering hope to  patients, doctors and the uninsured and while changing for the better a health care system that for all its very real problems is the best in the world.

Written By

Hal Scherz, MD, is a pediatric urological surgeon at Georgia Urology and Childrens Health Care of Atlanta, serves on the faculty of Emory University Medical School and president and cofounder of Docs4PatientCare.

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