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Initial thoughts on the ABC News ObamaCare special

I watched Wednesday night's ABC News special hosted by Diane Sawyer and Charlie Gibson, broadcast from the East Room of the White House and featuring an audience-driven Q&A session with President Obama. To their credit, ABC allowed audience members to ask a number of relevant and tough questions. The President handled the questions well, although in most cases he did not provide much in the way of specifics in his answers.

Here are a few observations of mine, in no particular order:

1) The selling point for ObamaCare seems to be "the worst thing we can do is to do nothing," which is the exact same hard sell line Obama used to push his stimulus plan. Congress bought into the stimulus, and yet, $787 billion dollars later, unemployment is worse that President Obama's worst-case "do nothing" scare prediction. It appears that the Obama Administration is not trustworthy when it comes to economic predictions.

The President says that without government intervention, health care costs will continue to rise 6% - 8% per year, or will double every ten years, and more and more people will be left uninsured. He believes that government intervention is the best way to stop this trend. He recognizes that certain private organizations like the Mayo Clinic have successfully kept quality of care high, while significantly lowering costs. But he does not believe that, industry-wide, the free market can provide enough incentives to make voluntary cost cutting an attractive option.

He never satisfactorily explained why health costs are rising at such a fast rate. I believe that understanding why costs are rising (and being able to offer a straight-forward explanation, which is best proof that you really understand a problem) is crucial before you propose solutions.

2) President Obama is optimistic that reallocation of existing health spending, combined with efficiency programs and effective cost reduction plans, will offset most of the cost of ObamaCare. Considering how badly his economic and financial advisers have bungled their economic forecasts, I don't share the President's optimism.

3) President Obama is serious about outlawing coverage limits for preexisting conditions. He said that insurers would make less money per insured, but overall the industry should still be profitable. Another prediction that the President is "sure" of. The problem here is that a public, government funded and managed insurance system doesn't have to worry about showing a profit. It can absorb whatever regulations Congress imposes simply by asking Congress for more money. But a private insurance company can't do that. If government regulations ruin the profitability of private insurance companies, you can be sure that the next "solution" will be a series of government bailouts and take-overs of private insurers that will eventually produce a single nationalized health care system.

4) President Obama is serious about encouraging more people to enter the medical field as primary caregivers, such as primary care physicians, nurse practitioners, and nurses. He believes that affordable and readily available primary medical care is the key to having a healthier nation. To this end, he seems to want to create some kind of financial parity between what specialists earn and what primary care physicians earn. He is concerned about the debt load that medical students accumulate during their schooling, and is troubled by the fact that (apparently) many medical students choose specialty medicine in order to earn more money to pay off their debts. (At least that is the impression I got from the direction of the discussion.) The President did not offer any specific solutions for these problems.

He also stressed that under his plan, doctors would not be "working for the government," they would still be self employed. But if your sole source of income is government-regulated payouts from a Central Bureau of Medical Efficiency (or whatever it would be called), what is the difference?

5) Finally, President Obama's efforts to explain how government management would both save money and result in a higher standard of medical care failed to establish even a basic level of confidence for me. There was a lot of discussion about efficiency standards, eliminating unnecessary tests, compensating doctors based on successful treatments rather than on the number of procedures they perform, and relying on science to determine the most effective treatment options. But all of these measures essentially boil down to statistics and bean counting -- neither of which embodies the proper ethos to serve as a governance tool for medicine.

I won't disagree with the fact that even now, and even with private health care, there are limits to what can be done and what insurers can afford to pay. But as long as there is hope, and as long as private money is available for whatever treatments doctors or patients wish, the government should not be allowed to force limits on those treatments.

...

Supporters of government-managed health care argue that the government can provide higher quality medical care because the government can do a better job of eliminating waste, which largely consists of overly expensive and unnecessary medical procedures. Yet such a program necessarily requires the government to put a dollar value on human life. Capitalists are generally considered "evil" if they value human life based on profit motives (remember the Ford Pinto?). But is empowering the government to value human life based on cost-cutting and statistical efficiency any real improvement?

More on this from Conservative Nation -- a must-read if you want to know what the "reformers" pushing a public health insurance option are really interested in achieving.


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Comments (25)

One of the reasons that the... (Below threshold)
hermie:

One of the reasons that there are 'so many unnecessary tests' is because in the numerous and costly lawsuits, providers are forced to show that they did everything and anything for the patient. If they don't perform a particular test; whether it had anything to do with the patient's illness at all; that is enough for lawyers to prove 'negligence'. You get repetitive or unnecessary tests because a $500 test may stand between the doctor and a multimillion dollar payout.

To their credit, ABC all... (Below threshold)

To their credit, ABC allowed audience members to ask a number of relevant and tough questions.
I appreciate that some good questions were asked, but I would not credit ABC because they shut out the opposing voice, and every one of the 164 member audience was hand picked.

This was nothing but a infomercial for President Obama and to discuss what was pro or con in the vacuum that was created last night and should not be the focus.

We should press long and hard for some *real* health care debates, with all opposing opinions and perhaps put on the table that until congress participates in the healthcare that the people receive...that we should not rush into anything.

Re #3: It's a fallacy to th... (Below threshold)

Re #3: It's a fallacy to think that insurers will make less money by eliminating restrictions on treatment of prior conditions, insurers will raise rates to cover these added payouts. Is Obama ignorant of this? Or hoping that the public is ignorant of this, that they think there really is a thing as a free lunch?

Anytime someone proposes making insurers pay more (for a specific treatment, to increase coverage rates, etc), the reality is that they're demanding that everybody pay more in premiums in order to benefit a relative few... and much of the fight over Obamacare (as well as with pretty much every other proposal to cover the uninsured, raise coverage and so on) is going to come down to whether the majority wants to pay more in order for someone else (it's always someone else) to get more. Those wanting the added coverage will claim it's only right, that a refusal to do so is selfish... while everybody else looks at their dwindling bank account to decide just how generous they feel like being right then.

I don't know what to say, b... (Below threshold)
James H:

I don't know what to say, but this blog really fired me up to hate spammers. Thanks for the motivating comment!

I have yet to hear the Demo... (Below threshold)
roakleyhall:

I have yet to hear the Democratic plan for tort reform regarding any public option that is proposed. I can't believe that being able to take a swing at the ultimate 'deep pocket' insurer will limit the trial lawyers ability to tap into the mother lode of settlements. I'm sure that cost is not calculated in the $1.6T estimate!

Point 3: the insurance indu... (Below threshold)
Dara:

Point 3: the insurance industry is currently making profits of over 400 percent by retroactively cancelling people when they get sick, denying needed care, and turning away millions for so-called 'pre-existing conditions.' Here's an idea: they can make less than 400% profits and still be profitable.
Point 4: the President spoke of paying primary care physicians sufficiently to keep them (my own primary care doctor left to become a specialist just this last year); also the President spoke of forgiving student loans for those promising to go into primary care (a powerful financial reward; person in the audience spoke of owing $300,000 in debts for medical education.)

From Ed M. over at HotAir,<... (Below threshold)
MPR:

From Ed M. over at HotAir,
President Obama struggled to explain today whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people -- like the president himself -- wouldn't face.

The probing questions came from two skeptical neurologists during ABC News' special on health care reform, "Questions for the President: Prescription for America," anchored from the White House by Diane Sawyer and Charles Gibson.

Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, said that elites often propose health care solutions that limit options for the general public, secure in the knowledge that if they or their loves ones get sick, they will be able to afford the best care available, even if it's not provided by insurance.

Devinsky asked the president pointedly if he would be willing to promise that he wouldn't seek such extraordinary help for his wife or daughters if they became sick and the public plan he's proposing limited the tests or treatment they can get.
President Obama struggled to explain today whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people -- like the president himself -- wouldn't face.

The probing questions came from two skeptical neurologists during ABC News' special on health care reform, "Questions for the President: Prescription for America," anchored from the White House by Diane Sawyer and Charles Gibson.

Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, said that elites often propose health care solutions that limit options for the general public, secure in the knowledge that if they or their loves ones get sick, they will be able to afford the best care available, even if it's not provided by insurance.

Devinsky asked the president pointedly if he would be willing to promise that he wouldn't seek such extraordinary help for his wife or daughters if they became sick and the public plan he's proposing limited the tests or treatment they can get.

The president refused to make such a pledge, though he allowed that if "it's my family member, if it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care.["]

Oopsie! So ObamaCare for thee, but not for me? Hope and change, baby!

Point #4: you also may not ... (Below threshold)
Dara:

Point #4: you also may not have understood what Obama referred to when he spoke of "incentives." There is a famous article about cost of health care in McAllen, TX compared to the Mayo Clinic and other areas where costs are lower. In McAllen, doctors make money by prescribing lots of tests, treatments, surgeries. In areas where costs are lower, there are different incentives such as rewarding primary care physicians when their patients quit smoking, lower their cholesterol, and achieve other preventative health outcomes that ultimately REDUCE our health care costs.

Worst president ever.... (Below threshold)
Mycroft:

Worst president ever.

Supporters of government... (Below threshold)

Supporters of government-managed health care argue that the government can provide higher quality medical care because the government can do a better job of eliminating waste...

Seriously? You typed that with a straight face? In what bizarro world does that view of the government ever become true?

There is a famous articl... (Below threshold)

There is a famous article about cost of health care in McAllen, TX compared to the Mayo Clinic and other areas where costs are lower.

Dara #9
You need to read this post

Abigail -That's th... (Below threshold)
JLawson:

Abigail -

That's the argument, anyway. But look at the Post Office, look at Amtrak, look at the VA, look at Medicare. ALL have budget problems, service problems, expense problems - and yet the idea seems to be if we just move into health care in a big way the unicorns will just start shitting gold to pay for it and everything will be just fine.

re: # 3- that's why having ... (Below threshold)
Jim x:

re: # 3- that's why having the government offer a public plan to compete with insurers is the best option.

If it's not possible for an inefficient government to compete, then everyone will stay with their private insurers. The market wins, problem solved.

Otherwise insurers - who are constantly increasing rates on **all 3 sides** of healthcare with no increasing costs as justification - will be forced to lower their rates **and** service to compete.

I mean, think about it. Insurance companies are currently sucking money from every angle - from patients, doctors, and hospitals. And on top of this, they are denying care for profit. Other nations have found that having at least some public insurance options have worked well for them, instead of this option.

Some other nations with what is generally agreed on as great health care, use a similar network of public and private insurers. Germany and Australia are two of them. They're getting better health care for about half of what we spend.

#10 - You seem to be forget... (Below threshold)
Jim x:

#10 - You seem to be forgetting the last guy. I understand; I want to forget him too.

Jim x--The point of ... (Below threshold)
iwogisdead:

Jim x--
The point of #3 is that private insurers cannot compete with a taxpayer subsidized government plan. Eventually, private insurers will have to go out of business for this reason. With no private insurance, everyone will be forced to go to the government plan. Prez O doesn't have to do anything to private insurers, just create this goofy public plan, and, sooner rather than later, we'll have a single payer system.
Then we're all screwed.

#10 - You seem to be forget... (Below threshold)
Mycroft:

#10 - You seem to be forgetting the last guy. I understand; I want to forget him too.

15. Posted by Jim x | June 25, 2009 11:21 AM | Thanks for voting!Score: -1 (3 votes cast)

I am forgetting no one. Worst president of all timeis Obama, next worst would have to be probably Carter followed by Clinton.

Bush, both of them, were fairly competent.

one termer.... (Below threshold)
Michael:

one termer.

Supporters of government... (Below threshold)
iwogisdead:

Supporters of government-managed health care argue that the government can provide higher quality medical care because the government can do a better job of eliminating waste, which largely consists of overly expensive and unnecessary medical procedures.

"Eliminating waste" is Obamaspeak for "rationing healthcare."
What else is there to be eliminated? If there are "overly expensive and unnecessary medical procedures" going on, aren't private insurers motivated to eliminate them? One of the things that we're being told is that private insurers wrongfully deny care, but at the same time we are seemingly being told that private insurers aren't able to eliminate "overly expensive and unnecessary medical procedures."
Makes no sense.

Mycroft sez: "Worst Preside... (Below threshold)

Mycroft sez: "Worst President ever"

I disagree. President Hoopty McFearsomeness goes down as the worst President ever. In 2947, he accidentally angers the Weaponeers of Qward and they attack Earth from their anti0matter universe, thus ending life as we know it.

The more you know.....

This could be a great oppor... (Below threshold)
Adrian Browne:

This could be a great opportunity for private health insurers to offer more profitable, more exotic health plans and not have to offer basic, less profitable health care that they're seemingly reluctant to actually provide anyway.

As it is they're not meeting consumer needs -- just like GM didn't meet consumer needs. A No Public Option Plan is a recipe for a future bailout.

A Public Option is like your feet. They are an expense, they're not perfect and they're not pretty but they get you from point A to point B.

Why should anyone trust he'... (Below threshold)
timajin:

Why should anyone trust he's right on this when he's not proven right on anything yet??!! Stimulus failed though we were told it would be a success. Admission that they were wrong on stimulus is admission that any plan of this size coming out of this administration and the democrats needs a lot more work! A LOT MORE WORK.

GLOD

I watched Wednesday nigh... (Below threshold)

I watched Wednesday night's ABC News special hosted by Diane Sawyer and Charlie Gibson

I just wanted to salute your cast-iron stomach, Michael.

President Obama is... (Below threshold)
Mac Lorry:
President Obama is optimistic that reallocation of existing health spending, combined with efficiency programs and effective cost reduction plans, will offset most of the cost of ObamaCare. Considering how badly his economic and financial advisers have bungled their economic forecasts, I don't share the President's optimism.

They showed a clip of a doctor from the Mayo Clinic who cited the high cost of extending a terminally ill patient's death. The phrase "extending the patient's death" makes the point that in many cases the treatment itself was so invasive that the patient's life ends when the treatment begins. A friend's dad went into a hospital for the treatment of colon cancer and his lucid life ended that day, but his body didn't die for a month. You can imagine the price for treating a dead man for a month in ICU. Had the doctors simply controlled this man's pain he might have had a few more months of quality life.

The problem is who decides the course of treatment? If it's the individual they may want every effort made to "cure" a terminal illness regardless of the risks or the odds of success. If it's the party paying the bills then no attempt would be made to "cure" anyone with certain conditions. Obama keeps saying that his plan will change the way doctors and hospitals are reimbursed. That change is from paying for services, like treating a dead person for a month in ICU, to paying for outcomes (no cure no pay). The result will be that people with conditions for which there is no statistically effective treatment will have a hard time getting treatment other than to reduce pain and the symptoms.

HughPost 11.... (Below threshold)
retired military:

Hugh

Post 11.

I notice Mara sorta ran away after your post. You beat me to it.

It is our government respon... (Below threshold)
jack hooper:

It is our government responsibility to meet the health care needs of people.

Watch Pirates of the Caribbean on stranger tides online




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