by Richard Reece, MD
I’m an ideological pragmatist. I believe in what works and what suits the temperament of American people, rather than what is politically correct or what passes some moral litmus test.
Whatever reform measure passes, it will be a public-private mix and will superimpose more government regulations on our private system. It will have uneven effects. It will cost more than the status quo. And it will expose the reality, that when it comes to health reform, Democrats and Republicans have their ideological blinders on.
All developed nations have a mix of public and private systems. The United Kingdom has the NHS (National Health Service) and BUPA (British United Provident Association and other private plans); Canada has its Medicare and private insurance plans to help citizens escape waiting lines.
It comes down to questions of the socialist-capitalist mix, how much government consumes of a nation’s GDP, what citizens are willing to cough up in taxes, what choices they are willing to give up, how long they are willing to wait for life-saving and function-restoring technologies, how free they want to be in their personal decision making , and how economically secure they want to be in health care matters.
Everybody in all countries knows if you have money and connections, you can jump the public queue to get care. In the U.S. Medicare and Medicaid cover about 105 million of our 310 million citizens at a cost of about $1 trillion, while private plans care for the rest for roughly $1.5 trillion. Then, of course, there are those “Cadillac plans,” which offer rich benefits, mostly of members of powerful unions.
Health reform as an “ideological exercise”
Democrats harbor the illusion of a high moral duty to care for all by expanding federal regulations to care for all. It may be more about political power than moral obligation. Nolan Finley, reporting in the Detroit News, says the “most tangible fallout of the electorate single-powerful rule in Washington is that public policy making has become an ideological exercise, rather than a pragmatic one.” Translated, this means, by God we Democrats have unlimited power, and we’re going to exercise it, no matter what the consequences.
Meanwhile Republicans seem to think Democratic power leads to serfdom, and the only solution is freeing the market from federal regulations, letting entrepreneurs innovate , and having consumers pay their money and make their choices. This isn’t going to happen, given embedded liberal ideologies of equity and equal outcomes and current political power.
Connections and ideology
One’s connections shape one’s ideology. I am no exception. I work closely with The Physicians’ Foundation, a nonprofit organization representing some 650,000 practicing physicians in state and local medical societies, and for the last 10 years, I have been on the MedicaL Advisory Board of Castle Connolly’s Top Doctors, which is closely linked to the nation’s top academic medical centers.
From the Foundation, I’ve learned most physicians cherish independence and direct relationships with patients without 3rd party interference. These physicians, contrary to what you might hear about AMA support of current health reform, tend to be profoundly skeptical of House-Senate bills because of their intrusiveness into doctor-patient relationships and constant lowering of reimbursements.
From the Top Doctor organization, made up mostly of more 3000 physicians practicing in America’s 125 academic hospitals, I’ve learned academics are skeptical as well. They are especially leery of the proposed $500 billion Medicare cuts proposed over the next ten years. High tech care of Medicare patients is often the life-blood of these institutions.
The American people
From recent public polls, I’ve learned 60 percent to 70 percent of the public do not believe reform will lower costs or improve care, or change their overall care for the better. At this stage, because of unemployment of over 10 percent, the perceived ineffectiveness of the massive stimulus bill, and soaring federal deficits, public belief in government intervention is at an all time low.
Because of these various factors, I remain pragmatic and skeptical about the ultimate outcome of reform and its political and practical consequences. To me talk of successful reform as “historic” remains mostly political histrionics. Time will tell how reform shakes out and whether criticism from the sidelines is factual or simply political jealousy. We do not yet know the impact or implications of this partisan party line bill, or how its final version will evolve.
Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.
Submit a guest post and be heard.
Similar Posts:
- Inconvenient truths about our health care system
- 10 health reform posts you may have missed
- Should a public plan option be part of any health reform initiative?
Scrubs
{ 22 comments }
“It may be more about political power than moral obligation… by God we Democrats have unlimited power, and we’re going to exercise it, no matter what the consequences”
You lost me here.
While I think both the Dem machine and the GOP machine have lost their marbles in many ways, I think their motives are sincere. There are big problems with the health care system here– that’s undeniable, its not a made-up problem– and the Dems have a sincere belief about the best way to solve them and the Repubs have an equally sincere belief about the best way to solve them.
Painting either party as some kind of one-dimensional power crazed cartoon characters who don’t really believe in their positions on major issues is just more of the silly partisan nonsense that has become the standard for political conversation in America. No discussion about an issue as important as our health care system can be considered legitimate where intellectually lazy caricaturing and stereotyping is treated as a point of fact. Its difficult enough to solve without all the secret conspiracies and imaginary ulterior motives mucking things up.
A lot of people assume I’m a Republican, I’m not. Registered as an Independent, I am.
My opinions about healthcare and “reform” are based on being shafted in almost every way a physician can be shafted . . . by a “non-profit” (all about charity – NOT!) . . . by the government I served (they can’t properly oversee a comparatively tiny public service program, but hey, let’s hand over EVERYTHING) . . . by my own kind (my Medical Board/Medical Societies/the AMA were USELESS as advocates – and STILL are) . . . by JCAHO (sentinel events are a big deal – except when they aren’t) . . . by my “progressive”/forward-thinking representatives in North Carolina (I cannot BELIEVE I ever pleaded my case to John Edwards!) . . . and (of course) by lawyers & suits (”people lie in Court every day”).
My “ideology” leans toward the conservative – and towards getting the government (and a good portion of the middle-people) OUT of the doctor-patient relationship – because most of the villagers doing the shafting in my case wore BLUE.
“In the U.S. Medicare and Medicaid cover about 105 million of our 310 million citizens at a cost of about $1 trillion, while private plans care for the rest for roughly $1.5 trillion.”
This statement is misleading: 1) private plans do not cover “the rest” and 2) Medicare and Medicaid patients are older, sicker and would probably not be covered under private plans. You are implying that private insurance is more efficient but leaving out facts to the contrary, showing how very ideological you are.
“…My “ideology” leans toward the conservative – and towards getting the government (and a good portion of the middle-people) OUT of the doctor-patient relationship…”
Can’t any doctor who wants everyone else out of the doctor-patient loop simply establish his or her rates for dealing only with patients and then bill them directly?
“……I work closely with The Physicians’ Foundation, a nonprofit organization representing some 650,000 practicing physicians in state and local medical societies, and for the last 10 years, I have been on the MedicaL Advisory Board of Castle Connolly’s Top Doctors, which is closely linked to the nation’s top academic medical centers…..”
That would be virtually all the physicians in the USA. Current number is, what, some 700,000-800,000 docs.
What’s AMA membership these days?
Does he really think he represents, or works with any organization that represents, that many docs in any meaningful way?
Tad,
While I agree that “both the Dem machine and the GOP machine have lost their marbles in many ways”, Dr. Reece is drawing possible conclusions from the implication in a statement such as “never let a serious crisis go to waste” by Rahm Emmanuel. Most, if not all, legislation starts out well intended but there is a reason for the old expression “the road to hell is paved with good intentions”. As Dr. Johnson notes (and has experienced) few things are done well by government but as Dr. Reece eloquently outlines in his book, there are pragmatic ways to incorporate both sides, at least as a start. Without taking the time to read his blog or book you are guilty of the very “intellectually lazy caricaturing and stereotyping” that you disparage. With that phrase, “you lost me”.
Who says it’s a crisis anyway? Haiti – that’s a crisis. Healthcare? Not so much.
I’m not sure what to call you… Ground? Mr. Down FP?
Unfortunately, your logic isn’t very good. “Never let a serious crisis crisis go to waste” means only that there is political opportunity there, it says nothing about the political opportunity being the motive, as in the phrase, “It may be more about political power than moral obligation. The Republicans are certainly no less opportunistic. They are STILL exploiting political opportunities from 9/11, but only a liberal way out there in Nutcaseland would suggest the GOP was motivated MORE by political opportunity than by avenging 9/11 and preventing another one. Or is it really your contention that the Democrats are slimier than the Republicans, that Republicans are doing the right things for the right reasons but the Democrats aren’t? I hope not. The absurdity of that notion is too silly to waste blog space on.
And secondly, I actually do read his blog, which I would have thought was fairly obvious since my comment is a reply on his blog about something he wrote on his blog.
Tad, I’m curious.
When you say “While I think both the Dem machine and the GOP machine have lost their marbles in many ways, I think their motives are sincere.”
What is leading you to believe their motives are sincere? Or is it just a gut feeling?
Logically let’s ask:
What would it look like if their motives were INSINCERE (ie more about amassing more power and appeasing special interests)?
What would it look like if their motives were sincere (truly care overall about what’s best for the country)
And what is the reality of what we’re seeing now?
I don’t understand this. We can treat most of the illnesses pretty well with generic drugs that are dirt cheap. But somehow the government needed to start up a drug program for Medicare that is going to cost about the same amount – a Trillion $$ which is going mostly into the pockets of Pharma.
But if you want to help the uninsured get coverage – That’s socialism? I am not a fan of what our lawmakers are producing right now, but it seems like we need a little more honesty amongst the two parties.
IVF:
My basic guiding principle– which I’ve never found to be wrong– is that everybody is pretty much like everybody else. That is, people who choose to become scientists are not, as a group, more incompetent, more deceitful, less conscientious, etc., than, say, wedding photographers. Now that doesn’t mean that some individuals can’t be insincere and morally bankrupt. But the numbers distributed evenly. There are as many florists who will try to cheat you as plumbers or clothing salesmen. Likewise, the Democratic party and the Republican party have roughly equal numbers of people who aren’t trying to do what’s best for his or her constituents. I think its cynical to say that ALL Republican and Democrat politicians are crooked, but it goes beyond cynical and becomes downright idiotic to say that only ONE of those groups is crooked but the other one is righteous. Imagine how silly it would sound to suggest that doctors don’t really want to help people, they’re all just in it for the money, but dentists really are all about healthy teeth. That’s kinda how the whole thing sounds to me. Lastly, the way our government is structured, one guy can’t do a whole lot of damage by himself. If someone were motivated by personal power, becoming a politician is not a very efficient way to achieve it.
Tad,
We’re not in disagreement here. (BTW, ground or down are both equally applicable). I almost also used former President Bush’s phrase regarding “having political capital and intend to use it”. I’m sorry that you assumed I was siding with only Republicans in using Mr Emmanuel’s phrase as one piece that Dr Reece may have used to conclude intent of lawmakers.This piece was not from his blog, by the way. He blogs at medinnovationblog, as noted at the end of the piece. This was only a guest piece as Kevin often has other bloggers content here.
I see, Tad. So if I read your reply correctly, your assertion that the politicians have sincere motives for helping people with this attempted healthcare takeover is based purely on your pre-existing beliefs that people (including politicians) are generally pretty good and it’s not based on any observation of what they are actually doing in this case. I don’t have the inclination to try to argue that.
Thanks for clarifying,
Oh, I thought you were talking about Kevin’s blog. You’re right, I only know about Dr. Reece’s positions what he said here, and it seemed awfully lopsided to me. It sounds like he is saying Democrats are crooked and Republicans are impractical. While there’s something in there for both parties, the Dems get the clear shaft in that comparison. I don’t think either party has a legitimate claim to any moral superiority. The paragraph in question left me with the impression that the good Dr Reece does. If he doesn’t, if maybe he just wasn’t as clear and precise as he could have been, all the better. Never mind.
IV…
Unfortunately, no, you didn’t read my reply correctly (I hope you read your patients’ medical charts better than replies to blogs). My assertions are based entirely on observation and a fundamental understanding of human behavior. I can only shudder at the thought of a doctor treating patients while professing no understanding or acknowledgment of the fundamentals of basic human behavior. Your position– which you must admit is severely compromised by a gigantic personal stake in the outcome– not only throws out everything we know about people, but goes further by making motives up, completely out of your imagination. Its a far more ridiculous position to take that you know these people’s motives and they’re evil than to assume their motives aren’t any different than yours would be if you held that job. I assume you’re a fair and reasonable man who tires to do the right thing by his patients. Are you really sayinf that if you were a politician, you would adopt a completely different personality and value system, tailored to whatever perks of the job you could wring out? I find that very hard to believe, but that’s precisely what you accuse those in Washington of. Your best defense, the “But They’re Aren’t Like Us” defense is very, very weak.
IV… what exactly has got up in your underwear about this health care bill? Try to have a little perspective: for a whole lot of Americans, this is one effed-up health care system. Try not to see the path America needs to take in order to fix it as being all about you. That’s pretty selfish and short-sighted, don’t you think?
lol Tad, if there’s an idea that you would like to discuss so that we, and other readers can be enlightened, I’d be glad to debate with you. I pledge not to resort to personal attacks and you are welcome to choose your own tactics as well.
I was merely saying that your conclusion about the motives of the politicians was based on something akin to what you call “a fundamental understanding of human behavior” and not based on what their actual observed actions are. I still think we’re in basic agreement on that. peace
Having read this article, I wonder why the author even wrote it. It doesn’t really accomplish anything. His last sentences are really meaningless. And I’m still trying to figure out what he means by his introduction: “I’m an ideological pragmatist. I believe in what works and what suits the temperament of American people, rather than what is politically correct or what passes some moral litmus test.”
‘What works’ has a lot to do with what one is trying to accomplish, which has a lot to do with one’s ideology. What Cuba does currently, by controlling its populace, nationalizing businesses, etc. – could be viewed as ‘not working’, since the country is highly non-productive. On the other hand, looked at through the leader’s eyes, they are ‘equalizing’ outcomes (even if the outcomes are generally bad) and so, they might view this as a success!
Can the author necessarily believe both in ‘what works’ and in ‘what suits the temperament of the American people’? What if the American people want no new taxes and the best health care in the world run by the government? It is up to the author (and each of us) to decide what is right and then convince others that it is right – the author is essentially abdicating this responsibility to think for himself.
Even if the author feels he knows what is correct (which he doesn’t appear to even claim) but realizes that the American public won’t be convinced to his way of thinking; at least he should advocate pushing, as much as possible, in the correct direction.
But his view is the borrowed: ‘All developed nations have a mix of public and private systems.’ and the implied – so we should too. It’s only a matter of the exact ratio of public to private, you see. There are no fundamentally right or wrong principles, there is good and bad on either side, there is honestly and dishonesty on either side, time will tell, we’ll see… yawn.
“I was merely saying that your conclusion about the motives of the politicians was based on something akin to what you call “a fundamental understanding of human behavior” and not based on what their actual observed actions are”
——————————–
Wow, IVF, you’re seriously astonishing me here. They couldn’t possibly let people out of medical school let alone into people’s organs with the kind of logic and intellectual rigor you’re demonstrating here, could they? That’s 10% insult and 90% genuine jaw-dropping shock.
Because even as you try to avoid saying it outright, you continue to state a pathologically delusional belief that you have the ability to read minds. Do you really believe you are able to discern evil motive from a loooong overdue health care bill that is trying to make the best attempt to solve problems everybody (but you, apparently) is on board with trying to solve? Seriously?
I’m not asking so I can debate a piece of the health care proposal wth you, you’re pretty clearly beyond the debating point.
I’m just trying to understand what has you so emotionally roiled up that you’ve started hallucinating.
Seriously.
Imagining that you can read minds is scary enough in a plumber. In a physician, its bone-chilling.
IV, I’m not a politician, and I stand to profit or gain power not one iota from a health care like the one being debated now.
Assuming I am genuinely interested in seeing it pass, which I am, what evil motive do you ascribe to me and the millions like me? What else can you tell about my morals and my value system from my support of the health care proposal?
That’s a serious question, BTW
Tad, you are obvious passionate about wanting to improve things and so am I. I have no qualms about your motives.
Where we differ is that you have been convinced that more legislation is better or maybe that this SPECIFIC legislation will make things better, whereas I strongly feel that it will make things worse.
It would be good then, for us to educate each other on the facts of the issue to help each other understand our viewpoints as to what changes would likely take place if this bill goes through. And perhaps even prior to that, we might both want to reflect on the even broader question of how each of us have come to believe the things that we believe, whether it be by examining the evidence empirically, thinking things out logically or by allowing ourselves to be influenced by the media and/or institutionalized schooling. The last two are actually very powerful and in many ways, more powerful than most of us realize.
Take care.
Yes I am convinced more legislation is needed, because I can’t think of any way to solve the problems of runaway costs and universal coverage without it. I know there are those who think the answer to everything is legislation, but I’m not one of them. Neither am I one of those who believes a free market solves all problems (for all the negative things one can say about the government’s ability to manage something, this isn’t really a good time to make a case for the competence and wisdom of big business, either). If you can think of a way to force insurance companies to lower the amount they charge us while simultaneously covering everybody, I’m all ears. But I’ll tell you upfront, I’m dubious about any idea that says “competition will take care of it”. We just came this close to sending the world into another Great Depression. You” forgive me if I’m not real high on the wonders of capitalism right now.
Comments on this entry are closed.