Tuesday, August 25, 2009

Obama has not Closed the Deal on Health Care

Sorry, but for me, Obama has not closed the deal on health care.

Real health care reform means both universal coverage and cost control. More people being covered is going to put more pressure on costs. And health care costs in the US are already way out of whack with the rest of the world.

When Obama talks about reducing costs, I feel like I am on a used car lot. As my colleague Jeff Lawrence says, "There's no such thing as a dysfunctional system because every system is perfectly aligned to produce the result it is currently getting." And the current reality is working well enough for medical malpractice lawyers, for people with private coverage (like me), for drug companies, for insurance companies, and for folks on Medicare and Medicaid. None of us well-situated folks want to take any real losses.

There's no real cost reform Obamacare.

Where is the requirement for service consolidation and elimination of overlap, where are the generic substitutes, where is the cap on malpractice suits, where is the middle class tax increase, where is the employer mandate, where is the ban on unnecessary procedures, where is the effort to shift services more toward younger people and prevention and, yes, away from people my age well into their AARP years?

Obama has not distributed enough pain to have any meaningful reform on the cost side. The evidence? There aren't enough of the right people people whining.

The protesters are middle class folks who are scared that either their coverage will go down, their costs will go up, or their taxes will rise. They have good reason to be fearful. The drug companies are all for Obamacare. That's a very bad sign.

If we are going to have universal coverage, with or without a public option, someone has to pay for it. Obama's feelgood administration is falling into the leadership failure traps of, gulp, his predecessor, failing to deliver bad news, failing to take the heat from his own constituencies, failing to try inspiring all of us to take a short-term hit for some larger, longer term goal.

Pain-free health care cost reform is an oxymoron.

Do you agree?


Paula Lalinde, Ph.D. said...

Hello Marty,

I am glad to see that you are back dribbling again... I mean blogging. :)) This is what came to mind.

Can you achieve systemic change without pain? Nope. Are the right people whining? Nope. The folks who have the most to lose are whining, e.g. they want the latest pair of sneakers, but not about health care. The real losers aren’t old enough yet to realize they are going to inherit a country run amok in part due to exorbitant health care costs – at least on the surface of things.

I pose the question, did Obama pace the work? Is health care reform possible when a country is already consumed by fear? Everyone is frantically holding on to what they got. Remarkably – 85% of the people are happy with their health care! Where did all the whiners about the quality of their insurance plans go?! More importantly is that even a relevant question?

The point is that we spend the most and have the poorest results than all other industrialized nations. Unfortunately the proposed reforms will result in status quo. We are shuffling the same deck of cards and the face cards are the same old folks.

Paula Lalinde, Ph.D.
Nothing Trumps Hope, LLC

Scott Eblin said...

Hi Marty -

Good to have you back. I agree with everything you said and also appreciate Paula's comment on pacing the work.

While we're in diagnosis mode (how apt), I'd add that there has been a noticeable lack of compelling stories from Obama that frame the issue in a way that resonates with the majority. I blogged about that myself a couple of weeks ago. Here's the link:


Cheers -


Peter O'Connor said...

I had been thinking for a long time that the question of "rationing" health care was something that we all avoid talking about when talking about health care reform, and I wondered if we would be able to institute health care reform and still avoid it. And sure enough, when the conversation got hot the issue came up, in the worst possible way. Of course, health care is already rationed to some degree, but not in any rational way (no pun intended), but we don't acknowledge that. Those who are employed and have insurance or Medicare get more and better care than those who don't. But if we ever want to control health care costs we will have to have a more explicit discussion about who should get care, when and how much. And hopefully in a more sensitive way than with a bunch of wingnuts running around talking about death panels.

Everyone impulsively wants all the health care they can grab, especially if they have a life threatening illness. But unless we debunk the assumption that if you have insurance, or are on Medicare, you are owed every bit of treatment that is available, regardless of its effectiveness and regardless of your chances of recovery, then we will just continue spending more and more, on more sophisticated and expensive treatment, until we spend every last dime of GNP on health care and nothing else.

Having just gone through this with my own 82 year old mother, who died 6 months after being diagnosed with ovarian cancer, I know how hard that discussion can be. She would have forgone treatment, but it was essentially forced on her by a health care system that defaults to the most care available. That can't be the default if we want to control health care costs. But to change this assumption would require us to have a different outlook on life, health, aging and death, and that is a conversation that, I am afraid, even Obama is not capable of leading in 2009. My mother's treatment did not extend her life one day beyond what was predicted without treatment, but the treatments themselves were a form of torture, robbing her of any peace or dignity in that last phase of her life. And the treatments were very, very expensive. This is a scenario that plays out over and over, thousands and thousands of times a year. And it will continue to, until things get alot worse than they are now, and continuing to avoid the issue becomes harder than confronting it. I think, sadly, we are a long way away from that time.

John Boehrer said...


I probably should realize that your blog is an extension of your leadership teaching, and therefore an instrument of your ongoing effort to provoke, rather than an otherwise unfreighted expression of opinion about policy and politics.

But, as did your earlier comments on empathy and judging, what you write about health care reform gets under my skin.

I guess by “Obama has not closed the deal…” you mean that he has not championed the right reforms, or that he has not succeeded in getting representatives or senators to include the right reforms in their bills, or that he has not persuaded the vast sources of wealth who fund those Congresspeople to accept the right reforms, or that he has not sufficiently given the public to understand what the right reforms would be, how they would work, and what (and whom) they would cost.

I guess that’s what you mean, because what else could you mean? But I wonder, because you write as if the entire universe of health care reform consisted of Obama, on the one hand, and everyone else, just waiting to be properly led, on the other, as if it were entirely within his power to “distribute the pain” – is there a danger of myopia in studying “leadership”? – as if there really were something called “Obamacare.”

“Obamacare” is nothing more, nor less, than a derogatory term for any effort whatsoever that Obama makes toward health care reform, propagated by those who would stymie any such effort to improve the current system. BTW, there are dysfunctional systems – those that yield unintended, counterproductive, or lousy results – and our health care system is one of them. (The “… every system is perfectly aligned…” dictum seems like one of those spiffy, little est-isms we should have all gotten over long ago.)

Quite frankly, I’m disappointed, too, in Obama’s leadership toward health care reform. I wish his charisma were more blinding, his tongue more silver, his lance more pointed. I wish especially that he could lay waste to the forces of greed, mendacity, and ignorance arrayed against him.

You write that “the protesters are middle class folks...” No, they’re not. They’re the demagogues in Congress like John Boehner, the cynics who bankroll outrageous TV spots and circulate lies like the euthanasia nonsense, the crazies who bring their guns to health care forums, and the Astroturf troops who drown out debate, like the idiots who shout out their opposition to “all government health care programs” while collecting their Medicare benefits.

How should a good, competent, inspiring leader respond to all that? Keep in mind that the only viable choice we have is between health care reform and better health care reform. No health care reform is failure – the “failure of good people to do something.” If that failure occurs, it will be seen as Obama’s, no doubt, but that misapprehension will itself be symptomatic of more fundamental causes.

Rather than read how Obama is falling short of leadership axioms, supposedly – given what the Blue Dogs are handing him, for example, “failing to take the heat from his own constituencies” seems like a particularly bad rap – could we instead hear some positive, specific ideas about how he might deal with what’s coming at him, or even, how we might otherwise view the burden than as falling entirely on him?



Rodrigo Silva Ortúzar said...


Great to have you back blogging. I was missing your posts.

Well, I don't really know how the Health Care Systems works in the U.S., but in Chile, although it's not perfect, we have a good enough heath care system, where everybody is free to chose between getting a private plan or a public plan. What it is not free, it's that a percentage of your salary must to go to one of this plans, but at least, the goverment's responsability it's not as big as it is in other countries.
Something similar happens with the Retire System.

Now, one question, where is the rest of the US citizen's responsability? I mean, are you people going to let the authority to do all the work?


Anonymous said...

"Self-righteous" is a powerless cliche that deflates the power of your fine post. It's the kind of word Rush Limbaugh uses.

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