About ObamaCare, America Wants a Second Opinion

July was an amazing month in the long political history of health care reform. The summer had begun with a focus on the plan's financing problem -- a straightforward case of sticker shock that in retrospect should have been anticipated. After the stimulus and the huge increase in the federal budget and House passage of a new tax in the form of energy cap and trade, the public had become skeptical of the notion that a universal health care system would save enough money to pay for itself. That meant support for taking on massive additional debt to insure everyone would be split at best.

The administration began a campaign of photo-ops to suggest the industry itself was on the support side. On May 11th, an obviously pleased President Obama lauded the industry's pledge to achieve a 1.5% reduction in the rate of growth of health care expenditures through such devices as improvements in efficiency, lower hospital readmission rates, greater use of generics, and so on. Someone calculated that these would produce a total of "$2 trillion in savings" by the end of the decade and a headline was born.

Then in late June, the Pharmaceutical Research and Manufacturers of America gave the President another positive announcement when they promised broad voluntary drug price reductions for seniors, the disabled and several government health programs. However, this "$80 billion in savings" also suffered from vagueness and the suspicion that it was merely a restatement of the same drug savings that had been announced the month before. At best, it was a fraction of the staggering projected cost of the new system.

So the public debate over the affordability of a new health care entitlement went on. And then on July 16th Douglas Elmendorf, the director of the Congressional Budget Office, told the Senate Budget Committee that it wasn't able to score any long-term health care savings from the proposed legislation. The effect was electric -- puncturing one of the treasured justifications for health care reform in one of those rare "the Emperor has no clothes" moments. From that point forward, it was clear that any further legislative progress would require a credible funding plan.

The era of believing in the myth of free health care was finally over, but rather than being confidence-inspiring, the funding proposals coming out of Washington were worthy of a David Letterman satirical routine -- a "millionaire income surtax" as if the wealthiest 1.2% of Americans would pay for the health care of the other 98.8%; a tax on soda-pop; some sort of obesity tax; a plastic surgery tax; several versions of a tax on health care benefits themselves. In a memorable spasm of over-exuberance Nancy Pelosi asserted, "... I believe that all of the cost of the health care reform bill can come from squeezing more savings out of the system."

But the financial questions are only the half of it.

For forty years the mantra has been that "health care is a right, not a privilege." This slogan has been repeated so often that it has become accepted as common wisdom by most Americans, although most have never thought about why healthcare should be different than other essentials like food or shelter, nor do they seem aware that it is already the standard of care for all physicians and hospitals. It's the value proposition that tends to get used most often when advocates are explaining why private health care has to be replaced with a tax-supported, single-payer, government-run health care system covering everyone. As recently as last week, the Congressional Progressive Caucus repeated it yet again, emotionally arguing against any legislative compromise if it means watering down the mission of setting up a strong "public" (i.e. government) health insurance option as a stepping stone to a single payer system.

To position America for what they see as its long-overdue entry into this promised land of universal health care, the House bill sets up no fewer than 53 new bureaucracies and creates or expands 33 separate entitlements. Obviously the funding of these new costs is not an immaterial issue. But the question of how the government will run this huge new enterprise may even be bigger. This isn't going to be as simple as taking over an auto company (as if that was easy) -- people have choices about the products put out by Government Motors; health care will be different and the public is suddenly very aware of it.

And on these ever-so personal issues of health care President Obama has been surprisingly maladroit. In a recent column Shelby Steele compared Obama to the German rocket scientist played by Peter Sellers in Dr. Strangelove who periodically loses his internal struggle to suppress his arm from extending into an involuntary Nazi salute. In Obama's case it's his private dislike and distrust of private business and businessmen (and on one memorable recent occasion, white policemen) that keeps breaking out when he loses control of his script.
So, in Obama's view, doctors in private practice needlessly prescribe red pills instead of blue ones, even though they cost half as much and work just as well. Or the doctor, with an eye on his fee, performs an unnecessary tonsillectomy on your child, or places a pacemaker in the chest of a 100 year old woman instead of having her "just take a pain-killer." (No one is quite sure what the President meant by this medical non sequitur).

America usually prefers to understand its problems in the form of moral struggles -- a face-off between the forces of truth and goodness against some wretched villain, so demonizing the opponent usually works for politicians. It has become one of Obama's favorite rhetorical devices. In this case though, he failed to recognize how health care is not an abstraction like Wall Street Speculators or Big Bankers, but a network of personal trusted relationships that people know, rely on and value. These are people and institutions that are not so easily caricatured or abandoned. If it comes down to the question of who America trusts more, its family doctors or some shiny new government bureaucracy that promises it can make better decisions -- it's the new bureaucracy that's going to be in trouble.

And so it is. Once the President tipped his hand and seniors understood that "better decisions on end of life care" was a euphemism for getting too old to qualify for expensive medical services (Ted Kennedy are you listening?), they turned on the accommodationist AARP and made it clear that it is not speaking for them or their concerns when it supports a government health care system. And although he may be too young to personally remember it, Obama's tonsillectomy example was a particularly sensitive hot button for many suburban moms who went to war against Managed Care over this exact issue -- insurance companies denying tonsillectomies that their doctors recommended and their children clearly needed, (which, by the way, they won). Now here is the President saying that government health care is going to impose all the same sorts of barriers and requirements again, (although perhaps now on their grandchildren), and this time because it's government, without legal recourse.

Finally, in the last week of the month we were reminded that the government that is now asking us to believe they can predict the weather fifty years out and should be allowed to take medical decision-making over from your doctor, failed to anticipate that a Boeing 747 flying low over Manhattan would scare the daylights out of the people who lived through 9/11, or that the "Cash for Clunkers" program that was supposedly funded through the end of the year would run out of money after its first few days. It didn't inspire confidence that these are the people to whom one can feel comfortable entrusting matters of life and death.

So, for the 80% of the American public who say they like their current health care, the reform initiative now looms as a frightening potential loss. Not only has the Obama administration failed to close the deal with the public, but through its unsupported, exaggerated claims and disregard for fiscal and medical realities it's made the case for health care change itself suspect. The public is no longer buying that "health care is simply broken" (at least not their health care), or "in deep crisis," or in its most recent incarnation on the last day in July, that the real villain is the insurance companies themselves.

One has to think that when the members of Congress get home for the August break, they are going to get an earful from a constituency that's been aroused by the fear of what they might do and now sees itself fighting to preserve a valuable piece of their lives. Then when Congress reconvenes in September, it's going to get really interesting. We already know what Obama and Pelosi and Reid and Waxman want to do -- they've told us, plain and straight. What we don't know is just how much political damage they're willing to absorb in order to do it.