Daily Archives: October 19, 2009

The President’s Job? Weighing In

In an Associated Press story hot off the presses we are told that when it comes to arguably the most ambitious public policy goal of the last 50 years–comprehensive health reform–the leader of the free world has a role to play. That’s not surprising. What is surprising is that his role is not to lead the effort, but rather to “weigh in when it’s important to weigh in.” Really?!

Call me naive, but I expect the President of the United States to do more than just throw his two cents in when they pass the plate to collect ideas, especially when the topic is a part of the platform on which he campaigned for the office–and the primary reason that this author voted for him.

It’s quite clear that Obama favors the public option, but he’s now going to take a backseat in the debate while Congress works to reach a compromise. Is that really how one stands up for what they believe is right? It’d be one thing if Obama didn’t claim the public option was a priority. Then we could just agree to disagree. What I take issue with is his championing the idea rhetorically, but not pursuing it tenaciously.

Now, to be fair, maybe this is his version of “speak softly and carry a big stick.” Perhaps Rahm Emanuel is that stick. If so, then there will be a great deal of compromise reached in back room meetings, with serious threat leveling and arm bending. If that’s the case, then my criticisms are leveled prematurely, and it’s best that such ugly politics are kept out of the public eye–lest they tarnish the President’s approval ratings. Then again, if everything the President does is carried out behind the scenes, will he be able to make as strong of a claim to victory should health reform pass? As with most of my other musings, I suppose that only time will tell.

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Posted by on October 19, 2009 in Uncategorized


Keeping Docs On The Sidelines

Amy Goldstein had a nice piece in Friday’s Washington Post exploring the AMA’s fence-straddling on the health reform issue. Now, before I go any further, it’s important to acknowledge that the AMA doesn’t speak for all–or even most–physicians. There can be little doubt, however, that the AMA speaks more loudly than any other physician group, because it is well-organized, well-financed, and well-known. Why should we care if the nation’s leading physician lobby is wavering on health reform? Because to date they have been largely uninvolved in the debate. If they suddenly enter the fray with gusto, they stand to greatly influence the final outcome of reform.

As has become abundantly clear by this point, health care reform has really been framed as health insurance reform, and the natural “enemy” of that effort has been health insurers–with America’s Health Insurance Plans serving as the most visible target. No doubt, that approach was decided upon for largely political reasons. Specifically, the public tends to hold physicians in high regard, while insurers are more often the object of scorn. Thus, it takes much less effort to convince people that insurance companies need to be made more accountable than it does to convince people that their doctors need to make less money (or some such thing).

Now, I happen to think that health reform–done right–will require two distinct phases. The first is the creation of a revised payment structure and the second is the reformation of the provider-delivery system. I firmly believe that when the political calculations were being made, it became clear that a one-and-done effort at addressing both the payer and provider components of health care wouldn’t be politically feasible. Why? Because the payer and provider groups would unite in their opposition, and history teaches us that such powerful entrenched interests are nigh impossible to overcome. Instead, I believe, the decision was made to employ a divide-and-conquer strategy. That means aiming for one target first, before following up with the second act. Of course, if you were paying attention earlier in this post, it should come as no surprise that insurers were first up on the chopping block.

But the AMA is made up of some pretty smart folks. I think they understand that they are sitting in the on-deck circle; that their livelihood will be coming under fire next. If, that is, part one of reform is successful. As the political strategy becomes more apparent, it seems increasingly likely that the docs are going to become more vocal in the debate. They sat on the sidelines for a while, content to let insurers catch the brunt of the reforms. Now, they may be rethinking that strategy, and planning to come to bat for the insurance companies, if only to save their own skin. Of course, the flip-side of their decision is that, if they oppose reform and it passes anyway, they will have spent whatever political capital they were amassing by sitting this one out so far. Consequently, Congress might bring the hammer down even harder during act two. Whatever the AMA decides to do, you can be certain that the decision wasn’t made lightly.

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Posted by on October 19, 2009 in Uncategorized

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