Posts Tagged Economy

I will give the President his due – he is a magnificent speaker, on par with Clinton, Reagan, Kennedy and Lincoln as one of the greatest orators in American history. However, the task before the country is to reorganize almost 20% of the United States economy in 90 days to preserve our economic stability, so extraordinary oratory is not enough. With that, a few thoughts from a healthcare businessman, not a politician, on tonight’s speeches:

• Is it possible for Republicans to be more tone deaf than to have a cardiac surgeon from Louisiana give a response to the President’s address? Maybe they thought Dr. Kevorkian would give a rebuttal. Is malpractice reform really the best Republican idea? At best, it is a 1% solution to the issues before us. As to rationing, it already happens, even if subtle ways. Cardiac surgery is not one of those subtleties – cardiac surgeons are not famous for performing bypasses on indigent patients.
• President Obama spoke for almost an hour and talked almost exclusively about health insurance reform. Does it concern you to think that it takes an hour tonight, in addition to most of August, to talk about insurance reform? Insurance reform is the easy issue for the American citizens – perhaps no other issue in the history of polling is so heavily slanted as it is against the insurance industry. If it takes all year to address the low-hanging fruit, how will Congress ever understand healthcare delivery? For a guess, see the first bullet above.
• As to the insurance reform suggestions, it sure sounds poll-tested – no caps on lifetime coverage (who pays for that?), no denials for pre-existing conditions, etc. Do Congress and the White House really think that the insurance companies will fail to pass the proposed taxes and incremental costs onto the policyholders?
• We will discuss in much more detail next week our “747 concept”. For now, we beg the White House to expand their search for examples of what is right and replicable about healthcare value. Professor Nicholas John Spykman once said, “Geography is the most fundamental factor in the foreign policy of states because it is the most permanent. Ministers come and ministers go, even dictators die, but mountain ranges stand unperturbed.” The theory of geography as destiny applies to healthcare, too, as does demography. Intermountain Healthcare has done some really innovative things, and Brent James, M.D. is well-regarded, but much of Intermountain’s success is due to a largely homogenous, if not teetotalling, population.
• When did the cost of health insurance for Congress become the benchmark for “affordable”? Is that compared to plans for union members?
• The President firmly stated that the public option has to be self-sustaining from premiums? History suggests how that works – lower premiums=fewer benefits. The public example is CoverTN; the private examples are often fined by insurance regulators for misleading consumers on the amount of the benefit. History also suggests that government sponsored plans are subject to lobbying for increased benefits, which usually become unfunded mandates. If the public option has to pay for itself from premiums, and Congress establishes minimum benefits, then premiums increase, right?
• In speaking on healthcare for an hour, the President mentioned value only once.
• In speaking on healthcare for an hour, the President never mentioned individual behavior or personal responsibility, except for the proposal to require everyone to obtain healthcare coverage like auto liability coverage. Anyone notice that was one of the three times (the others being malpractice caps and no federal funding of abortion) that the Democratic side of the chamber sat on their hands?
• The President called out Alabama as the example of a state in which a single insurer dominating a market, with the clear inference that less payer competition is worse for Americans. The Hospital Value Index™ study suggests just the opposite of what the President stated  – higher value markets are usually characterized by less competition on the payer side, whereas lower value markets are often characterized by more competition on the payer side.
• Finally, the President finished with a predictable appeal to Senator Kennedy’s legacy. Two things come to mind: First, watching Speaker Pelosi glowing while hearing the stirring tribute to Senator Kennedy was ironic, given that she appears to have failed to grasp his legislative genius. History suggests that Senator Kennedy would take as much ground on healthcare reform as he could get this year, and return next year to fight for more. That stands in stark contrast to Speaker Pelosi’s stance that there is no bill without a public option. Second, as to the President’s remarks regarding Senator Kennedy’s appeal to morality, if we have learned anything in this country, isn’t it that morality as the foundation for government policy is built upon sand? Wasn’t morality the underlying justification for the idiocy regarding death panels? We might be better off if both parties left morality to the church, as the separation of church and state suggests.

So, now the hard work begins. The good news is that there are 747 hospitals that are exemplars for healthcare reform, and next week, Washington will know who they are.