It is not a left-wing agenda.  It is not socialized medicine.  This is the first time the Federal Government has mandated the purchase of a private party product.  And from the very racketeering group that is the root cause of the problem in the first place.   What a travesty.   Another government subsidy.   Effectively amounts to another “government bailout.”

As Michael Moore wryly said:

The larger picture here is that the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it.

This is not the same as a state mandate for auto insurance.

The State of California is unrelenting on this point.  Driving is a privilege!  It is not a right.  If you do not drive, you are not mandated to purchase auto insurance.  Furthermore, the reality is auto insurance does not cost $5000-12,000 annually.

This is the first major landmark piece of legislation in American history that was passed by such a narrow margin without a single Republican vote.   Social Security passed with bipartisan support in 1935 — 81 Republican Congressman and 16 Republican Senators.   In 1965  Medicare passed with bipartisan support –  70 House Republicans and 13 Senate Republicans.  In 2010 there was not one single Republican vote.   And the margin in the House was razor thin — 220 to 212.

It also violates a well-tested political strategy — sell it first to the American people who will then pressure Congress to pass new legislation.  The public is not aboard.   The latest Quinnipiac and Washington Post polls show the public still opposes this landmark Act.

AT&T has already made plans for a $1 billion write-off in advance of cost shifting.   And legal staff is hard at work looking for technical loopholes.  This just in from Robert Peer at the New York Times:

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message.  If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”

Everyone is giddy about “the win.”   This is only the end of the beginning.

Remember the Telecommunications act of 1996?   It was enacted to guarantee local competition amongst the major carriers.  It never happened.

Now watch this interview with Michael Moore:

Ave, Imperator, morituri te salutant

The secret fate of all voting democratic House members.  The arm twisting in the house rises to epic proportions not seen since the days of the infamous Tom DeLay – the Hammer.

This will be a bad bill.  You are all unwitting pawns in this game.  It will solve nothing.  It cures nothing.  It has emboldened the insurance racketeers and Big Pharma.  It has only one potential good outcome — Rush Limbaugh has promised he will leave the country.

They have rolled Howard Dean and Dennis Kucinich.   Other voices have been marginalized – Bernadine Healy, Robert Reich, Norman Goldman of Talk Left, Marcia Angell. And who will benefit from a fatally flawed passage?   The rising unaffiliated — the independent vote.  This is a Greek tragedy.   A Pyrrhic victory.

We are all too aware of the right wing echo chamber.  A well orchestrated score promoting stereotyped rat a tat answers.   How do they do this?

The same may be true in on the left as well.  We hear platitudes and assertions over and over again without challenge.

1. United States ranks number 37 in the world in healthcare.

Why repeat this assertion over and over and over again?  Because it makes a false point.

This figure is derived from life expectancy in the OECD  (organization of economic cooperation and development) countries.  The spread is narrow – less than five years.

My friend Burton Goldberg, one of the most successful publishers of alternative medicine, constantly beseeched me on this issue — investigate life expectancy derivations.  Life expectancy is a highly complex mathematical formula that balances death with infant mortality.

A country with a high infant mortality has a lower life expectancy rate – at birth.

For the most perplexing reasons, the United States still has a relatively high infant mortality rate.  If the figures are adjusted for life expectancy after the age of 60 we rate number 5 in the world.   If life expectancy figures are adjusted after the age of 80 we rate number 3 in the world.

In other words, as we advance in age, the effect of infant mortality is factored out and the real life expectancy becomes more apparent.  We are not number 37 in the world.  We are in the top three.  Life expectancy figures beg a revised definition.

US Life Expectancy -- 3rd place by age 80

Furthermore, life expectancy is a dreadfully  inadequate measure of the health of a nation.  It says nothing about the quality of life.  HDI, (Human Development Index) may be a better measure.]  It says nothing about vibrancy, activity, mental health, social health, sexual health, or productivity.   It simply means that you crossed the finish line at a particular age.   No matter whether you dashed across or fell across the finish line and died.

In Anti-Aging Medicine, we talk about “squaring the curve.”  Increased Health Span and not Life Span.  A healthy life until old age followed by sudden death.  Not a slow inexorable painful march to the end.

2. The medical system suffers from over utilization.

Not as I see it.   Quite the opposite.  I see scores of patients who have pleaded for years for adequate and thorough lab testing only to needlessly suffer through unnecessary dysfunctional states   This is a natural consequence of HMO and PPO medicine.   Bottom-line cost-recovery medicine is a zero sum game.

3.  If you do not pass this bill everybody will end up in the emergency room.

There is such an appalling lack of medical input in this entire debate.   Urgent care medicine had its roots in the 1980s.   Originally funded and promulgated by astute entrepreneurs and ex-emergency physicians, these facilities answered the need for acute medicine outside of an emergency facility.   There are more than 8700 Urgent centers visits vs. 4600 emergency departments.     [And by the way, Emergency care represents less than 3 percent of the nation's $2.1 trillion in health care expenditures while covering 120 million people a year.]

This is market-oriented medicine.  A workable and elegant solution in response to a market demand for immediate care outside of exorbitant emergency rooms.   They are successful and see all comers.   In Atlanta alone, my good friend Jordan Rice, one of the leading Urgent Care entrepreneurs in the country boasts of the ability to see any and all comers — Medicaid and cash paying patients.

Even the original Medicare bill of a 1965 garnered 13 Republican votes in the Senate and 70 Republican votes in the House.  To pull every legislative trick in the book only underscores the thinness of support for this ill-conceived rewrite of our society.  To be honest, Michelle Obama’s anti-obesity campaign could have more far-reaching effects that all 2700+ pages of this legislative lunacy.

Football holds less interest as I age.  So it is with some amount of disinterest and idle  curiosity that I decided to watch the Super Bowl yesterday.   I was rooting for the Saints.

This was a perfect game.  It had everything.  A storybook Cinderella team representing a broken city hoping for a symbol of resurrection.  And a great quarterback from the opposing team who had everything.

I have always maintained that a truly great team is defined by this Trinity: a great owner, a great coach, and a great quarterback.   For one afternoon, the Saints found this.

Championship games are defined not only by the greatness, courage and persistence of the players but by the genius and wiliness of the coach.   Great plays are called by the coach.  Bill Walsh used to call the first 16 plays of each game, according to his playbook.  So the third quarter onside kick will be remembered for years.   Genius.   And courage.

This had the requisite suspense, back-and-forth momentum.  It was never a blowout.  The outcome was in doubt until the very end.

Baltimore suffered from a rookie coach.  Only one rookie coach has ever won the Super Bowl– George Seifert — with the help of Joe Montana.

New Orleans had not only heart but genius.   A storybook ending.   A great game.

From Inside Washington, Nina Totenberg encapsulated it best.   The economy and job prospects dwarf all other issues.

If we had 5 percent unemployment, he probably would have gotten the plan through.  But you can’t refocus people’s attention on an aspirational goal for a society — I think it’s very difficult to do that — when people are hurting so much in the immediate sense and businesses are going down the tubes, small business on a daily basis.  You just look in any mall, places you’ve gone for years, they’re gone now.  People in every level of life are struggling to even have a job or they’re working part time.  Kids coming out of school can’t find jobs.  This is a very dire situation and he has – I can’t say he’s ignored it, but he hasn’t focused on it in a way he probably should have.

From the Chris Matthews Show, David Brooks always seems to have to most cogent social insights:

Mr. BROOKS: Yeah, if I had to generalize, it used to be in this country people of high school degrees lived the same kind of lives as people with college degrees. That’s no longer true. Divorce rates, attitudes towards society, attitudes towards government, it’s very different. College degree, non college degree.  …  And they look at the people who are running them, most of them are college degrees, Harvard law, on both sides.   …  And they say, `That’s not me. That’s not my life.’   …  `And they’re not listening to me.’

And so the President shifts focus in his annual State of the Union address.  It’s about jobs and the economy.  Then education … our future.

The simple answer:  everything was wrong.   This never was about health care reform.  This was always an attempt at health insurance reform.  And in that regard it was a miserable failure.  The bill, as passed by the Senate, was a cruel proposition.  The ultimate lay away plan: pay me now and you might be able to enjoy your coerced purchase in four years.  Do you know how much can change in four years?  Everything.

It involved all the wrong players — Tom Daschle and Max Baucus.   You never involved any physicians, most notably Howard Dean.  This was a policy wonks party gone awry.  2000 pages plus.  It could have been so much shorter.

You never framed the debate.  You never defined the problem.  If you cannot define the problem you have no hope of finding an acceptable solution.    That is why all the DH administration spinmeisters could never convince us of the positive benefits.

Almost immediately, and for one protracted year, this debate was a diversion from the most pressing issue facing Americans today — an anemic economy with unemployment numbers never seen in our lifetime.   The real unemployment rate in California alone is estimated at 18%.  This is not the stuff of a vibrant economy.

I saw Up in the Air this past weekend.  I will admit George Clooney is one of my favorite actors.  Along with Matt Damon and Clint Eastwood –  effortless, articulate, compelling performances — always.   What was so poignant about this movie was the repeated face-to-face encounters with a diversity of people, of all ages, backgrounds and skills — about to lose their job.  The pain, the pathos was immediate and palpable.

This is the major issue of the day.   This is how and why a president’s popularity plummets — always.

Last night a lifeless pretender to the Kennedy throne was outfoxed by a beefcake from the right.   Just as Gray Davis was outfoxed by Arnold Schwarzenegger, the Lion of the Left is superseded by a new media pin-up.  Mr. GMC pickup man.  Mr. Everyman.   American Idol.  He is a Rorschach inkblot of simmering angst.   Public officials have taken their eye off the ball.

Bill Moyers interviewed Kevin Drum and David Korn who sadly concluded that we have been hypnotized into thinking that big business is always preferred to big government:

KEVIN DRUM: … You know, in poll after poll for decades now, if you asked people who are you more scared of in terms of America’s future, is it big government or big corporations? Big government always wins by a landslide.

Tony Blair, even more succinctly encapsulated the entire political paradox four years ago:

Fierce struggles about nationalisation or privatisation, about the precise level at which public spending started to crowd out private investment, dominated the era of post-war politics.  Conservatives were for ‘business’, often ‘Big Business’, progressives for trade unions and the public sector.

And above all a state that sees its role as empowering the individual, not trying to make their choices for them, can only work on the basis of a different relationship between citizen and state. Government can’t be the only one with the responsibility if it’s not the only one with the power. The responsibility must be shared and the individual helped but with an obligation also to help themselves.

And his vision for the National Health Service (NHS) of Great Britain:

In 10 years time, and if possible long before, I want the health debate in Britain not to be confined to the excellent NHS that treats people when they are sick; but to the broader national health service that is about prevention as much as cure, about personal responsibility as much as collective responsibility, about the quality of living as much as life expectancy. It is an ambitious goal. But one totally in tune with the times. It means changes in Government, business and people, but that is the way the modern state should work.

– The Guardian Wednesday July 26 2006

Great leaders learn more from failures than success.  Regroup.  Refocus. You’ve met your Bay of Pigs.  The best defense is a good offense.  Time for boldness, not shrinking and cowering.  Now go back and fix what really matters most.  “It’s the economy stupid.”

Dr. Howard Dean

Political HealthCare

This debate has never been about Health.   Certainly not your health.  For the last six months I have steadfastly maintained the large insurance racketeers will not lose this one.   They have thrown all their money into the ring.  It has paid off handsomely. Their paid surrogates have performed well.  Like their Wall Street kin, the pirates have won again.   Robert Reich pulls no punches:

In other words, the private insurers are winning and the public is losing.

Pharmaceutical companies are winning as well.

Howard Dean, on Meet the Press, was almost spot on although it was evident he had been “rolled” by David Axelrod White, chief White  House proxy.  As Dean highlighted,  all the health insurance stocks, as best illustrated by WellPoint (formerly Blue Cross), have moved to 52 week highs.   Investors are now bullish.   They see nothing but a pot of gold in this legislation.

WellPoint hits 52-week high.

Dean, on Meet the Press, continued his conversation on insurance reform:

… Now, there are two countries that have done this without a public option, Switzerland and the Netherlands, but they treat insurance companies as public utilities.  That’s what we would have to do.  And I don’t have an objection to that.  The–my, my concern about the public option is not ideological. But I just think a 30-year fight with the insurance industries over every little detail about how they’re going to control costs … have essentially wrote the bill, is not likely to happen.

In the last six months you have been distracted by the pitchfork mobs manipulated by Dick Army and Glenn Beck, the Democratic assertions, the Republican assertions, the White House spokesman, the President, the CBO.   The list is prodigious.  Everyone has had a say.  But the one group conspicuously absent are … physicians.   Don’t think for a minute that the toothless AMA had any real input.

Who is against this bill?   The California Medical Association; Dr. Jeffrey S. Flier, Dean of Harvard Medical School; former Labor Secretary Robert Reich; Dr. Howard Dean; Dr. Marcia Angel, former editor of the New England Journal; and Dr. Andrew Weil.  In fact, I just saw a copy of Andrew Weil’s latest book, Why Our Health Matters … 50% off retail.  A testament a lack serious focus on … health.

Most of the provisions, we are told, will not even take effect in 2014.   If this is such a crisis, why a 4 year delay?

So who really benefits?   Not that many.  The estimate is an increase in insurance from 83% to 94%.   All of this for a 11% yield?   And primarily because of a forced mandate.   You will be forced to buy coverage that in all likelihood you will not be able to afford.    If you consider yourself a true progressive, this bill has nothing.  If you are a true conservative (not a phony one), this bill has nothing.   Unions are upset.   If the House Stupak abortion restrictions are reintroduced in conference, women will see the clock turned back 30 years.

Near as this practicing physician can see … little benefit for anyone.

As Ariana had so forcefully said, the real storm lies ahead.  We have taken our eye off the ball.   Call it what you want — recession, depression, upturn — the loss of jobs and the economy is issue numero uno.   This entire year, with the advent of a fatally flawed bill shoved through in the dead of winter, will produce nothing but a Pyrrhic victory for the Democratic Party.

staggering job losses

They missed the golden opportunity … financial banking reform.

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A bad and corrupt bill is worse than no bill at all. The President’s high stakes gamble is overtaken by the raging storm of job insecurity and … the economy.

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And to dispel any lingering doubt, watch Wendell Potter, former CIGNA VP, explaining just what is a stake here:

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“It’s not health care reform … and it’s too bad it’s come this.”

“You are going to be forced to pay, on average, 27% of your money to pay CEOs $20 million a year…”

[starts at about 4:08 into this clip]

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