During the past week we have been subjected to repeated sales pitches from our “Huckster-in-Chief” in a desperate attempt to convince us that he is still the Obama of the 2008 campaign, and that we are still the same malleable, adoring throng who will enthusiastically back any program he touts – in this case bad health care reform. Mr. Obama’s rhetoric has left me wincing and looking away in embarrassment. Doesn’t he realize that our relationship has changed?
Today, for example we were treated to the vintage campaign Obama “Let me be clear – now listen up y’all,” introductory gauntlet. Somehow it was as if all the nuances and details that we have learned over the past year regarding health care reform and its pitfalls should suddenly be ignored and simplified into “populist-speak.” The result was surreal, and as gratingly out-of-place as fingernails on a blackboard at a physics lecture. The President went on to say that “We have heard every ridiculous argument against this bill…” Clearly the President is ignoring the innumerable previous versions of this bill whch were indeed amended in response to those “ridiculous arguments,” in a vain attempt to obtain a half-way decent bill that might have some small chance of succeeding. If those arguments had not been raised, the current bill would now be even worse!!
The President’s claim that these many arguments can’t possibly have merit, and must have been raised by the opposition with the purpose of denying progress to the American People, and of aiding the Insurance Companies is also ludicrous. The real reason that so many, many objections have been raised to the health care reform bills is that these bills are so overambitious in their scope – because they attempt to tweak and control so many aspects of the “health care system,” all at the same time. The bills have attempted to cover everything from the “self-esteem” of handicapped children, to the intricate formulae for the utilization rate of MRI machines in rural areas and everything (and I do mean EVERYTHING) in-between. This soup-to-nuts approach is one of the main reasons that the Administration’s inappropriate attempt to call this monstrosity “Health Insurance Reform” has never caught on. And, of course, this is also the main reason that so many criticisms have been launched against the bill – because it is so seriously flawed in so many ways.
The attempts made in the bill to define and control these infinite disparate aspects of “health care,” are theoretical, at best, but, mostly, just uninformed, (or tremendously underinformed) amateurish guesses. The result is a bill that, although several thousands of pages long, is basically no more than a concept paper for some actual health care reform bill which is not yet written. For example, the bill is full of “pilot programs” for many untried delivery and reimbursement systems that seem to have been drafted without the help of professionals in these various areas. Essentially, these pilot programs are “feasibility studies.” To anyone with a background in design, this is a signal that we are still very, very early in the development of a design for our reformed health care system, and that, in fact, prudence might well dictate that we should consider performing these “feasibility studies” FIRST and let them inform our ultimate design (bill-writing) efforts!!
Instead, the Administration would have us hurry up and sign on to this tremendously flawed and uninformed effort and then wait years to find out whether any of it is even partly worthwhile. Even the discovery of what works and what doesn’t will be extremely difficult in the environment of this bill – basically the bill tweaks everything at once, so it is difficult to see which tweaks are working and which are not. The proponents of each tweak will be pointing fingers at the others, and blaming them for failure to improve health care quality and costs. This is yet another aspect of the “politicization of health care” discussed in another post. Just as economists are always able to justify their theories and blame outside factors for any unpredicted results, so the partisans for each program will be able to justify their program and protect it from deletion even if it appears to be a miserable failure. There will always be one more tweak to perform that will set the program right and tap into its full benefit to Society. Because there is no way to measure the truth of their claims, the result, will be massive inefficiency and waste that might have been saved by using a more scientific, incremental approach.
This is all by way of circling back to my original point – No, Mr. Obama, these anti-bill arguments weren’t raised to help insurance companies – they were raised because the bill is so underinformed – so lightweight in terms of technical merit, and so short-sighted in terms of heading off unintended consequences. And the reason there are so many arguments is because the bill is so overreaching and attempts to do way too many different sorts of things. Bottom line? Almost all of the many major objections raised against these bills do indeed have merit, and many more of equal merit have probably simply escaped our notice. The bills are just that bad.
And Mr. Obama is equally underinformed and bad at promoting them. This week, listening to Mr. Obama’s regrettable interview with Brett Baier of Fox, I was struck by the President’s impatience and bad faith. Some of my observations regarding President Obama previously addressed in the post https://reformhealthreform.wordpress.com/2010/02/02/process-vs-policy-mr-obama-and-ms-pelosi/ were definitely reinforced by this interview. Specifically, Mr. Obama’s indifference to Constitutional considerations, and his “ends justify the means” mindset are tremendously amplified by the Baier interview. In fact, this recent interview totally erases any of the grace points in his interview with Diane Sawyer where he intimated that perhaps his Administration may not have “gotten the process right.” By contrast, in the Baier inteview, Mr. Obama disparages the process as unimportant – it’s something he doesn’t even need to try to get right!! And it is also, according to Mr. Obama, something the American People don’t care anything about! This is a total turn-around from his previous explanation of the Scott Brown victory, that Americans had been turned off to the virtues of the bill due to the dirty process!! Wow, if he actually believes his new spin, I can’t help but think that this is a man every bit as disconnected and “bubble-ized” as the critics claimed that George Bush was!!
Even worse, the President was petulant in his refusal to acknowledge that he had called for “an up-or-down vote,” and insistent that whatever mechanism the Congress would devise would, by definition, be an adequate test of support for ” My health care proposal.” Simply stunning in its circular, insular nature, and almost delusional in its framing of the bill under consideration as “my health care proposal,” a proposal which has never existed! In fact, one of the real criticisms of this whole process has been the lack of input provided by the Administration as to what it wanted from the reform effort.
This has been a bad week for the President featuring gracelessness, divisiveness, and bad-faith that we thought he had left behind at an earlier phase of the debate. At this point, no amount of happy “populist speak” inane rhetoric will soon erase our picture of a win-at-all-costs individual with no visible moorings to precedent, Constitution, or even to ideology. In this graceless push for some bill- any bill at all- by any means at all- the President has expended a huge amount of political capital on what might have been, with proper management, a popular reform effort. Regardless of the outcome of health reform in Congress, It is hard for me to see how the President can erase the negative images he has now created and how he can effectively unite the Nation behind the rest of his agenda.
The Skeptic
Health Care Scepticism 
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