President Obama Takes His Plan to the New Digital Airwaves

President Obama went on TV tonight to promote his bastard child of a "health care" reform package. It covered 90 minutes of television, minus commercials, during which little was said that you couldn't have learned from doing a little rudimentary web searching, or even just an occasional visit to the Drudge Report.

I must admit, it was not as much of a puff piece as I thought it was going to be. Charlie Gibson and Diane Sawyer actually asked some real questions regarding some of the problematic issues with Obama's plan. Mind you, they weren't real tough questions, but they were specific questions about the deficiencies of the plan, such as how it is to be paid for, why a public plan wasn't going to just outcompete the private plans in the Exchange, and the like. They even allowed a question from John Sheils, senior vice president of The Lewin Group, a health care policy research and management consulting firm, who estimated that up to 70 percent of those with private insurance would end up on the public plan. (Just as I predicted last October in Presidential Politics 2008: Health Care Proposals.)

The major theme of Obama's discourse was weaseling out of the tough questions and going back to his talking points, which don't sound like they have changed much since the campaign last fall. For example, AMA President J. James Rohack, MD asked a pertinent question about how this plan was going to guarantee that medical decision making was going to be left to the doctor and his patient and not by some governmental overseer whose main concern would be bean-counting. Obama replied by going off-question to his talking points about how the Exchange would operate. Furthermore, in answering the question from John Sheils, he avoided the intent of the question by going into nitpicking about how there would be a firewall to prevent individuals from choosing the public option over their employer-provided plan, ignoring the obvious fact that the question was about preventing employers from dropping their coverage for their employees in lieu of the public option as it will likely save them (the employers) money -- just as I outlined in my previous post.

A few more observations:

President Obama used the Mayo Clinic as an example of a system that is able to provide care in a more cost-effective manner, primarily by reductions in duplicative testing. Of course they can do that! The Mayo Clinic is a giant group practice, complete with a unified record system that all members of the group can access. We doctors not in that kind of a practice could do that too, if it were not for pesky little things like state and federal privacy laws, not to mention HIPAA. And lest we forget, the Mayo Clinic is in Minnesota, a state that has been dominated by managed care for decades, forcing the Mayo Clinic to develop its efficiencies simply in order to survive. (A medical version of Darwinian survival of the fit.) I do give kudos to ABC for airing that they have been receiving emails using the Mayo Clinic as an example of how the free market can provide less expensive, high quality care if only given a chance, and that more government intervention was not needed.

Obama dodged the partially formed question about the 99 year old mother who got a pacemaker after one electrophysiologist turned her down due to her age. She is now a 105 year old mother and still going strong and enjoying her life. Obama wants medicine to be evidence-based; that's what his Office of Comparative Effectiveness Research is all about. There is no study on the effectiveness of pacemakers in 100 year old people. If one were to be performed, I'd wager that it would show little or no benefit of using pacemakers in 100 year olds, because the mortality rate at that age from all causes would likely mask any beneficial effect provided by the pacemaker. EBM would likely have led to this woman not receiving a pacemaker, and Obama knows this; that's why he looked so uncomfortable answering the question. And this extraordinary woman would have come to a premature end. This did not happen because the patient/family and their doctors were allowed to make a decision in contradiction to EBM, suspecting that in this one case EBM did not apply. They were right -- but only because they were free from government interference in making that decision. Under Obama's plan, they would not have been so free.

Obama also gave a list of things he thinks will free up money to pay for this monstrosity:
1. Preventive health care -- nope, this will cost more in the long run. Only politicians think this is a cost saver.
2. Improved efficiency of health information technology -- not yet proven; and if it can, it will only be after privacy rules have been relaxed, which no one seems to want and which the stimulus bill actually made more stringent.
3. Eliminating all of the paperwork and bureaucracy -- in a government system??? ROTFLMAOF!
4. Evidence-based care -- again, there's no proof that this will reduce costs, and every likelihood to suspect it may increase them overall.
5. Changes in reimbursement -- A-ha!! Here it is! The only one on the list that he can guarantee will save money, because it's the only one that is directly controllable. Of course, changes in reimbursement must in this event mean lower reimbursements, to doctors, hospitals, et cetera. And as reimbursements go down, so does the supply of doctors overall, as older practitioners retire, and fewer young people enter the medical field. And as the supply of doctors goes down, so does your chance of getting an easy appointment, followed by waiting lines, followed by rationing.

I hope that this little spectacle tonight has the opposite effect from what was intended. I hope that those watching now have more questions and are more critical of what is about to be done to them. Time will tell.