Gambling With American Medicine

Posted: Dec 04, 2009 12:01 AM

This week I asked four proponents of Obamacare to spend some time on air with me. Transcripts of these interviews with The New Republic's Jonathan Cohn, Brookings' economist Dr. Henry Aaron, Princeton economist Dr. Uwe Reinhardt and MIT economist Dr. John Gruber are all available here .

While I appreciate very much the willingness of Obamacare enthusiasts to come on air with an outspoken opponent of this radical and very risky scheme, I found the exchanges very frustrating, and many in my audience --especially practicing physicians-- found them outrageous. The problem is that each guest left many in the audience with the impression of not being forthcoming about the profound nature of the changes being proposed. I was sympathetic to the difficulty they found themselves in given the complexity of the legislation, but listeners sensed that these experts knew exactly the problems with the bill but simply were not in a hurry to level with them. My interview with Dr. Gruber, for example, took a long time to get around to the obvious point that Obamacare does nothing about the deep cuts scheduled for doctor reimbursement rates in 2010, cuts that everyone admits must be canceled, but which have been left uncorrected by Obamacare because their necessary correction would destroy the illusion of the bill's budget neutrality.

Similar verbal gymnastics occurred whenever the deep cuts in Medicare Advantage were discussed --the guests dismissed the idea that the inevitable benefit cuts were serious or would lessen the quality of life of the covered population-- or the impact of Obamacare's taxes on private insurance, or the risk the bill poses to the incentives for doctors to become doctors and practice the long hours they are presently used to practicing. A bill should not be that difficult to discuss, the impacts that hard to define or the cost impacts subject to such a wide array of estimates. As you read through the transcripts, take note of how often direct questions are met with convoluted answers or non-responsive asides, and sometimes with talking points.

Going Rogue by Sarah Palin FREE

At least one thing came through with complete clarity in my conversation with MIT's Gruber: Obamacare does nothing to halt Medicare's rapid march towards insolvency. Much of the public labors under a number of false impressions about Obamacare, one of which is that all the so-called cost controls of Obamacare and the massive cuts to Medicare will somehow work to keep the senior citizen healthcare program solvent when in fact they won't do anything of the sort. All of the debate and all of the effort are bringing forth only a massive new entitlement program with no fix whatsoever for the deeply broken health care entitlement programs that already exist.

Doctors listening to these exchanges throughout the week called or e-mailed their incredulity about the economists' naivete about conditions under which American doctors are presently practicing. Over and over again these doctors repeated the same dire warnings about the impact of Obamacare on the quality of American medicine. Professor Gruber dismissed such testimony as "anecdotal," but the volume and specificity of the accounts should give pause even to the most enthusiastic supporter of single payer. We are gambling with a system on which all of our lives depend, and Obamacare is pushing us to the edge of catastrophic breakdown.

Dr. Gruber candidly admitted that his view was that the "public option" wasn't that important but that abortion funding was. He also proclaimed the Massachusetts health care program a huge success and noted that Medicaid was deeply broken and leading to greater gaps in treatment for the poor. In other words, he has many opinions which are passionately held but which are either at odds with majorities of Americans or unaddressed by the Senate's version of Obamacare.

Here is one of the key exchanges of the week, and it is also with Dr. Gruber:

HH: Let me ask you to listen to a quote from President Obama made many times over the course of this year of debate.

JG: Okay.

BHO: Here’s a guarantee that’s I’ve made. If you have insurance that you like, then you will be able to keep that insurance. If you’ve got a doctor that you like, you will be able to keep your doctor.

HH: Can he make that guarantee?

JG: Yeah, he can, because the law has actually grandfathering provisions that say that literally, if you like, it’s literally in the law, there’s a grandfathering provision that says if you like your plan today, you don’t have to give it up.

HH: Is it true for people to believe that when their employer controls their health care decision?

JG: Well, their employer controls their health care decision today. So basically, I guess the issue is that, it’s always true today that your employer could drop your health insurance tomorrow. And under the bill, it’s true as well. So in some sense, that doesn’t change. The issue is really does this bill make that worse, and the answer is no.

HH: No, that’s not what he said. I’ll play it again, so that we hear it all clearly.

BHO: Here’s a guarantee that’s I’ve made. If you have insurance that you like, then you will be able to keep that insurance. If you’ve got a doctor that you like, you will be able to keep your doctor.

HH: Is that true, Jon Gruber?

JG: That statement played in that clip is not true.

HH: All right, that’s all…

JG: No, no, no. But let me finish. The statement that if you have insurance that you like this bill will not cause you to lose it. That’s a true statement.

HH: But that’s not the statement he made. The President sold this bill…

JG: But once gain, he was talking about a health insurance bill. He wasn’t talking about the world. He wasn’t saying I promise no one would ever lose their doctor, and that’s just, you know, that’s just parsing, that’s just trying to parse his language too fine. He was talking about a health care bill, and this health care bill will not cause you to lose your doctor or have to lose anything you like.

How many Americans are genuinely aware of what is in the bill? Of how it will impact them? Of how it will profoundly change the willingess of doctors to stay in practice or of young, talented college students to pursue a career in medicine?

And how many have been sold --by the president or others-- the false illusion that this is a comprehensive bill that will leave them with the health insurance they presently have and at least as good as a health care system as presently operates?

The answers are obvious. Hard for proponents of Obamacare to say, but obvious.

If you want to help stop Obamacare, visit and use this tool , and visit and contribute to . The future of American medicine is in the balance, and now is the time to speak up and speak out. Only if democrats fully understand the political fury that will follow their recklessness with American health care will they pull back from the brink.