Osler's Razor

You make many good points here, Mark. I really like the idea of assessing individual administrations individually.

Nevertheless, here is brief and incomplete but noteworthy list of similarities between Presidents Obama and Bush:

1. Admitting error is hard (this is a quality these two men share with me and you and the rest of human kind). In addition to the basic human nature of the failing, Presidents face additional political problems when they admit error.

2. Each president faces a daunting task, governing an American state on a trajectory ultimately unsustainable, which, with each passing year is progressively more difficult, trending toward nearly impossible.

3. Both men were decent men who expected the job to be something totally different than it was. Both men were decent men whose assumptions about their capacities and the realm of their own possibilities blew up in their face when confronted with the ugly reality.
 

I agree with you on the first two points, Farmer, but not the third. I think that the ACA is kind of a disaster, but in the long run will be popular and people won't remember much about the rollout issues.

I'm not saying it SHOULD be popular, just that it will be. Which is part of the continuing problem of both Republicans and Democrats building a deficit by giving us government subsidized benefits.

And there is the rub-- Medicare Part D SHOULD have blown up in Bush's face because it created deficits, but it didn't because people liked what they were getting and did not see the cost affecting them. It is the war and immediate economic meltdown that blew up in his face instead.
 

Also, are you a real farmer? Because you always seem to get up before dawn.
 

Actually, ACA and Medicare Part D make for a truly problematic analogy. And, I fear that every comparison that begins with that forced coupling results in a less than helpful conclusion.

To your bigger and long-and steadfastly-held point, I will not say definitively that ACA will never be popular. It may prove popular at some point--but it will only be after drastic changes that will make the program virtually unrecognizable compared to its present state. In this way, the folks who have asserted that ACA is a way station to something else are likely to prove correct.
 

I wasn't analogizing ACA and Part D, just saying that Part D should have been a bigger deal re the deficit. They are different things (as I said in the original post).

Let me put it this way: Can you identify any other program which paid benefits to the middle class funded by debt which turned out NOT to be popular? Just one?
 

I guess you are not counting the Reagan-era catastrophic healthcare plan because it applied only to Medicare recipients? Or for other good reasons?

Regardless, in truth, we are in such a fundamentally different place in our national and economic history that anything could happen. We are at a place where "breaking the bank" is a reality. Therefore, tradition and/or history is not a completely safe hedge against oncoming potentialities.

But, having said that, I do not disagree with your main point, this program will not rise or fall on CBO numbers or even real numbers; it will rise or fall on the public perception of VALUE and competence and efficiency and perhaps even honesty. But the most important of these is VALUE.

BOTTOM LINE: It will succeed if it makes me feel like something good is happening to me. It will fail if it makes me feel like something bad is happening to me. Right now most of us feel like something bad is happening.
 

Actually, for MOST people, nothing at all has happened. It just toddles along like before. The numbers of people on the exchanges and/or displaced from their current insurance is far short of a majority. Some people, not many relative to the whole, have already benefited from the pre-existing conditions rule, or kids staying on parents' insurance until 26.


 

The problem with the line is not the comparison between programs, but rather, a fundamental problem with the premise that "just because someone else did something bad, we should be able to as well."

How you can be a "little tired" of that line is what riles me up! We should all, ALWAYS reject that logic.

People just don't have any honor these days when it comes to taking responsibility for when things get screwed up. There are a multitude of reasons for this that we can debate at another time though. Unfortunately, people as a whole need to grow a pair and learn to ADMIT things. The other side will have their "I told you so moment" but it lasts a few seconds. Then comes a time when people have moved on. For some reason, this idea ebbs and flows throughout the history or politics, but is never constant.

It would have served Bush well and, I would argue, would serve President much more.
 

We'll see what President Obama has to say today about all this...
 

Again, perception is the key. Today the President is working on perception; I will bet the house that he has nothing to say today that will substantially alter the program.

He is fighting a desperate game of PR; it truly is the fight of his presidency. It truly is the fight for his presidency.
 

WC and Mark: You guys can go on and on about the persistent train wrecks that are our public policies concerning healthcare. However, most of our recent policies have been crafted by the healthcare industry.We have spent decades creating the most unhealthy health delivery system money can buy.
Now, when a meager attempt to begin to institute a fairer, more affordable program is proposed it is being carefully designed with restrictions approved by those who have created the mess. Until the greed and its influence is removed from the system, the people of this country will not get the health care they pay for.

I am appalled at our national discussion as it masks the basic moral decay of our country. We are outraged that a family of 4 making $96000 a year are having their private insurance rates go up. We, however don't seem to mind that many tragically ill folks cannot get proper treatment except at jacked up prices. Our anger should be aimed at a perverse industry which can by its nature benefit from illness. We accept it because many can afford this luxury.
I have been asking myself what kind of person works hard to make piles of money when a population of patents needs their medicine or their assuring touch. We know who. It is not the doctors and nurses

The chasm between a caring system we imagine and the self enriching industry we have is getting bigger and bigger and I think it is time to talk more about the stick than the shadow. We should focus on the powerful and not on their lackeys. Then, lets more clearly define our real healthcare costs problem and come up with solutions.

We will neither be a great country nor a good one until we have affordable care for all.
 

I don't even understand the argument. It seems to me it goes like this:

1. Obama screwed up.

2. But hey, Bush screwed up too.

3. And since you didn't criticize Bush, you can't criticize Obama.

PROBLEM SOLVED.

But this hardly seems like the rhetoric we should expect from the hope and change party. These were the ones we were waiting for. They were gonna fix health care, and stop the seas from rising. But, apparently, those miracles did not require a basic understanding of HTML coding.

I guess Democrats are accusing Republicans of the greatest of all political sins...hypocrisy, because they supported Bush but criticize Obama. But, as my father likes to say, hypocrisy is the tribute virtue pays to vice.

Anyways, heres to hope, change, and a future where our national healthcare system isn't hosted on a AOL page.
 

RRL-- that was pretty much my point in the initial post. Except the AOL part, which I would have included if I had thought of it.

Dad-- you are right about the influence of the health care lobby. I would add, though, that part of the ACA was broadening Medicaid, and that is a good thing for the poor, as are many of the other provisions in the law. The problem is paying for it!




 

By the way, I am all for the expansion of Medicaid that ACA represents. In fact, I would be willing to extend Medicaid (or some form of subsidized government healthcare) to anyone who wants it. Obviously, that would cost money, but there are costs to civilization. Most importantly, we would need to be honest about the costs and find an equitable and agreeable way to fund the program. But there are ways to achieve universal coverage (which ACA does not) without causing the sort of disruption that ACA seeks to impose.
 

Mark; There are states that deliver good healthcare to those who know how to access it. Many don't get care. When the states tighten their belts it usually strangles the poor. In Michissippi where I live, the state is making it harder and harder for the non corporate world to have access to the larder. The state insists on ID, blood tests and forms. To get state ID you have to have a drivers license or birth certificate. To get those you need ID and so on. The fees are being raised again on IDs. Every day the states are making it harder to get care outside going to the emergency room. This is great for the industry. We pay outrageous costs for health care for the poor, because we used to be able to afford the inefficiency. The states now rely on the industry to be good citizens. That is not in their corporate business plan.

Mark; Paying for the poor is the easy part. We are already paying for everyone to get care when they are desperate.. It now done in the most expensive way possible: emergency care for uninsured patients, by using reactionary care instead of preventative care, by paying retail prices to the most profitable industry in America.

We are paying far more now than if we had universal health care with a one payer system. The ACA by leveraging its buying power will lower the costs from what we are now paying.

I feel very strongly that the transferring of wealth to the top has had a corrosive effect on our ability to help when help is needed. We have never had so much wealth and power in so few hands. most dramatically in the health care industry. America,known for its big heart, certainly could afford heath care for all if we could only get the power back.

Vote out the lackeys for the health care industry even if your neighbor works for one.

 

John Osler, I like everything you've written here.

Personally, as an independent who supported this president, I was surprised when healthcare became such an early major initiative.

Doing a top notch job with infrastructure project spending to help goose the economy, and going after Wall Street and the big banks should have been major focuses of his first two years, and Dodd-Frank should have been better, i.e., not written by the bankers in large part. A simplified and top-earners' increased tax code would have been a good project in the first two years as well; the huge and growing disparities between the uber-wealthy and everyone else was on the radar screen at that time. These would have been big things which likely could have been achieved and popular. Getting the country on a stronger footing vis a vis the deficit, instead of going after a healthcare initiative might have guaranteed no Tea Party, less Grover Norquist impact, and no overturned majority in Congress. But that's all water over the damn.

As someone who worked 16 years for a Fortune 500 medical device company, I am so disheartened to see all this hullabaloo over eliminating a new tax on medical devices. Yes, they should be taxed. The medical device and drug industries have been historically very profitable, and I know devices and drugs are both over prescribed and often priced at premium levels.

The basic healthcare problem in America is preventative care and guidance. Fundamentally, our diet is a huge part of what ails most Americans. The USDA food pyramid, although fairly recently changed, is still wrong for optimal health, probably due to our flawed agriculture policies. Corn, soybeans, sugar beets and most grains are not particularly "healthful" crops, yet all of them find their way into almost all processed foods. Mass produced dairy, poultry, pork, beef, etal raised on sub-optimal diets with hormones and/or antibiotics added, and in crowded, too often cruel conditions, logically compromise national health.

I am a firm believer in wellness education and counseling, including top notch, up-to-date diet, nutrition and wellness counseling (topics too insufficiently covered in medical school), accompanied by an equal measure of subsequent personal patient accountability for preventable health issues and outcomes under any healthcare plan.

By the way, I heard President Obama take personal responsibility for the ACA roll-out issues.




 

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Rebecca K; Thanks for your comments. The medical device industry is the most profitable part of healthcare. They have a loud voice. To my surprise, Elizabeth Warren and Al Franken both approved of eliminating the taxes. Mn. and Ma. are big device manufacturing states. This is a measure of how deep we are in the trough.
WF: Shame on you. You are asking us to put the Iraq war and the ACA in the same category. War is about death and destruction and the ACA is about caring for our neighbor through healing. We can disagree on whether the principles are good at their tasks or not, but their purposes were clearly different. I think history will decide if these acts were done by decent men.