nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, July 23, 2009

THE PRESIDENTA TALKS (A LOT) ABOUT HEALTHCARE REFORM, BUT LITTLE SPECIFICS

Well, I watched the President’s remarks last night, and they were essentially a cheerleading session.  Don’t get me wrong, he is very good at scripted speaking.  The news conference was what we have seen in the past:  a set of 13 approved questions which the president had prepared answers for.  Again, this is not unusual for some presidents.  He avoided talking about almost all of the specific concerns about the proposed healthcare reform bill, speaking at length in the abstract about what he hopes reform can accomplish.  Two specific things jumped out at me:

 

  1. He reiterated that people would be able to keep their plans if they are happy with them, but admitted that the government would be involved in managing elements of the plans.  I mentioned that the language we have in the House bill actually forces existing plans to stop taking any new enrollees, prohibits them from making any changes to what they contain, and in five years must conform to the standards set by the Executive Branch for government-approved programs.  That is, they make your plan, that you like, into the government plan.  I read an article here that discusses this more clearly than I do: http://www.ibdeditorials.com/IBDArticles.aspx?id=333066661999894.  If you don’t want an interpretation, you can go back to my reference to page 16 of the bill, HR 3200

 

  1. He mentioned the statement from the Mayo Clinic that his plan does nothing to control costs or promote value in healthcare, and implied that with reassurances that an independent board of doctors that already exists, called MEDPAC, would be reformed and renamed to IMAC, and given greater power to recommend changes to the plans, the Mayo Clinic was now on board.   That’s a gross exaggeration.  I went to the Mayo website, which I gave you yesterday, and there IS a blog that this would be a “first step” toward incorporating value, but complained that even this small first step will come too late…five years from now.   Also, it’s important to note that the President’s claim that it will be given more power is just a personal assurance, there is nothing in the board’s charter that give it any authority:  they will be appointees of the President, who serve at his leisure, and who make recommendations that he can ignore if he wishes (as those of the former MEDPAC were), and even if he endorses it the Congress can vote it down if they act within 30 days (as before).  I think this is a hollow offer.

 

No other issues that I or the press have explored were addressed.  The rest was, in the words of one journalist, “The president’s remarks on his chosen subject, health care, were cautious and choreographed, hemmed in on one side by the calculations of his professional wordsmiths, on the other by the delicacy of negotiations with two houses of Congress.   He never detailed his own plan or named a single victim of America’s broken system, and he spoke largely in the abstractions of blue pills, red pills and legislative processes. It’s not easy to turn delivery system reform into a rallying cry for change, but at times, it was as if Obama wasn’t even trying.” (Ben Forbes, Politico 23 Jul)

 

This will be my last post on this topic.  From last night’s conference, and other interviews with members of Congress on both sides of the aisle, it is clear to me that a lot of work is being done on the published bill to offer carrots to holdouts, twist arms, threaten reprisal, and all this is being done invisibly.

 

I predict that there will be a massive re-working of the bill which will be released late one afternoon, and then a large amendment will be slipped under Congressmembers’ doors during the night, and then a forced voted on passage the next afternoon, before anybody has a chance to know what’s in it.  This worked for Cap-and-Trade…and precludes close scrutiny that would make moot further declining support for the proposed reforms.  The danger is that this becomes a Democrat plan imposed on the nation, there’s rising outrage over pushing legislation that nobody has even had time to decide whether they want to vote for it or not, and the administration risks backlash.  Maybe they think that the payoff is worth the price, since they are steadily approaching reduced effectiveness anyway.

 

Any bets on whether I’m right?

 

Comin’ atcha with the regular format for this newsletter until something striking happens.

 

 

Doc D

 

Opinions are entirely my own.  As always, you may share this column, with appropriate attribution (here and in the text) included.  Please do not forward my email address…thanks.

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