Thursday, May 14, 2009
Can you feel the love? Cupid ran out of arrows in Washington, D.C. this week. On Monday, several medical industry groups including physicians met at the White House for a health care reform love fest. For as long as I’ve been a physician, the pharmaceutical industry, insurance companies, hospitals, physicians and medical device makers all viewed medical reform as a disease that needed to be vanquished. This week, these erstwhile reform antagonists are sitting around Obama’s campfire in a Kumbaya moment. These health care stakeholders pledged to reduce health care spending (read: their income) 1.5% annually over the next 10 years. What happened? Were they drugged or hypnotized? Is there a secret deal that we don’t know about? Did they drink the Obama Kool-Aide that has intoxicated much of the nation? Did they hear an inspiring sermon at their church services this past Sunday and were inspired to do the right thing for America?
The correct answer, of course, is none of the above. These medical interest groups are savvy survivors and are feigning cooperation with their eyes wide open. They have calculated that it would be a clumsy strategy to oppose the president at this early phase. In particular, the pharmaceutical industry, so often demonized in congress and in the press, needs to buff its image now before it is given a scarlet letter and ostracized. These groups have even suggested cooperation with comparative effectiveness research, which could substantially reduce their profits. These medical industries want a seat at the reform table so they can influence a process that might otherwise dismantle them.
The president has joined hands with this medical coalition because he needs them. These reform adversaries, with their tons of money and influence, could sink the ship before it even leaves port. Harry and Louise, the hokey and effective media campaign that helped to deflate the Clintons’ health care reform effort, will seem like a pea shooter compared to the weapons that medical special interest groups are prepared to wield today. The Kabuki dance we witnessed at the White House this week can quickly evolve into a hostile conflict.
Both sides will stay at the campfire for now. This is the domestic version of realpolitik, the policy of dealing with unsavory governments if it serves our national interest. Everyone knows the game here. They will all sing from the same hymnal as long as it serves their interests. Soon, however, interests will diverge and fissures will develop. Accusations will replace amity. The peace pipe will be exchanged for a lead pipe. Each side will stridently argue that if the other side prevails, then the health care system will be ruined.
For the moment, we are to believe that the romance is real. But, this love won’t last. Soon, arrows will fly and they won’t be coming from Cupid’s bow.