Sunday, February 14, 2010

The Health Care Reform Summit: A One Act Play


Whistleblower Grand Rounds Submissions!

Whistleblower will be hosting Grand Rounds on February 23rd.  All submissions are welcome.
Here are some tips to maximize your chances of acceptance, which will guarantee that your blog posting will receive worldwide exposure.

  • Send your posts to MKirschMD@gmail.com
  • Write Grand Rounds in the subject line.
  • Include the URL of the post in the email message.
  • If you do not receive an email confirmation, then I did not receive it.
  • Remember, brevity is the soul of wit.  If you are torn between 2 of your masterpieces, please send me the shorter one.
  • Please include a sentence in the email expressing the point of your post.  This is your opportunity to  wield your razor sharp wit.
  • DEADLINE for submission is Sunday, February 21st at noon.  Earlier submissions are preferred. Please send your stuff at your earliest convenience. In other words, now is not too soon.

Now, on to this week's Whistleblower.

How many times have we all been issued the directive, choose the best answer, in our academic lives? In our society, those who test well enjoy many advantages, even though standardized testing skills may be less useful in real life. Pre-med students, for example, are measured numerically, even though the skill sets for MCAT success and clinical medicine are quite distinct. Nevertheless, we measure our students by the numbers. High school students and their hovering parents, who are aiming for elite institutions, hire personal coaches and tutors who promise 3 digit score increases on the SATs.
Most Whistleblower readers are well beyond the standardized testing zone and no longer have to fill in rows of ovals using #2 pencils. It was nearly 35 years ago that I faced off against the wily SAT opponent. But, the memories of these experiences are still vivid. Back then, we brought our school ID cards with us for verification. There were no fingerprint checks, retinal scans or other sophisticated biometric analyses to confirm a student’s identity. In a few years, a quick oral swabbing for a spot DNA check may be the new standard.

I still recall the bold faced warnings that were also read to us by humorless proctors.

Do not open your test booklets until you are told to do so.
Make no stray marks on your answer sheets.
Fill in the oval spaces completely.

Standardized testing skills are like tying your shoes or roller skating. They are lifelong. I’ll prove it to you with simple standardized test question that is so easy, that even a physician can get it right.

Which of the following scenarios is most likely to result in a harmonious outcome? Choose the best answer.

(a) A boa contrictor and a mongoose sharing a dorm room
(b) Ken Starr going on a hunting trip with Bill Clinton
(c) A medical malpractice plaintiff’s lawyer mountain climbing with a group of anesthesiologists and OB- GYN docs
(d) Bernie Madoff lecturing investment firms on how they can recapture lost assets
(e) President Obama meeting with GOP leaders on February 25th for a public airing of their respective health care reform (HCR) views.

Stumped?

The White House announced prior to the Superbowl that it was convening a half day conference to meet with Republican leaders to discuss the health care reform quagmire. Unlike the adminstration and the Democrats' previous backroom dealings, this meeting will be televised. The GOP readily accepted the President’s proposal to meet, but they are wary of his intentions.

The administration has described the meeting as bipartisan, but a duel is a more accurate description. Why should bipartisanship bloom now after months of bitter recriminations, misrepresentations and political intrigue? It won’t. Just this past week, Roll Call reported that Speaker Nancy Pelosi is disparaging the Republicans and threatening to ram HCR through with a simple majority vote that could defy a fillibuster. While this is red meat to the political left, it spooks Democratic moderates who fear that the ghost of of Scott Brown’s electoral masterstroke could haunt them this November. The GOP, in contrast, sees Brown’s victory as a magic carpet ride that could lead them toward the political promised land of majority control.

If the Democratic position at the meeting is to begin negotiations where the House and Senate legislation left off, the GOP will push back, knowing that the public is increasingly skeptical of these expansive and expensive health care ‘reform’ proposals. The Dems, of course, will reject rewinding back to the status quo ante, and will want their legislation to be the essence of the final product.  At this very moment, Democratic leaders are trying to meld the Senate and House versions in advance of the upcoming television special, provoking GOP angst.  Does any reader see the makings of an agreement here? If so, then you should be immediately dispatched to D.C. as you may be the only individual alive who can forge a deal.

This ‘summit’ meeting, as with much of HCR, has nothing to do with health or reform. It is about achieving political power and influence. It's unspoken objective is to tarnish the other side.  In the campaign, candidate Obama promised us C-Span coverage of health care deliberations. We never got the ‘Span’, only lots of spin. Now, with HCR teetering on a precipice, we will be able to watch live action of this political Kabuki dance. Desperation breeds transparency.

This will be political theater where each side will try to gain advantage over the other. The most recent New York Times/CBS polling shows that the public believes that the President gets higher marks for bipartisanship than the GOP.  President Obama hopes that the upcoming meeting will widen this gap, while the GOP aim to exploit public skepticism.  Each side will accuse the other of intransigence, while claiming to be compromising and conciliatory. This will not be a substantive policy review, but a carefully crafted performance by all players.  The speechifying may sound medical, but it will have nothing to do with health care. Every word spoken and every phrase uttered on the last Thursday this February is directed toward the first Tuesday in November.

When the 'bipartisan' health care summit fails, which of the following statements will be issued within minutes of the meeting’s conclusion. Choose the best answer.

(a) “We will not adopt the Republican’s Bush-Cheney Health Care Plan.”
(b) “The President extended a hand in friendship, and was greeted by GOP brass knuckles.”
(c) “Republicans stood with America and wouldn’t accept the President’s prescription of government-run socialized medicine.”
(d) “Their plan is great for the health of trial lawyers, but is bad medicine for the American people.”
(e) “The Professor-in-Chief lectured us like school kids. The Final Exam is this November.”
(f) All of the above.

Pencils down!

You've heard my view.  Now, what's your prediction?

8 comments:

Anonymous said...
This comment has been removed by a blog administrator.
academicobgyn said...

Sadly, nothing is going to happen. The Republicans refuse to cooperate whatsoever, despite the obvious need for some kind of health reform. Obama's desire for bipartisanship has led him down the wrong path. He should have had a scorched earth policy with the republicans from the beginning. Now he's halfway through his term with minimal success, with a real possibility of being a 1 termer.

Michael Kirsch, M.D. said...

To my academic colleague above, do you really think that Obama (and the Democrats) pursued a bipartisan path? I acknowledge that the GOP has wielded its political influence skillfully to serve themselves, but I don't think they have had a monopoly on this strategy. I think there has been, and will be, sharp partisanship on all sides.

academicobgyn said...

I think he tried to placate the other side, but the current Republican ethos is so contrary to what Obama thinks is needed in healthcare that there seems to be little common ground to reach. The Repubs popularize ideas like "death panels" and "health care rationing" as if those things don't already exist in the form of clandestine insurance rationing systems. Rationing of health care is an obvious requirement of any system, socialized or not. Healthcare is like the light bill - you have a to pay or it every month. Going into debt to pay for healthcare on a national level makes no sense at all, as it does not ever pay back. American goes further into debt to China every day to pay for an unafforadable health care system because we refuse to admit that unlimited health care at any time for any person is unachievable and in fact undesireable.

Michael Kirsch, M.D. said...

Thanks for the comment. For any version of health care reform to succeed, players will have to give up money, control and health care services.

Here are some of the stakeholders:

(1)The government
(2)The public
(3)Physicians
(4)Trial Lawyers
(5)Pharma
(6)Hospitals
(7)Medical device companies
(8)Medical schools
(9)Insurance Companies

Can you imagine a scenario where all or most of these folks fall on their swords for the greater good?

LeisureGuy said...

First of all, a medical malpractice lawyer would have nothing to fear from anesthesiologists. That specialty actually took action against medical malpractice (something other specialties have yet to do to the degree that anesthesiologists did) and as a result the occurrence of malpractice in anesthesiology dropped to almost nothing, and their malpractice insurance premiums also dropped. Medical malpractice lawsuits, as study after study has show, have their original in medical malpractice.

Second, the government could be much more effective than it is. See this post by James Fallows, and also read the PDF at the link in the post: http://bit.ly/9eiXny

Third, even now we see the GOP refusing to participate in good-faith negotiations by their approach to the healthcare summit. The Democrats have (insanely, IMHO) reached out to the GOP during the entire process. You may be aware of Max Baucus's efforts to incorporate GOP ideas in the bill, and the entertaining way that the GOP opposes their own ideas once those ideas are adopted by the Democrats. (That is the very definition of bad-faith negotiating).

Finally, you might be interested in this series of articles that began with a medical whistleblower and her subsequent firing. Read from the bottom up at http://www.salon.com/news/camp_lejeune/index.html.

LeisureGuy said...

Oops: "original" should be "origin"

Jay Parmar said...

Suffering hospital negligence can result in death or serious injury with large costs and suffering associated to it. If someone you love has been harmed by hospital malpractice, here is some important information that you should consider:

* In order to prevail in a hospital malpractice suit you have to prove that the hospital staff acted unreasonably and that the hospital staff conduct was a direct cause of injury. Unless both issues are proved, there is no case.
* A hospital staff is not negligent simply because his/her efforts were unsuccessful.
* The failure of a treatment is not negligence if it was an accepted treatment based on the information the doctor had or should have had when the choice of treatment was made.
Visit Clinical Negligence for more information.

Add this