Sunday, February 28, 2010

The Health Care Reform Summit: ‘Breaking News’ or a TV Rerun?

 Tinkerbell in Bronze

I never thought I would have a chance to watch the health care reform summit on live TV this past Thursday. Fate took a U-turn. 175px-Tinkclose-1-[1] I didn’t expect to be in a New Jersey blizzard on Thursday morning. I was scheduled to be in the ICU performing an endoscopy examination of the stomach on a patient who I had seen in the emergency room a day before with intestinal bleeding.

The plan was to fly to New Jersey on Thursday evening so that we could witness the milestone event of my brother being sworn in as a Superior Court Judge in on Friday afternoon. No human plan, however, can prevail against an Act of God. A torrential blizzard was descending upon the east coast and was threatening to postpone the event that was the result of years of my brother’s work and hopes. Unlike his anonymous gastroenterologist blogging brother, Robert has a deep network of judicial and political luminaries, developed over a career in the U.S. Department of Justice and the U.S. Attorney’s Office. Speakers at his swearing in were to include the newly elected Governor, the Chief Justice of the New Jersey Supreme Court and a Federal District Court judge, who is awaiting senate confirmation to the Court of Appeals. These aren’t hired speakers, but are folks who Robert knows intimately.

As I write this, it is likely that the swearing in will not take place tomorrow. Will the world end? No, but this will be a deep disappointment to Robert and to all of us who are gathered here. Imagine you are about to attend a great family or professional celebration to be attended by hundreds of friends and family, and are confronted by a sudden power failure that aborts the event?

When I returned home from work on Wednesday, after trying to make constipated patients looser and looser patients more constipated, my wife gestured and whispered that she was on the phone with Continental Airlines. They had contacted her. This is never a hopeful sign, as airlines do not call customers to cheer us up. For example, here are some examples of phone calls we have never received from Continental, or any other airline.

“Dr. Kirsch, we noticed that we had extra First Class seats on your flight and wondered if you wanted to be moved from your seat in the baggage department at no charge?”
“Dr. Kirsch, we noticed that your last flight was delayed 2 hours. We felt it was only fair to reimburse you for your time. Please advise us of what 2 hours of a gastroenterologist’s time is worth, so that we can promptly reimburse you.”
“Dr. Kirsch, thanks for your recent email commenting on our meal service. We understand that some might not agree that a foil pouch of honey-roasted peanuts is dinner, even though our Culinary Committee has determined that this food item meets the corporate threshold for meal definition. Because customer satisfaction is paramount, we are shipping a crate of Omaha Steaks to your home with our compliments.”
Continental called my wife to advise her that all Thursday flights were now cancelled. With a lot of diligence and a lot of time, she arranged for us to fly out 2 hours later on Wednesday night, hoping that the swearing in ceremony would still proceed, since all 7 of us would be headed to New Jersey on planes and trains from different parts of the country. Is this sounding like fun yet?

We raced to the airport and hustled to the absolute farthest gate to discover that our flight was cancelled. (There’s a reason that airlines try not to give you this news until customers have passed through weapons detectors.) Then, a small miracle materialized in this morass of madness. There was a flight bound for Newark that had been delayed 2 hours and was presently parked at its gate. We made that flight home. There are times when passengers are grateful for delayed flights.

So, Thursday morning I am looking out a New Jersey window watching snow come down, instead of scoping a stomach in a Cleveland ICU. Then, I realized that a new opportunity was before me. I could watch on live TV the health care summit meeting that the President had convened. This was the historic event where a year of suspicion, rancor and bitterness would be washed away in just a few hours, once the President, in a Tinkerbell moment, sprinkles bipartisan dust throughout the room. Bitter rivals yesterday, the GOP and Democrats would suddenly join hands, drink some Kool Aide and sing Kumbaya. Who could predict what unexpected outcomes might develop after this bipartisan love-in? Here’s a sampling of some potential Shnagri-la moments that we might witness at Blair House.

Harry Reid would smile and state that the public option should be abandoned.
Chuck Schumer, who is usually welded to a microphone, would yield his time to John McCain.
Nancy Pelosi would state that tort reform must be an integral part of health care reform.
Chuck Grassley would reflect and remark that we need to cover the uninsured no matter what it cost. “Can we afford not to?” he would ask rhetorically.
Mitch McConnell would suggest raising taxes, not merely on the wealthy, but on everyone so that every American can have the government run health care they deserve.
Lamar Alexander would suggest that the pharmaceutical companies be prohibited from earning any corporate profits, donating the money to close the dreaded ‘doughnut’ that is sapping seniors of their savings. When asked why a drug company would risk tens of millions of dollars to develop a new drug without the lure of a profit, Alexander would respond, “They will do it because it’s good for America.”
Well, I have just watched the first half of the conference and I have not seen even a Kumbaya nanosecond. The august group of bloviators is now on lunch break. I heard the same positions this morning that I’ve heard repeatedly over the past year being regurgitated. (As a gastroenterologist, I have been trained to recognize various forms of regurgitation.) I learned nothing new, and I doubt any of them did either.  The conference was political theater, but only a weak matinee that is not ready for prime time. It’s been a yawn so far, and I don’t think that any minds in the room, including the president’s, will be changed. Even a Nobel Peace Prize winner is not sufficient to bridge the chasm that separates the two sides.

Bloggers at both poles of the political spectrum struggled to conclude that anything worthwhile occurred.  For example, Josie Raymond from the left at and Philip Klein from the right at American Spectator, who likely agree on very little, both wrote that the conference didn't alter the dynamics of the health care reform issue.  There were partisan bloggers, of course, who claimed that their side prevailed over their craven adversaries.

How will the public react? I suspect with indifference. We will read the performance reviews in our Friday newspapers and then watch pompous pundits on the airwaves opine on who won and who lost. I think it will further decrease the already abysmal approval ratings that Congress now enjoys. It will reinforce that these guys and gals simply cannot get anything done for us. The President has succeeded to an extent to hover above the partisan fray, but he is still tarnished by the process and the results.

The GOP had to show up, because they couldn’t leave bunch of empty chairs in the room to be used against them. Judging by the what I’ve seen so far, the GOP held their own. The electoral victory in Massachusetts has given them some wind at their backs. All sides know that the public is deeply skeptical of the health care legislation that has been passed. If the Dems try to force their version through with reconciliation, by simple majority vote, then they will risk an even greater backlash in November than already awaits them. I do not think that they will do this, and am not even certain that the Dems in the House and Senate can reconcile their own plans.

The pressure is on the Democrats here. They can jam their stuff through and risk a very Black November. Or, they can retreat and pursue incrementalism and further alienate their base. Good luck, guys.

I wish there had been some bipartisanship. This might have created a glow and a radiance that might have caught the attention of the Almighty. Perhaps, then, pleased by this unexpected display of humanity and brotherhood, He might turn New Jersey snow into a light rain, so that my brother can put his hand on the Holy Bible tomorrow and take his oath.


LeisureGuy said...

"Forcing things through" by simple majority vote has long been the practice in the House---and reconciliation was used quite frequently by the GOP. (I should look back and read your posts objecting to that.) And, of course, the Senate already passed the healthcare reform bill; what would be "forced through" with reconciliation would be the reconciliation of the House and Senate bills.

I thought the GOP did not have any answers to the problem of "pre-existing conditions" as a way for health insurers to deny coverage, nor an answer to the millions of uninsured.

I think the bill will become law, and the incremental work will be in fixing it as we go on---as the Medicare donut hole was finally fixed (by this legislation).

All polls show that people like the individual provisions of the bill.

Jackie Fox said...

Dr. Kirsch,
Thank you for continuing to shine a light on this. I didn't see the summit but you confirmed my worst fears about it. Why can't they think in terms of what this is doing to people instead of which party "wins" or "loses."

I had a series of five surgeries for some very stubborn DCIS that tallied up to just under $83k. I would have been taking out a second mortgage if I didn't have health insurance. Think of all the people who don't have insurance and already have a second mortage or don't own a home. I wonder what this cost scenario would look like if the insurance landscape were different. That's what needs reforming--the health care I received was stellar.

LeisureGuy said...

Examples abound of people having no problems with health insurance: in fact, every other industrialized nation has solved this problem that so far has stumped the US.

Anonymous said...

Doctors were only too happy to take the government's money when Medicare started, because they got the assurance of getting paid. Now hat the gravy train is ending, they don't want the government anywhere near medicine. Well, except they do want the government to take over jury trials involving medicine.

Physicians are nothing if not intellectually inconsistent.

Anonymous said...

"Health is wealth" is known to all and everyone wants good health. That means no one wants to leave this wealth. So, Let us build a food habit discipline, keep pace with work, rest and or exercise to Achieve good health, The ultimate wealth.
The Health Dude

Evinx said...

Amazes me how many commenters, here + elsewhere, believe they are entitled to the labor and knowledge of another human being.

A transaction should be free of coercion so that a willing buyer and a willing seller agree.

Where is all this demand for services from others, regardless of the cost (not just monetary) coming from? It is really disappointing.

Anonymous said...

Dr. K,

Today I read this piece of writing while at home where I could take my time and read it word for word.

Thank you for being my brother. I am in awe of how your thoughts talk on a tablet .

Bravo to Roberto!

Anonymous said...

speaking of legal reform, any chance your brother will work on changing the judicial hellhole that is new jersey for the better?

Michael Kirsch, M.D. said...

To anonymous, regrettably, this issue is outside of his jurisdiction.

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