Friday, June 26, 2009

Gotcha. Not.

From a commenter:

I think as long as Obama admits that he wouldn't subject his own family to the limitations he proposes for everyone else, his plan will fail.

A Better Angel
I assume he/she refers to comments by Obama during the recent ABC News "town hall" held at the White House, in which there was this exchange, edited selectively in many "news" sites:

"Q: If your wife or your daughter became seriously ill, and things were not going well, and the plan physicians told you they were doing everything that could be done, and you sought out opinions from some medical leaders in major centers and they said there's another option you should pursue, but it was not covered in the plan, would you potentially sacrifice the health of your family for the greater good of insuring millions or would you do everything you possibly could as a father and husband to get the best health care and outcome for your family?

OBAMA: [....] I think families all across America are going through decisions like that all the time, and you're absolutely right that if it's my family member, my wife, if it's my children, if it's my grandmother, I always want them to get the very best care.

Predictably, this has been jumped on by detractors and touted in pretty much the way the commenter did: Obama's plan is good for your family but not for his, says Obama. Since we all love our country and don't wish our President to fail, I'm sure it was just an honest misunderstanding. Like my snippet above, most of the criticism leaves out the President's next sentence:

...but here's the problem that we have in our current health care system. Is that there is a whole bunch of care that's being provided that every study, every bit of evidence that we have indicates may not be making us healthier.

Which, of course, is the most important thing he said.

First of all, the wording of the question was, well, questionable. It's a false premise. It implies there are "plan physicians." It implies that treatments recommended by "medical leaders in major centers" wouldn't be part of "the plan." There's simply no reason to think either is true. There isn't, as far as I know, a proposal to separate "plan physicians" from others. And there most certainly is NOT an implication that therapies that carry the weight of "leaders" in "major centers" would be off the list. The opposite is true.

And it's exactly the point Obama was making. But it's neither sound-bite worthy nor easily explained; and, as we've seen, it's very much selectivequotable and outofcontextable. (Incidentally, that he got tough questions like that sort of shows the right wing fury (ie, Fox News) over the "unprecedented access" ABC was granted was so much hot air...)

Among the many ways to control health care costs is to establish what works and what doesn't. As I've written, severally. Patients and families, as President Obama said, face such dilemmas all the time. "The very best care," he said. Exactly. Would that it were always as easy as the example that the questioner (a doctor) gave, in which there would be general agreement from the creme de la medical creme. (It'd have been better if Obama had pointed that out: again, showing the session was hardly planned and canned.) On the contrary. It's often a decision involving futile care: the operation with a one in a million chance of helping; prolonging life in the ICU; trying dangerous drugs with virtually no chance of helping. Or -- and one assumes this would not be covered, since it currently isn't -- heading to Mexico (or, like Farrah Fawcett, to Germany) for entirely bogus treatments.

These sorts of things are, in my opinion, way too difficult for our political system, as currently manifested, to handle. Rather, at best (if that's what to call it), we'll get a plan to pay for insurance for those who can't afford it, leaving the excess costs of insurance untouched and not tackling effectiveness in any meaningful way at all.

But, perhaps, we could at least do it or not, without deliberately taking out of context what the President said.




tom said...

My concern about the health care reform issue is that true reform will impact the players who say they are not the problem. Insurers who only want to insure people with low probability of a claim, pharmacy companies which for some reason are able to sell their products outside of the US for less than we pay in the US.

I would also like to see an end to the belief that " the market will address health care costs". Last time I looked, no one was competing to capture all of the uninsured.

You opine that "it is too difficult" for our political system to address. Are you inferring that the task is too great, the risk too great, the reward too little, or ?

Sid Schwab said...

I'm implying that our politicians in Congress are too weak, too influenced by insurance companies, too hidebound by ideology, too lazy, too concerned about party politics, too dumb, too weak, too unwilling to say what needs to be said.

I think the solutions are fairly obvious, but politically impossible for the above reasons.

Anonymous said...

Is this post all about me? Goodness! Can I ask then...

Did obama actually answer the question? A clear answer would have been, "Of course, this is a great plan and my dear ones will be happy to submit to it."

Well, no, he didn't answer. In the question, the docs didn't suggest some "hail mary" procedure--they point out another option not covered. Now, the plan I'm under right now is pretty good, but there are some things it doesn't cover. I think this is the question before obama...which he dodges.

As far as "plan physicians" goes, it's pretty clear that this will end up being similar to Medicare--docs will belong and follow or will opt out entirely.

And obama's answer sound a little like he's preparing everyone for rationing--"we get care that doesn't make us healthier". But it seems like we don't know that until we get it and it doesn't work. Obama wants to cut out the attempt? Does obama think that his loved ones get too much treatment? "Sorry, Michelle--there's another option, but, you see, people get a bunch of care that may not be making them healthier."

Finally, Dr. Schwab, your tone is a little harsh. 'Yeah. Right." Sorry--I don't think I took him out of context. I think he dodged the question and the rest of the answer is attempted slight of hand.

--A Better Angel

Sid Schwab said...

BA: first, I was referring to all the right wing organs and organelles that are taking it out of context. Since I began with your quote, I can understand why you'd think the harshness was toward you. It wasn't, and I'm sorry to have left that impression. In fact, I gave your comment the credence and respect of an entire post.

In the above comment, you said "In the question, the docs didn't suggest some "hail mary" procedure--they point out another option not covered. No! My point is that he asked about some theoretical therapy recommended by experts. That's exactly NOT the sort of thing that would be excluded by an approach based on rationality. An option not covered would be one found to be of no use. Which is excluded by the details of the question.

And, no, Obama didn't do a thorough job of answering the question, in that it seemed not to occur to him how falsely premised it was. Which is why I posted this. To set the record straight. When he needs my help, he gets it.

Finally, I'd say your definition of "rationing" is a little loose, if you mean not covering treatments shown not to be of benefit. To me, rationing is placing limits on access to useful treatments, based on age, severity of illness (as in liver transplants, currently). An entirely different kettle of fish, not yet -- and unlikely until we're on the verge of national bankruptcy -- being addressed.

Anonymous said...

Cute picture. Real question though. Who/how would we determine what is and is not covered? Not just end of life care, but does GOVins cover said procedure? Also, I think a good way to get providers to participate in GOVins would be to offer an incentive, such as, LIMITED malpractice judgment coverage.

Ken said...

Regarding Obamacare or any other issue Congress passes, or in the case of Nancy Pelosi, "let's pass it to see what's in it" Congress always opts themselves out of the coverage they pass for our benefit...if it's so good, why do they always opt out?

Sid Schwab said...

Kind of a tired old comment, Ken, on a tired old post. And, given the like in your name, borderline spam.

We don't disagree in general about the fecklessness of Congress, both parties. But in the case of opting out of so-called "Obamacare," you're not entirely correct.


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