Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Barack and Hillary: The Ol' Soft Shoe

{Hillary Clinton}
Hillary Clinton

For decades the AMA House of Delegates has held its semi-annual meeting in the same hotel in Chicago, renting the whole hotel for the purpose. President Obama unveiled his new plan for health reform this year, just as First Lady Clinton did, sixteen years earlier. They both made theatrical entrances, and both gave flawless speeches. Hillary spoke for an hour without notes or mistakes; teleprompters can be hard to see, but Obama ordinarily uses one for his near-daily speeches. The AMA always tries to get advance information, and rumors were circulating that he would have something dramatic to say about tort reform; the rumor was met with delight. Do you suppose, is it possible, he will agree to a cap on awards for pain and suffering? For forty years, the medical profession has been suffering from abusive malpractice suits and has tried out dozens of proposals for reform. For forty years, absolutely nothing has worked except to place a $250,000 "cap" on awards for "pain and suffering". That proposal works, and pretty much works every time it is tried. Do you suppose, do you suppose, we finally have a lawyer President who understands?

{Barack Obama}
Barack Obama

The President had a legislative plan to present, and with tort reform promised as the climax of it, the doctors applauded regularly, and laughed at jokes that were a little weak; that's what was expected of them. As he outlined his plan, it seemed a flop but don't be rude. He proposed to spend a trillion dollars on providing health insurance for 16 million of the 42 million uninsureds and intended to pay for it with a trillion dollars worth of cuts to the reimbursement of hospitals and pharmaceuticals, plus taxes on the rich, defined as roughly every person in his audience. And still, they applauded, even good-naturedly joining into one of his cadence counts. He was building to the climax; tort reform was coming. When he started the topic, there were cheers.

Unfortunately, he saw what they meant, and took pains to announce that he was not at all in favor of a cap on "awards", he didn't believe in that. It was pretty easy to hear the boo-ing. When all was said and done, his plan for ensuring everyone amounted to putting 16 million people on Medicaid, the absolute worst part of the present system. The money to pay for it would be provided by the State Governors, who would somehow get it from the Federal Treasury.

And so, Obama lost the chance of a lifetime, the sort of opportunity Kipling was describing as sixty seconds worth of distance run. Of course, he had been surprised and unprepared, but he was performing in front of surgeons and cardiologists, and directors of emergency rooms, anesthesia, and critical care units. There was scarcely a person watching who had never faced a split-second decision involving life and death, in full knowledge that if a mistake was made, a plaintiff lawyer would pounce. It is my opinion -- I sat in that audience for 25 years -- that if he had said he would try his best to get what we want, the profession would have united around his otherwise feeble plan and tried to help him out with it.

What about Hillary's Shakespearean demureness of a generation earlier? Well, the average life expectancy of Americans is five years longer than it was then, so we really didn't miss her plan a great deal. But fundamentally it was the same plan that California doctors devised during the 1960s. It was then called Foundations for Medical Care, but it was essentially an HMO. When the private insurers took it away from the control of physicians, they turned it from success into a disaster; it's still regarded as an antitrust violation for physicians to run one. The California patients loved it when it was run by doctors, hated it when the insurance companies took it away. The last fifty years of so-called health reform have amounted to building bridges without engineers, flying airplanes without pilots -- and delivering health care without the supervision of physicians.

Have a nice time, sir.

Originally published: Friday, June 19, 2009; most-recently modified: Tuesday, May 14, 2019