The Audacity of Spin

Regarding Tom Daschle’s withdrawal from consideration to be the next secretary of Health & Human Services, a front-page story in this morning’s Washington Post pulls off one of the most ingenious feats of political spin I’ve ever seen:

But some observing the debacle wondered if the capital’s ways were changing. The story of how [Daschle] fell in with the monied elite and out with the popular mood involves a longtime Democratic financier, Leo Hindery Jr., and his keen interest in currying influence with powerful politicians. The outcome caught many in Washington off guard.

“I think it’s possible this is some sort of bridge between an old Washington and the new Washington,” David Arkush of Congress Watch said of the initial backing of Daschle and the sudden reversal.

So you see, Daschle’s withdrawal is actually a victory for President Obama!  He’s changing Washington already!  Brilliant!

Actually, the brilliance is Arkush’s for getting the Post to adopt his spin both in the article and the subtitle (“Some See Failed Nomination as Harbinger of Change”).

For the record, I hope Arkush is right.  I hope Obama does something about the revolving door that lets people like Daschle write complicated laws and then make millions of dollars helping people navigate and alter them.  Of course, as they say, the only way to reduce the amount of money in politics is to reduce the size of government.

More Reax to “Does the Doctor Need a Boss?”

Based on some critical comments that Greg Scandlen made in his Consumer Power Report newsletter about “Does the Doctor Need a Boss?” – a Cato briefing paper on improving the coordination of medical care, coauthored by Arnold Kling and me – I invited Scandlen to a “blogoquy” on that paper.

Readers of Scandlen’s newsletter also offered their reactions, which Scandlen printed in a subsequent newsletter.  I’ve pasted those reader comments below, with some links added:

From Jane Orient, M.D., of Tucson, Arizona, and head of AAPS:

So just who should be my boss? What credentials? What oversight of the boss? Who gets sued if there’s a problem?

The “project manager” in cases like Mr. Kling’s used to be called “doctor.” Seeing to all those details used to be my job when I was the attending internist rounding on my private patients in the hospital, calling the consultants but doing all the medical work outside of the specialty procedures, always looking for trouble.

I don’t do that any more; very few doctors do. They rely on hospitalists. Reasons: (1) They don’t get paid. (2) They do get hassled constantly by managers with clipboards, not to mention Medicare bureaucrats. They have to cope with increasingly complex although largely pointless, legalistic hospital procedures and impossible Medicare billing requirements (and threats of draconian fines and prison terms for errors). Probably worst is the lack of experienced, well-trained nurses who know their patients and are familiar with the hospital unit because they work there all the time.

A job that interns used to be able to do, with the help of a good nursing staff, is now probably impossible for any human being, thanks to all the bosses, supervisors, overseers, committees, risk management, quality assurers, teams, team leaders, managers, utilization reviewers, etc.

Pretty soon you won’t be talking about bosses for doctors, because there won’t be any doctors. Who needs them anyway? If the project manager is capable of bossing the doctor, and if he’s a hospital employee gets paid even if the doctor doesn’t, why doesn’t he just do the doctor’s job?

From Peter Nelson, with the Center of the American Experiment in Minneapolis:

As someone who works almost entirely on health care issues at a state-based think tank, I find incredible value in your regular emails. However, I must say that I was a bit put off by your recent assessment of the Cato paper by Michael Cannon and Arnold Kling. Writing “YIKES!” and calling it “one of the most offensive papers I’ve ever read” were unwarranted.

As you recommended, I did read the paper and I did draw my own conclusions. Permit me to share.

First off, asserting that the authors arrive at their conclusions primarily from an emotional reaction versus logical contemplation was quite unfair. Almost everyone in health care has an emotional health care story that in some way colors their view. I know I do and I suspect that you do too. Based on personal experiences, I readily admit to a bias against UnitedHealth Group. However, I would be highly offended if someone dismissed my policy work in regard to general insurance regulation because UnitedHealth refused to pay my father’s medical bills in bad faith for a year and a half after his death. The fact is, if anything was tainted by emotion, it was your critique.

Second, the paper presents a vision for how health care could be delivered if people were given more control over health care dollars. Importantly, it doesn’t say this is what needs to happen, it just describes possibilities. While I might disagree with a number of the points made by Cannon and Kling, the paper delivers a more imaginative and thought provoking vision than we’re used to seeing from think tanks.

Finally, the paper attempts to address a mind boggling question: How can we improve the way we pay for health care? Whether you agree with them or not, anyone who enters this thicket deserves significant leeway.

From Kirby Neilsen, a retired insurance agent in Ohio:

Greg, your Consumer Power Report #162 seemed especially well timed and well written this week although I think your writing is good every week.

Over the weekend I had a chance to read “Does the Doctor Need a Boss?” and I am left wondering really why they think Corporate Medicine will solve all the problems we have in health today? In fact in one section they talk about “Corporate Competence,” while I thought the phrase to be an oxymoron. Give me my individual MD’s any day. Not that corporations can’t do things well. Like the authors said, corporations can build houses and cars and space ships, but that model doesn’t easily translate into health care.

Although I am living a chronic and complex disease process and can certainly say more needs to be done at refining interdisciplinary care, I just can’t see any way to do that other than through a consumer centric model of care. Not a corporate model of care.

The authors’ perception of physicians as worker bees in a beehive run by managers and ultimately queen bees leaves one with a perfect reminder of bureaucratic complacency and the manager clocking out at 5:02 pm while the poor patient has to wait until the morning to learn whether or not they are going to get the treatment the MD ordered. Going on, they insist that case management be replaced by something called “senior management” which doesn’t sound like there is room for any consumer input. It sounds like bureaucratic power struggles to me.

The way they denigrated physicians was shameful and unnecessary. I know a lot of doctors both as an agent and as a patient and not one has exhibited the old “I am God” syndrome to which they referred. Plus, who do they think is going to care for all those folks out in rural Minnesota, Montana, and North Dakota?

There are other areas I reacted to, including the National licensing of physicians and other health care providers (talk about your Federal Control of medicine), and the notion that corporate competition using their model will really bring about better health care results. So they said would happen if we only had more big privately owned hospital chains. I recall that specifically from Columbia, the corporation once owned by the Frist family and who ended up with huge Medicare or Medicaid (or both) fraud convictions. They bought up hospitals all over the country and were going to drive down the cost of health care. Right.

I also compliment you on your calling out the use of personal experiences as a basis for a position statement. My reaction was, aren’t families supposed to put a stop to too much chaos in health care for their parents? Don’t blame MD’s for doing their job, convince them that you are not going to allow any more moves and advocate for prioritized care.

Another person who blames MD’s for the death of a parent is the world famous prognosticator and management guru Tom Peters in his blog … If you hunt around some of the archived issues you will find out he believes MD’s in a hospital killed his 97-year old mother while at the same time admitting she had multiple serious health problems. The link above takes you to the current posting on his blog where he wants to seek out all obese Doctors, School Principles, and Teachers and remove them from addressing obesity because they are no long credible in talking about obesity. Mr. Peters is in the same camp as a lot of folks these days and feels that we do need more regulation to protect people from themselves. So get ready docs, you may have to weigh in before you are allowed to counsel patients.

More to come …

Drop the Pipe Dream

The gargantuan “stimulus” coming down the pike has suddenly gotten education a lot of attention, but commentators continue the pipe dream that politicians might finally leverage this infusion of cash into effective reform.

Here’s an idea: Wake up and smell reality instead of hoping upon hope that this time our billions…er…tens of billions will get us something. As Adam Schaeffer and I document today on RealClearPolitics, the U.S. has been stimulating education at all levels for decades, and have gotten essentially nothing for our money. And of course we haven’t: As the “Washington must do something” rhetoric driving the pork-laden stimulus-to-end-all-stimuli well illustrates, the overwhelming goal of most legislation is to make politicians appear to “care,” not to actually accomplish anything. And nothing, unfortunately, says “care” as much as wasting tens of billions in the name of cute, innocent children.

Welcome Developments on Trade

Yesterday, President Obama broke his long silence about the Buy American provisions in the congressional spending bills. In an interview with ABC’s Charlie Gibson, Obama expressed support in principle for removing the provocative language to expand Buy American provisions:

CHARLES GIBSON: A couple of quick questions. There are “Buy America” provisions in this bill. A lot of people think that could set up a trade war, cost American jobs. You want them out?

PRESIDENT OBAMA: I want provisions that are going to be a violation of World Trade Organization agreements or in other ways signal protectionism. *** I think that would be a mistake right now. That is a potential source of trade wars that we can’t afford at a time when trade is sinking all across the globe. (***Per the White House, President Obama misspoke and meant to say, “I want provisions that are not going to be a violation of World Trade Organization agreements or in other ways signal protectionism.” )

CHARLES GIBSON: What’s in there now? Do you think that does that? Do you want it out?

PRESIDENT OBAMA: I think we need to make sure that any provisions that are in there are not going to trigger a trade war.

And in an interview with Fox, the President said:

I agree that we can’t send a protectionist message…I want to see what kind of language we can work on this issue. I think it would be a mistake, though, at a time when worldwide trade is declining, for us to start sending a message that somehow we’re just looking after ourselves and not concerned with world trade. (my emphasis)

It looks like President Obama gets it, although I would be more convinced of that if his last statement didn’t seem to regard “world trade” and “just looking after ourselves” as mutually exclusive. More engagement in world trade is one of the best ways to look after ourselves.

Finally, just a word of caution to our friends in Europe and Canada, where this morning’s newspapers are gleeful about the development: even though the U.S. president opposes the Buy American restrictions, the Congress still needs to strip out those provisions. If Congress keeps those provisions in a final spending bill, which passes both chambers of Congress, it’s going to be very tough for the President to veto the legislation.

Does SCHIP Work?

That’s the title of my latest oped over at National Review Online.  Here’s how it begins and ends:

Pres. Barack Obama proclaimed in his inaugural address, “The question we ask today is not whether our government is too big or too small, but whether it works.” If he was serious, he should veto the $115 billion expansion of the State Children’s Health Insurance Program that is soon to reach his desk—and insist that Congress eliminate the program entirely…

If President Obama wants to cover more uninsured children, he should set ideology aside and repeal SCHIP. After all, you can’t argue with what works.

Might be time to drag out the Church of Universal Coverage’s pro-SCHIP campaign:

There I go, killing kittens again.

Destination Universal Coverage?

I’ll be appearing on the Destination Casa Blanca program to share my thoughts on the State Children’s Health Insurance Program and the question, “Is this legislation the first step to universal health care?” 

I’m told that other guests will include someone from the Republican National Committee and the Obama administration.  The host will be Ray Suarez, senior correspondent for The NewsHour on PBS. 

The program will air this Thursday night (2/5) at 9pm EST, with encore presentations on Friday (12am) and Sunday (10:30am and 10pm).  Destination Casa Blanca is easiest to find on DirecTV (438) and the Dish Network (843 & 9401).  Otherwise, check here.