By MICHAEL MILLENSON
The health care community is discovering to its shock and dismay that it’s not simply traditional Republican conservatives who have taken control of the House of Representatives, it’s a new group of cynics.
Conservatives, like liberals, have a more-or-less coherent set of ideas. They use political power to push preferred policies, whether related to health care, housing or a hundred other possible issues. William F. Buckley Jr., one of the fathers of modern American conservatism, “had a way of … making conservatism a holistic view of life not narrowed to the playing fields of ideology alone,” as one admirer put it.
Although cynics may claim conservative credentials, their view of government is really nothing more than a quarrel about its cost. It brings to mind Oscar Wilde’s immortal phrase, “The cynic knows the price of everything and the value of nothing.”
The contrast between the two viewpoints was on stark display at two recent marquée meetings, AcademyHealth’s yearly policy conference and the sprawling Health Information and Management Systems Society — HIMSS — Health IT Conference and Exhibition.
AcademyHealth’s “Running of the Wonks” (my term, not theirs) is a magnet for researchers and policy mavens who are inured by long experience to most political rhetoric. Yet at the general session featuring a bipartisan dialogue among congressional staffers, the harsh rhetoric from the GOP participants stunned the crowd. The new federal health law, it seemed, was evil incarnate, and the rhetoric of “repeal and replace” was wielded with a fundamentalist zeal.
“The bureaucracies that administer ObamaCare” must be cut, declared one aide to a powerful congressional leader, setting the tone. And in case anyone didn’t get the point, the word “ObamaCare” was deliberately repeated every few syllables in a tone of disdain combined with wonder at how such a monstrosity had ever come to be. (AcademyHealth meeting rules said the staffers could not be quoted by name.)
The audience of wonks quailed, then quietly queued up for the question-and-answer period. They knew, after all, that the health law’s fine print incorporates a generous helping of initiatives championed by both conservatives, and those on the left. Besides, these were staffers speaking, not politicians playing to the press. Surely, gentle reason would triumph. Alas, it was not to be.
The Prevention and Public Health Fund? “You mean, the prevention health slush fund, as we like to refer to it?” replied a GOP staffer.
The Innovation Center at the Centers for Medicare & Medicaid Services? “An innovation center at CMS is an oxymoron,” responded a Republican aide, before adding a personal barb aimed at the attendees: “Though it’s great for PhDs who come to Washington on the government tab.”
There was also no reason the government should pay for “so-called comparative effectiveness research,” another said.
“Everything’s on the chopping block,” said yet another.
Everything? At HIMSS, where GOP staffers also spoke, attendees were chagrined to learn that “everything” applied to them, too. The subsidies for health information technology that were part of the American Recovery and Reinvestment Act were targeted in legislation introduced in late January by Rep. Jim Jordan, R-Ohio, chairman of the Republican Study Group. His bill would repeal this funding and eliminate all remaining stimulus spending, including about $45 billion in unspent health IT funds.
Those focused on the substance of health policy might be forgiven for feeling blindsided. After all, the McCain-Palin health policy platform in the 2008 presidential election called for coordinated care, greater use of health information technology and a focus on Medicare payment for value, not volume. Once-and-future Republican presidential candidates such as former governors Mike Huckabee (Ark.), Mitt Romney (Mass.) and Tim Pawlenty (Minn.), as well as ex-Speaker of the House Newt Gingrich, have long promoted disease prevention, a more innovative federal government and increased use of information technology. Indeed, federal health IT “meaningful use” requirements can even be seen as a direct consequence of Gingrich’s popularization of the phrase, “Paper kills.”
Ah, but that was back before the Republican cynics swept into power. It was back before traditional GOP conservatives — worried that any suggestions outside a single-minded focus on slashing spending would be seen as disloyal — eschewed ideas in favor of ideological declarations.
This column was filed just days after a two-week compromise was signed into law to avoid a federal government shutdown. It allowed funding for health reform to continue, but instituted other budget cuts. Obviously, the cynics yielded a bit, at least for the moment, to the conservatives, and the liberals and centrists have given ground to both.
Still, one wonders what the urbane Buckley would think of a movement that seems intent on ignoring the real-world context of its actions. Buckley launched his lifetime crusade against liberalism with God and Man at Yale, a book that took aim at the academics who’d taught him as an Ivy League undergraduate. Alas, the GOP cynics are cocooned instead in an underground bunker of their own design, as impervious to realities they’d prefer to ignore as the ivory tower academics they’ve come to scorn.
This post first appeared at Kaiser Health News.
Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age”.
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Again that same old lie- “One should be cynical when the Speaker of the House states that the law must be passed BEFORE we find out what’s in it.”
Lookup fox news- Pelosi said- we have to pass the health care bill so that you can find out what is in it
http://www.youtube.com/watch?v=KoE1R-xH5To
And how profound, the more it has been around, HCR popularity has been improving.
These are moments of spotlight for conservatives and they will run down their capital at this pace pretty fast. Reminder will be, that middle rules.
It will be a pretty tough battle for conservatives since insurance industry is also now for bill with mandates. As I see it’s just a sham fight.
Hey Michael, courts have also declared the law constitutional. So, let’s see how it plays out.
I’ll add my cynicism about the health care bill and saw it adding subsidies, not cutting costs and just forcing people to buy the Cadillac plan to keep providers (donors) still fat. But I’m in favor of the rabid right finally getting to do what it wants and think the Dems should just let them have at it. Repeal the bill, cut the programs, slash the departments and then we’ll see how Repugs are going to solve the continuing unsustainable inflation of healthcare.
It is just so pathetic and immature to listen to this extremist banter between Democraps and Repugnocants in fixating their assessment is the only one to consider. As M Scharf said so accurately,
“One should be cynical when the Speaker of the House states that the law must be passed BEFORE we find out what’s in it. Many of us are cynical that the law was passed on parliamentary maneuvers and not a straight up or down vote in the Senate. At least the Republicans sat there and took it, rather than leave like the Democrat State Senators in Wisconsin”, and
“There are big changes that have to be made in how we deliver health care in the US. It’s too bad that no one is having that discussion. Rather it’s come down to power politics, with destruction of the other side the only goal.”
And then we have to listen to the inane echo banter of each side’s blind loyalists tell those of us who are interested in neither sides’ appraisal of what is alleged “right” to do for “fixing” health care.
Fixing health care. Like it is an automobile product or business service. It really is a shame the predominate commenters have chosen their side and will cling to it desparately until they either shout opponents down to submission, or finally succumb to the persistent lobby that is interested in helping the public they serve and aid, not the special interests who are only interested in sucking the system dry of profit margins, and then move on to other susceptable arenas. Like we saw in the financial industry.
Hey, I have no interest in following the republicans blindly, as their agenda is not to improve any legitimate legislative interventions, just to block any Democrat process. But, I hope to empower the 60% of Americans who really do not give a damn about Democrat or Republican representatives these days. And that really scares you extremists of either side, that the majority of voters are out of your boxes of limited thinking and choices.
Good for me, good for those who entertain that I may have another path to chose. Go to the post about Berwick and read those extremists banter on how unfair he might be outed from his post at Medicare. Blind loyalty, it is an accurate term!
Those who earn a living lobbying for government handouts to implement health IT are right to quail before these so-called “cynical” GOP staffers. However, if they do gut the heath IT funding provisions, we will have more innovation in health IT, because businesses will have to focus on the needs of customers, not government.
The total lack of concern for the consequences to the US of NOT beginning to try to fix a seriously broken health care system is a partisan and short sighted direction by conservatives.
Unless they have a better way to fix the US health care system, I’d suggest that they think long and hard about the consequences to government spending, access to health insurance and the economy of having to shell out more and more money for health care.
If the Republicans are so interested in fixing things, where’s their proposal? Also, other disctrict judges have ruled the bill constitutional. That used to mean something too. Oh wait, all judges ruling so far ruled according to their political preferences rather than an objective of the law.
There is nothing but cynicism in any of this. All bills passed through the Senate today are passed through parliamentary maneuvers.
I guess Republicans today fall into two categories: cynical and naive and it’s clear which camp Michael Scharf falls into.
Sorry Michael, but there really are big problems with the healthcare reform act passed last year. It’s not that conservatives are just cynical, it is that more than one federal court has declared the law unconstitutional (that used to mean something to both sides of the aisle, now apparently it does not).
One should be cynical when the Speaker of the House states that the law must be passed BEFORE we find out what’s in it. Many of us are cynical that the law was passed on parliamentary maneuvers and not a straight up or down vote in the Senate. At least the Republicans sat there and took it, rather than leave like the Democrat State Senators in Wisconsin.
The fact that there is $105 Billion in the current year’s budget to implement this unconstitutional law means that this money should not be spent, not that it must be rushed through before the Supreme Court makes a final ruling.
There are big changes that have to be made in how we deliver health care in the US. It’s too bad that no one is having that discussion. Rather it’s come down to power politics, with destruction of the other side the only goal.