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Tag: Politics

Politics in the Exam Room

An ancient maxim  of dinner party etiquette, which  I believe has been proffered  from more than one source,  is “never discuss politics, religion or sex in polite company”. In some ways, for me as a physician, entering the exam room with a patient seems to require some similar degree of discretion. But the consequences of straying outside the bounds of polite discussion in the doctor’s exam room are quite different from any awkwardness that might ensue after a social misadventure.

Dr. Henry Lee, the well-known Connecticut State forensic medicine expert likes to relate a tale of his own introduction to dinner party etiquette, which I will try to relay somewhat faithfully. His English was poor when he arrived in the U.S. and, invited to a party in which guests were seated in the traditional “boy-girl-boy-girl” arrangement, he knew he would be pressed to make conversation with the women on each side of him. A friend reassured him, “You’ll have no problem if you can just get the woman talking about herself and then all you have to do is listen politely. Simply ask  ‘Are you married?’ and then ask “Do you have any children?’. This should get things going just fine.” Armed with this strategem, Dr. Lee was seated and turned to an attractive young woman on his left and asked if she was married. She replied “No”. So of course, he went on to the next question, “Do you have any children?”. He was surprised when she reacted with a look of indignation and quickly turned her attention to the guest on her other side. Puzzled at her reaction, he surmised that he must have gotten the sequence out of order. Trying out the other way around, he turned to an older woman on his right and asked confidently if she had any children. “Three!”, she replied happily. Delighted with his progress, he then inquired if she was married. Dr. Lee says he spent the dinner conversing with his soup and salad.

I have also had exam room encounters come to grief because of sex, politics and religion, but nothing has caused me more regret than politics. I will explain.

Continue reading…

Turf Wars

So many folks express views that are obviously self-serving, but they try to masquerade them as altruistic positions that benefit some other constituency. These attempts usually fool no one, but yet these performances are common and ongoing. They are potent fertilizer for cynicism.

Teachers’ unions have been performing for us for decades. Their positions on charter schools, school vouchers, merit pay and the tenure system are clear examples of professional advocacy to protect teachers’ jobs and benefits; yet the stated reasons are to protect our kids. Yeah, right. While our kids are not receiving a top flight education, the public has gotten smart in a hurry on what’s really needed to reform our public educational system. This is why these unions are now retreating and regrouping, grudgingly ‘welcoming’ some reform proposals that have been on the table for decades. This was no epiphany on their part. They were exposed and vulnerable. They wisely sensed that the public lost faith in their arguments and was turning against them. Once the public walked away, or became adversaries, established and entrenched teachers’ union views and policies would be aggressively targeted. Those of us in the medical profession have learned the risk of alienating the public. Teachers have been smarter than we were.

The medical profession is full of ‘performances’ where the stated view is mere camouflage. For example, there is a turf war between gastroenterologists (GI) and anesthesiologists whether GI physicians can safely administer the drug propofol to sedate our patients before colonoscopies and other glamorous procedures. This drug may be familiar to ordinary readers as it was involved in the death of a superstar pop music legend in 2009. GI doctors insist that with proper training we can safely administer this drug to our patients. Indeed, there are numerous scientific publications that support this view. Anesthesiologists have pushed back hard and they have prevailed. “It’s too dangerous,” they warn. “No one can use this drug unless you have advanced anesthesia training,” Of course, the only physicians who have ‘advanced anesthesia training’ are anesthesiologists. I’m not claiming that my anesthesia friends don’t have a legitimate point. But, let’s be clear. Their position is not merely an effort to protect patients, it is also meant to protect their turf. Continue reading…

Does the GOP Have a Health Plan?

The Republicans have no plan to insure the uninsured.

How do I know that? A New York Times editorial told me. So did Ezra Klein, writing in The Washington Post. Matt Miller, also writing in the Post, went further. “I’m willing to repeal ObamaCare,” he wrote, provided the Republicans can “cover the same number of uninsured” and “do it at a lower cost.”

So why don’t the Republicans have a plan? That’s easy. “They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do,” wrote Paul Krugman in The New York Times. The Times’ own editorial said the same thing.

All this has caused me to suffer a bout of severe depression. But, wait a minute. Wasn’t health care the biggest issue in the last presidential election? And…how memory fades…didn’t the Obama campaign spend millions of dollars…promoting his own plan?…no, that’s not right…

Ah, now I remember. The Obama campaign spent tens of millions of dollars on TV commercials attacking the John McCain health plan! It spent more money than has ever been spent for or against any policy proposal in the history of American politics.

The McCain plan, for all those suffering from collective amnesia, proposed to replace all existing health care tax and spending subsidies with a universal health grant, structured like a refundable tax credit. The Patients’ Choice Act version of the idea is sponsored by Tom Coburn (R-OK) and Paul Ryan (R-WI). It promises $2,300 (individual) or $5,700 (family) to everyone who isn’t enrolled in a government health plan.

So what was candidate Obama’s problem with that? Did he object that the plan wasn’t generous enough? Too few regulations? No, none of that. The Obama TV ads focused like a laser on raw self-interest. McCain’s health plan, the ads said, will cause your withholding taxes to go up (without mentioning the offsetting credit that would cause them to go down).Continue reading…

UPDATE: Medicare, SCHIP and Kids

Last night the Senate voted 68 to 31 to renew and expand the State Children’s Health Insurance Program SCHIP). A day earlier the House voted 225-204, largely along party lines, to approve a larger expansion of the SCHIP program. As Matthew notes below, the Senate, unlike the House, would not try to help fund SCHIP by eliminating Medicare’s overpayments to Medicare Advantage for-profit insurers. (See my post below)

Meanwhile, President Bush has said that he would veto either version of the legislation. But the Senate bill garnered enough votes for its version of the bill to overcome a veto. (18 Republicans joined 48 Democrats and 2 Independents in the vote.)

According to PBS, the House and Senate plan to meet after their August recess to reconcile the differences between the two bills before sending a final measure to President Bush.

Below, Matthew offers his best guess as to what will happen next. He suggests if the Senate/House compromise avoids taking a whack at the Medicare Advantage private sector insurers, the President might well sign it. Nevertheless, Matthew believes that Democrats won’t be able to resist the temptation to include the provision cutting over payments to insurers in order to provoke the veto and then campaign on the fact that Republicans hate children.

I’m cynical but frankly, Matthew is so cynical. I take this as an ethnic (i.e. British) trait. On the other hand, I’m Irish, so I probably shouldn’t open a discussion about ethnic Achilles heels . . .

But I am idealistic enough to think that there are enough Democrats and Republicans who care about healthcare for uninsured children that they will eliminate the cuts to insurers in hopes of avoiding a veto.

It’s worth noting that on Tuesday, Sen. Orrin Hatch (R. Utah) and Sen. Edward Kennedy, (D-Mass), told the Washington Post that House-Senate negotiations will aim to keep the final bill within the scope of the Senate’s measure in order to try to avoid that Presidential Nix.In the end, if Congress doesn’t touch insurers’ profits, would President Bush say “no” to expanding SCHIP for kids? I don’t know.

What do you think?

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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