Sunday Morning Politics - GTL Style

My new facebook friend Paul Erickson comments, "Dave, the way I see Obama is that he is truly a leftist. I think there are certain realities he has to live with being president that cause him to move from his leftist agenda. I don't know what kind of a strategist he is. He's come out on the wrong side of several areas: health care, unemployment, bank bail out etc."

Now, I'm only a guy who cares, not a genius who knows all, and I won't comment on whether or not it's a good thing that my wife's unemployment check has allowed us to keep our house and feed our children since she lost her public-school teaching job. Nor will I attempt to untangle the merits or lack thereof regarding those bank bailouts.

But Health Care is something I do know a lot about. So here's my response:

Paul, here comes a lengthy response, so brace yourself! I'd like you to read it with an open mind...

I work in health care - psychiatric hospitalization, specifically - and have turned people away for lack of insurance and have watched people stumble out of the hospital in tears, untreated, because even with commercial insurance they could not afford their co-pays and deductibles, often in the thousands of dollars.

From the perspective of a front line, boots-on-the-ground health care provider working with at least 15 separate insurance companies every goddamn day, including all the biggest ones, smaller ones, plus Tricare (military), Medicare (federal), and Medicaid (state), I can categorically state that here in Massachusetts the present is orders of magnitude better than the past. And I have heard not one complaint from any citizen, employer, or provider with ANY insurance plan, that the new system is either broken, arbitrary, or unfair.

In fact, time after time, people lament that they wish they had Medicaid because only Medicaid provides the comprehensive services at low costs that they need. Some facilities in my city of Lowell will ONLY take Medicaid, because all other comers are too difficult to deal with and reject too many claims.

Medicaid, BTW, has lower overhead, and is the model of efficiency compared to, say, Cigna, Aetna, Fallon, Harvard Pilgrim, Blue Cross/Blue Shield, Modern Assistance, and the mother of all substandard insurances, United Behavioral Health (unfortunately, I am insured by UBH, so I'd better keep the crazy to a minimum). I wish you knew the guilt I feel, having to tell people exactly what their benefits are and how much money they will spend in co-pays and deductibles. It is not what I went into clinical social work to do, and it feels just terrible. Remember, the people who come to me are mostly NOT poor, and have private, employer-contracted insurances they can nevertheless not afford to use in many cases.

In short, The HCR package, imperfect as it is -- as all laws are -- is a great leap forward. Plus, although the Right doesn't want you to remember this, it is a truly bipartisan creation, crafted from ideas born in both Democratic and Republican philosophies and think-tanks. The only reason the Republicans fought it is they wanted it to be "Obama's Waterloo," regardless of its merits or the fact that a few years earlier they pushed the same ideas.

For Obama's opponents - I won't call them enemies, we're all Americans - politics trumped the needs of their constituents.

The Obama Health Care Reform law is modeled in large part on Massachusetts' HCR ("Romneycare") law, with which I have abundant direct experience. The reforms have saved millions of dollars and thousands of lives. I know this firsthand. Also, the same companies that administer the so-called "government" insurance plans also offer identical commercial plans to employers for their workers. The only differences between the two are that the private plans have high co-pays and deductibles, arcane and wasteful administrative procedures, and result in denials of care fairly routinely even when people decide to shoulder the hefty debts they will incur -- and these are the WORKERS, understand, not the poor.

Romney should be proud of his accomplishment. Instead, to win the votes of the "government-is-bad" Republican voters, he will either have to repudiate his proudest accomplishment or spin it as fundamentally different than Obamacare - which it is not.

Irony abounds!

One thing is for certain, and that is that there is no government takeover of anything. No death panels, government doctors, government clinics, packed waiting rooms and long waits for inefficient State-provided procedures. Everything feels and functions exactly as before, but is more equitable and protects us better. The insurers working in the government plans make generous, though regulated, profits, and companies compete zealously for those contracts. The new system balances profits with care in truly laudable ways -- UNLESS ---

Unless you have an ideological bias against government providing health care funding in any situation.

In this instance, and there are plenty of people who feel this way, I have little to say except that I care about my patients and any system that gets them the care they need at lower costs and with greater protections must be good. If government does it better, then it cannot be said categorically that government is "never the solution, always the problem."

In this case, the truth is more complicated than slogans.

Thank you for the pleasure of your ideas and intellect, and the privilege on this fine Sunday morning of debating with a person who so obviously cares for his country and fellow man.

Peace!