I just finished watching the well-delivered, but frankly heavily partisan, health care reform speech by President Obama. After seeing it, I did not think it was a game changer, but no doubt others will be wooed by the authoritative tone set by the President. The speech was clearly not aimed toward the Republicans in the Congress but rather appeared, in my view, to be a warning shot and "call to action" to the conservative and moderate Blue Dog Democrats as the President struggles to win their support of the Public Option and his plan for health care reform. Hard to see the Republicans nuzzling up to the President at this point and the strategy seems to have shifted to getting a bill through by reconciliation.
There were good points made early and late in the speech, like the need for reform and the need to provide insurance options to those who cannot afford it, making the denial of pre-existing conditions illegal, and even the requirement that insurers can't cancel coverage mid-way. But these reforms were no-brainers. And while there was no question that the best part of the speech was the heartfelt memory of Ted Kennedy through a letter he wanted opened after his death that reinforced his desire to define the "character" of the country through this initiative, there were some glaring problems with the speech as well.
First, I thought the President did a poor job as he spoke "directly" to seniors, convincing them how the hundreds of billions of cost savings he proposed to discover in Medicare and Medicaid would not affect their benefits in the program. Simply put, our seniors are smarter than that. This remains a major problem for the President and the reform efforts underway.
More importantly for doctors, there was the issue of medical malpractice reform. It was interesting to review what the President actually said:
Now finally, many in this chamber, particularly those of the Republican side of the aisle, have insisted that reforming medical malpractice laws will bring down the cost of health care. (Republican side of the aisle finally applauds, to which the President points out: "There you go. There you go." and then continues.)That was it. Medical malpractice reform by putting patient safety first. You could see the members of Congress sitting there somewhat stunned and with puzzled looks on their faces. They weren't sure if they should clap or not.
Malpractice law is not a silver bullet. I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.
So... so, I am proposing that we move forward on a range of ideas to put patient safety first and let doctors focus on practicing medicine. I know that the Bush administration authorized demonstration projects in individual states to test these ideas. I think that is a good idea and I am directing my Secretary of Health and Human Services to move forward in this initiative today.
But a quick check on what the President was referring to can be found in the medical literature. In 2006, Hilary Clinton and Barack Obama co-authored a "perspective" piece published in the New England Journal of Medicine entitled "Making Patient Safety the Centerpiece of Medical Liability Reform." (Note: I have discussed my concern regarding the use of medical journals for political commentary previously). In this article, Clinton and Obama stated:
Instead of focusing on the few areas of intense disagreement, such as the possibility of mandating caps on the financial damages awarded to patients, we believe that the discussion should center on a more fundamental issue: the need to improve patient safety.So there you have it. It will be medical liability reform through more safety supervisors, hand soap dispensers, operative "time outs" and hall monitors. No unseemly caps on financial damages. Boy, the Bar Association members must be giving each other "high fives" for how well the President handled that part of his speech, don't you think?
But despite all this, an even more surprising and memorable moment came when the President promised not to pay for coverage of illegal aliens in any government health care reform bill and a Republican Congressman blurted out so all could hear, "You lie!" The Democratic side of the aisle immediately booed the vocal Republican Congressman. The look on Nancy Pelosi's face as she sat befuddled behind the President following the outburst was, as they say, priceless. And while this was a tense moment that passed quickly, it reinforced the passionate nature of the debate for all Americans and served as a reminder of how hard it will be to pass any bill of this scope and magnitude.
Photo credit: Whitehouse.gov