By Clark S. Judge, managing director, White House Writers Group and former Special Assistant and Speechwriter to President Reagan
On Sunday the Rasmussen organization reported that 42 percent of likely voters had told them they strong disapprove of the president’s job performance. At this rate it is not out of the question that the new year could see this number break the 50 percent mark.
The record strong disapproval – which also must set a record for how quickly an administration has turned the public against its policies – came in the middle of several days of wall-to-wall media coverage of the passing of Senator Edward Kennedy. We won’t know for sure until midweek polls come out, but if the White House was hoping for a bump, either for it or its policies, from the outpouring of affection for the liberal senator, it appears at this moment it will be disappointed.
This week’s announcement that the Justice Department will investigate and prosecute CIA officers for their interrogation of senior al Qaeda officers undoubtedly hurt the president, what with the television news outlets playing over and over his indication in February that he would not pursue this course.
But the anchor tied to Mr. Obama’s feet, dragging down his approval rating, remains the health overhaul and all that has become associated with it – a string of trillion dollar charges against the national credit card; White House dissembling about everything from rationing to run away expenses; the president’s easy embrace of confiscatory tax rates.
Thursday brought yet another expert in yet another Wall Street Journal article confirming that the social democratic health overhaul model that the administration and Democratic leadership in Congress have embraced is a road to rationing. Health policy expert Betsy McCaughey detailed (here: https://tiny.cc/D8a90) the candidly expressed policy thinking of Dr. Ezekiel Emanuel, White House advisor and, as brother of the President’s chief of staff, widely assumed to be a central shaping force behind Administration policy.
“Dr. Emanuel,” she reports, “is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs.” She quotes a February 2008 article in the Journal of the American Medical Association, where Dr. Emanuel writes, “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”
Instead, in a June 2008 JAMA article he wrote that (as McCaughey summarizes) “doctors should serve two masters, the patient and society, and that medical students should be trained to provide socially sustainable, cost-effective care.” McCaughey continues, “One sign of progress he sees: ‘the progression in end-of-life care mentality from ‘do everything’ to more palliative care shows that change in physician norms and practices is possible.’”
In January in the medical journal Lancet Dr. Emanuel advocated a “complete lives system” to guide health policy. As he explained (McCaughey quoting him), “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated.”
Despite denials from the White House and its backup singers in Congress and the media, no one should be surprised that rationing is the magic cost bullet in the President’s policy gun. Ludicrous waiting lists for what in the United States would be regarded as urgent procedures are the norm wherever the social democratic health model is in force.
There are two ways to control health inflation: more rationing (in Medicare and Medicaid we already have some) or more productivity.
The true heart of the U.S. health cost inflation problem is captured in one set of statistics. As Harvard professor Regina Herzlinger, one of the nation’s most respected health policy experts, reported in 2004, “[F]rom 1978 to 2001, the defined benefit, third-party-driven health sector demonstrated productivity losses of 24 percent compared to the nonfarm productivity gain of 42 percent.” She added that, “Physicians’ output per employee decreased a hefty 29 percent.”
Like many others, Herzlinger advocates what is called “consumer-driven” health reform. Indeed, the passages quoted above come from her book “Consumer-Driven Health Care: Implications for Providers, Payers and Policymakers” (a title that could only come out of academia). Specifics of consumer-driven reform include giving individuals the same tax breaks for health spending that companies receive, so buying insurance yourself rather than through your employer isn’t prohibitive; health savings accounts, so you can pay directly for regular health expenses, making your own decisions about value, not depending on someone else’s; creating a national insurance market, not the Articles of the Confederation state-by-state markets we have now, by allowing insurance approved for sale in one state to be sold in all. Herzlinger also calls for public reporting of health costs and outcomes and creation of a Securities and Exchange Commission-type entity to ensure that the data are timely, comprehensive and accurate.
More consumer control will do what it has done in every other sector of the economy, create irresistible pressures to produce more for less, in other words to increase productivity. If we had seen the same productivity increases in health care as we have witnessed in other sectors, we would not be giving serious consideration to Dr. Emanuel’s rationing by demography as a guide to policy today.
With Washington looking forward to September and the return of Congress, the White House’s health policy dilemma comes down to this: the social democratic model of health overhaul that they have embraced will only make the health cost inflation worse and limit access to care. But the consumer-driven model is unacceptable to the president’s ideological base. How they resolve this dilemma will be the major domestic policy story of the months ahead – and will determine whether the president’s job approval ratings proves capable of recovery.