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ObamaCare versus the old ClintonCare: a major step backwards

Clinton, despite his failings, which were only human failings, had something that Obama didn’t have although he thought he did and many in the media gave him credit for having. Clinton truly had a transformational vision for health care and that vision was masterfully expressed in this address to Congress that evening. It was probably one of the best speeches, if not the best speech he ever gave. Obama could have used these same six principles if he wanted to. They are worthy principles that all Americans want to achieve in any health care reform. One in particular needs to be examined very carefully, Clinton’s fifth principle, quality.   Although the other five are as worthy of mention when comparing Clinton’s vision to Obama’s, quality is the most important and most valuable attribute whenever one encounters the health care system and it is over quality that Obama’s vision makes it most drastic departure from Clinton’s.   

 

Of quality, Clinton said, “If we reformed everything else in health care but failed to preserve and enhance the high quality of our medical care, we would have taken a step backward, not forward.  Quality is something that cannot be left to chance. When you board an airplane, you feel better knowing that the plane meets standards designed to protect your safety. We must ask no less of our health care system…” In his own words, high quality care will be the safest care possible, as safe as flying in an airplane.  He went on to say, “…More efficient delivery of health care does not decrease quality, and may even enhance it.”   Again,  his own words describe quality as the most effective care necessary to produce the best medical outcomes. Cost is only secondary; hence high quality care would be the most cost effective care possible..  He went even further by saying, “…Our plan will guarantee that the  highest  quality health care is available in even the remotest areas of our nation… Our plan will ensure quality by effective prevention and treatment measures for cancer, for AIDS, for Alzheimer’s, for heart disease and for other chronic diseases. Our plan safeguards the finest medical care in the world, and makes it even better.” Therefore, for Bill Clinton, high quality care  will be universal, ensuring  every American treatment for  cancer, for AIDS, for Alzheimer’s, for heart disease and for other chronic diseases without raising the specter of how those suffering from these disease would contribute to society after treatment is rendered.  These attributes of quality are an awesome vision, one that every American, every doctor, every politician regardless of party could embrace.

 

Obama, who some say possesses rhetorical skills eclipsed only by Abraham Lincoln and, maybe, not even by him, and whose genius is unsurpassed by anyone who ever held the office, never said anything remotely similar. The reason why is he does not believe it.   On July 15, 2009, he spelled out exactly what he thought of quality and he did so right in the face of the AMA.  “Today, we are spending over $2 trillion a year on health care… And yet, for all this spending, …the quality of our care is often lower; and we aren't any healthier.”   It is rare for a president to address the AMA and rarer still to tell it that the quality of American health care is second rate.  Yet, since Obama’s health care juggernaut began just 8 weeks ago, life expectancy was raised and data showed that survival rates for Americans  with cancer, were superior to any European counterpart.   However, Obama  truly believes what he told the AMA and nothing will change his mind nor his agenda to bring us into his brave new world even if we don’t want to go.   

 

Nothing, though,  speaks to the differences between the visions of these two men  more than the two bills, themselves. It starts in the preambles of both. The preamble of Clinton’s Health Security Act promises to protect the health security of every American and provide them the highest quality care while at the same time controls the growth of health care spending. The preamble of ObamaCare, in the guise of HR 3200, says only “to provide affordable quality care for all Americans and reduce the growth in health care spending and for other purposes.” 

 

 

We know that Clinton’s vision of high quality care is the safest, most cost effective care possible available to all Americans regardless of the conditions from which they suffer.  On the other hand, what is affordable quality care? The crafters of HR 3200 could have used words like high quality care or most cost effective care but, instead, chose to use affordable quality care. Clearly, they do not mean the same things because, if they do, there would be no need to be so ambiguous. The only conclusion that could be reached is that Obama and the crafters of this bill or any other bill with which they may later be associated, do not hold quality in the same regard as does Bill Clinton. The answer, though, is found in the contents of  HR 3200. Affordable quality care is whatever  the Comparative Effectiveness Research Commission created by this bill says it is, and is whatever physicians,  who are now agents of Accountable Care Organizations also created by this bill,  are told it is, and is whatever the criteria for quality adjusted life years for those with cancer, AIDS, Alzheimer’s, heart disease and other chronic diseases determines it is.  It is no more and no less. If safety and cost effectiveness are factors, it is only by accident. Cheap and mediocre, though, are by design. Universality remains to be seen and will be determined by how members of Congress behave whenever they or their family members need medical care.

 

But, there are those, like Ezekiel Emanuel, a medical ethicist and chief health care advisor to President Obama, who would tell us  we are wrong,  This is not contained in the bill at all.  With the conviction  of a holy warrior, they will correct our misinterpretations.  After all, these steps are not rationing;  what is happening now is rationing.  Rather, these steps are rational - absolutely necessary when medical resources are scarce. We have to be utilitarian in our approach to health care reform because ultimately the end does justify the means - sacrifice few to save many. Doctors take the Hippocratic Oath too seriously and, by so doing, they spread precious resources too thin. You know what?  He’s right – in a  post apocalyptic world - but we are not facing an apocalypse and a health care system worth $2.3 trillion has plenty of reserves. We do not have to sacrifice people to save money and this is precisely what ObamaCare will accomplish. This is affordable quality care.

 

Clinton’s Health Security Act had its share of problems. However, after he first unveiled it that evening on September 22, 1993, it was enthusiastically received by 80% of all Americans. We trusted that while his reforms will make sweeping changes in the insurance industry through managed competition, no one will interfere in medical decisions. While this might have been an illusion, there was no threat of it in the language of the bill itself. The bill also offered malpractice reform in terms of what it called enterprise liability. It took 11 months of scrutiny and debate before it lost the  support of the American people.  When its approval was down to 47%, Senator George Mitchell announced that this bill is “dead on arrival” but it took 11 months.

 

In the beginning of July when  HR 3200 was unveiled by the House Education and Labor,  Energy and Commerce  and Ways and Means Committees, it was  with  little fanfare even from network TV, CNN and MSNBC, who were on board by reflex. But, as soon as Obama said he wanted this bill on his desk before the August recess, others took notice and support began to plummet. More and more Americans downloaded HR 3200 from the internet, read it for themselves, contacted their representatives, went to town hall meetings and, instead of getting answers to their concerns, there were attempts to convince them to believe that what they read with their own eyes didn’t really exist. The more vocal opponents became, the quicker  Pelosi, Reed, Frank and others were to show utter contempt. While their behavior was becoming more and more Orwellian, the White House established an email address for real Americans to report dissenters who made  fishy claims about health reform.  

 

In America,  voices of opposition cannot be silenced and, in less than 8 weeks since ObamaCare’s unveiling,  support was 47%, this despite very favorable media attention if not overt endorsements of it and shrill condemnations of anyone with the audacity to question what HR 3200 contained.  Still, Obama and others remained undeterred and anyone who took the initiative to read the bill themselves were told,  "Who are you going to trust, us or your lying eyes?  We know what is best for America."  Nevertheless, they also  knew that they needed us because even they didn't have the courage to force this thing down our throats.  So,  to ingratiate our support they intend to  attach Senator Kennedy’s name to their agenda.   

 

Damaged goods are still damaged goods no matter what is done to sell it.  The only difference this tactiic would make would be to damage Kennedy’s legacy.  Let ObamaCare stay ObamaCare. Despite tough economic times, we are still a prosperous nation not a third world country like the ones for which Obama has such admiration. We must bring them up to our medical standards not us down to theirs. Despite the  economic challenge of entitlements, things are not so severe that we  need the ethics of Dr. Ezekiel Emmanuel and God forbid if doctors stop taking their Hippocratic Oaths seriously enough.   ObamaCare will ultimately be scrapped and, when Congress comes to their senses if they want to be re-elected, they  will craft enduring health reform which will be the envy of the world rather than just another copy of  a national health care system. This is what Senator Kennedy would want.