Operation: Health care

Feb 28, 2010 — The Boston Globe

Bryan L. Tucker

Feb. 28, 2010 (The Boston Globe delivered by Newstex) --

Just as in 1993, it's a fight to the political death

DURING THE health care summit of Republicans and Democrats called by President Obama, I heard Virginia Representative Eric Cantor claim that his party's steadfast opposition to the Democrats is a principled one.

Perhaps Cantor forgets what his colleague, South Carolina Senator Jim DeMint, said last July regarding health care reform: ``If we're able to stop Obama'' on it, ``it will be his Waterloo. It will break him.''

In 1993, conservative activist Bill Kristol argued that if Republicans did anything to help President Clinton succeed in reforming health care, it would ``revive the reputation of . . . the Democrats as the generous protector of middle-class interests,'' thereby threatening to relegate Republicans to minority status for a generation.

In the immortal words of Yogi Berra, what's happening today is deja vu all over again.

Whatever one thinks of the Democrats' efforts (to me, reform worthy of the name would mean a Medicare for all or a single-payer plan), the transparent bad faith with which Republicans approach this issue ought to be roundly condemned. Instead, the public seems poised to punish Democrats and inexplicably reward Republicans for their self-serving obstructionism.

Such is the state of democracy in an age of sound bites masquerading as news.

Jamaica Plain





Preparing to shove bill down country's throat



RE ``HEALTH care summit underscores divisions'' (Page A1, Feb. 26): When the Republicans were in power, it was called the ``nuclear option.'' Now it's called ``reconciliation,'' or ``majority vote'' as in the following subhead of Friday's front-page story: ``Democrats lay path to pass bill in majority vote.''

You quote Nancy Pelosi as saying, ``We need to have the courage to get this job done.'' The reason she needs courage is that the bill is so unpopular with voters. A better subhead might have been, ``Democrats lay path to pass bill in defiance of majority of voters.''

Cambridge



Inaction is too costly



AS A Boston primary care physician, I flew to help at a two-day medical clinic in Kansas City. The line formed long before the doors opened. I was told to search for those who needed urgent care. Most were working Americans, though some had been laid off. None had health insurance. I had seen patients with this burden of illness, but that was 40 years ago in medical school.

I found a man with an unstable heart condition and called 911. He was taken to the emergency room with a possible heart attack. Had there been no free clinic, and his daughter not insisted he come that day, he may have died.

The cost of reform is not the question. We already incur the expense with care for the uninsured in emergency rooms. The question is how much it costs not to reform. Doing nothing cannot be an option.

Boston





If only cost were subordinate to efficacy



RE ``TO trim medical costs, apply `best practices' '' (Editorial, Feb. 22): Would the Globe be editorializing or insurers and politicians mandating that physicians choose therapies that have greater efficacy and fewer adverse events yet are more expensive? Of course not. Once the private dialogue between patient and physician has been opened to accountants, economists, and politicians, the only relevant headlines are about cost and not benefit, savings and not better clinical outcomes.

Physicians have been coerced into being the messenger for insurers whose business model is to maximize profit by minimizing spending. Insurers hide behind beleaguered physicians who are trying to achieve best practices (that is, best for patients, maybe not for insurers), when patients ask them why they are being given an antihypertensive with side effects rather than a more expensive one without them.

Want to know best practices? Ask your physician which samples he takes for his own hyperlipidemia or reflux. These therapies will be best in class, where cost is subordinate to efficacy and benefit. They are not the therapies that managed care mandates. For regretfully, in insurers' - and editorialists' - eyes, cost trumps everything else.

Medford



Good reason to fear

government's influence



PHYSICIANS TODAY have relative freedom to prescribe the best treatments to meet the unique needs of individual patients. In your Feb. 22 editorial ``To trim medical costs, apply `best practices,' '' you propose that these important decisions be limited to treatments or medications approved by a committee appointed by the US government without knowledge of the unique condition of each patient. Are we all comfortable with that? Committees with such power would undoubtedly be influenced by those with political or ideological agendas. Will we (literally) be able to live with that?

Those who keep telling Americans that health care is ``broken'' should note the recent CNN survey that indicated 86 percent of Americans think that government is broken. That is why they resist turning all medical decisions over to the government. That is one reason they resist the Senate and House bills that would force all physicians to obey the ``best practices'' decisions of the US government.

Executive director

Americans for Free Choice in Medicine

Newport Beach, Calif.



Yes, it will be rationing



YOUR SUPPORT of taxing ``Cadillac health plans'' is despicable (``As health costs keep rising, Obama is right to try again,'' Editorial, Feb. 23). Millions of small-business people (not just large unions) struggle to pay a huge premium from our own pockets for what you unwittingly label as Cadillac health plans. I have paid higher premiums so that my children could continue to see their out-of-network therapists and other providers who were critical to their health. This is not overuse of health care; it is fundamental health care that I pay for and that, with a 40 percent further tax burden, may be prohibitive. In effect, this will amount to the rationing you deny is in the current proposals.

Newton

Newstex ID: BGL-1035-42425318