By Daniel R. Hoffman, Ph.D.
Last week a reader, "Hjeff," replied to my posting in a rather exasperated tone, claiming he wanted a serious discussion about the big issues of health care. Since writers for publication are typically flattered when their musings inspire readers to serious thinking, I thought I would give Hjeff's comments the attention of an entire posting.
Starting off, he expresses displeasure about my tendency to describe the health care policies of Mitt Romney and other Republicans as "rightwing bull" and "disingenuous fantasy." Apparently he prefers calmly reasoned discourse, the invective-free sort that is guided by hard facts and sound logic.
If that wish could go from Hjeff's keyboard to American reality, the public forum would certainly be more enlightened. But we must honestly ask, who has debased the level of conversation? On health care and across the range of public policy issues, Republicans have perpetrated wholesale lies and scare tactics that are pathological even for politics, a realm of life that remains notorious for distorting the truth. They have polluted the air with slogans such as death panels, made fraudulent claims about the Affordable Care Act stealing $761 billion from Medicare, and lied about a voucher system not destroying existing safety net programs. They have done this in a cynical effort at appealing to their Republican base of half-wits, lunatics, bigots, economic exploiters and blind-faith, market advocates.
Coming from the business world, for whom they act as servants and whores, Republican politicians confuse marketing with democracy. As good marketers they know that more than two-thirds of rank-and-file Republicans believe in demonic possession while less than half of them believe climate change is real.
A practical person cannot expect to engage in reasoned dialogue with morons and malevolent psychopaths. For that reason, the statements of Republicans and rightwing ideologues should be treated with the scorn they deserve. The wisest approach toward those propagating such rubbish should consist of exposure, ridicule and contempt.
Unfortunately, those who know better often fail to do what is required. For more than thirty years, progressives have instead responded to rabble-rousing, Republican distortion with dispassionate, public policy statements. The result is that a substantial portion of the public believes the Affordable Care Act, which delivers millions of new customers to private health insurers, constitutes socialized medicine. If reasoned dialogue could sway the body politic, the quality of America's health care system wouldn't lag behind those of so many industrialized nations.
An example of the sort of well-informed, biting and blame-laying public dialogue I suggest can be found in a recent book, "Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients," by Ben Goldacre, a British physician and researcher. In well documented fashion, Goldacre demonstrates how pharma companies typically suppress the findings of their own studies and allow public access to only half of their clinical trials. Even there the pharmas publish only those results most favorable to their products. In many cases their trials enroll unrepresentative patients while the companies use questionable statistical techniques to develop their results. Their clinical hocus pocus, according to Goldacre, then provides grist for a marketing mill that sometimes manufactures "diseases" to justify more product use.
As if stacking the data weren't enough, Goldacre recounts how pharmas frequently bribe, seduce and mislead those ostensible guardians of individual patients, the doctors, with sham Continuing Medical Education classes.
But I doubt that Dr. Goldacre's cool analysis is what Hjeff has in mind. So what, pray tell, are some of the big issues that he wants to discuss in Governor Romney's "quiet rooms?" For openers he states that none of the major political camps has systematically addressed policy issues related to end-of-life decisions. Fair enough, but who degraded that discussion with the bumper sticker about death panels and succeeded in turning any serious discussion into a forbidden subject? The Obama administration at least tried to approach the issue, albeit in gingerly fashion. An early version of the Affordable Care Act would have paid physicians who counseled their patients about end-of life matters in an effort to inform the decisions people make about their final days. The Act did eventually create an Independent Payment Advisory Board in an effort to address the fact that 85% of the medical cost a person consumes in her lifetime occurs during her final eighteen months. Immediately Sarah Palin and other, truth-twisting Republicans called it a "rationing board" and "the real death panel." They did this despite knowing full well that the law specifically prohibits the Board from even recommending anything that would either ration care, alter Medicare premiums or restrict benefits.
Hjeff believes malpractice reform is yet another "serious" issue, one that he considers near and dear to his heart as a physician. Such tort reform, according to Republican phantasmagoria, could significantly reduce medical costs. Yet the Congressional Budget Office has shown that malpractice reform would have saved only one half of 1 percent of the nation’s overall health care bill in 2009. Meanwhile the costs of extra tests and treatments result more from the profit motives of physicians working in a fee-for-service environment.
And finally Hjeff expresses displeasure with the Affordable Care Act because it creates an additional 30 million medical consumers without commensurately increasing the number of physicians. Fair enough, but his observation then begs the question of why Republicans reflexively deny federal funding that would greatly increase the size of medical school classes.
One approach to rectifying the inadequate number of physicians consists of increasing the supply of nurse practitioners and employing them as primary care givers. Would Dr. Hjeff's desire to maintain restrictions on the labor supply in medicine permit him to accept this breach to his cartel?
Let me conclude by reaffirming my preference for a more highly spirited public discourse. Toward that end, a important objective for fair-minded people consists of holding Barack Obama's feet to the fire, now that he has won a second term. The alternative lies in letting his backbending inclination and the business-sucking recommendations of his advisors give away important parts of America's remaining safety net. Tuesday's election results should only sharpen our tongues.