July 27, 2010
Magical Thinkers in Washington
Predictions of cost savings through ObamaCare, like most liberal politics, were based on magical thinking. If they want something to be true with sufficiently intensity, liberals know it must be true.
Small children are natural magical thinkers. Ask any psychologist, pediatrician, or parent. Magical thinkers believe that because they want it or can conceive of it, "it" is so, or will be so. The magically thinking child ties a cape on his back and knows that with it on, he can fly. When he jumps off the roof, he will, of course, fall, not soar like Superman. The usual cure for magical thinking is ToT (tincture of time) and evidence.
People in Congress and in the White House, though not physically small, behave like children: They depend on magical thinking. Because they say it, "it" will be. The latest example is the passage of ObamaCare (HR 3950).
If House Speaker Pelosi says that HR 3590 will save money, it must save money. If President Obama says his health care "reform" will increase care, reduce errors, and improve quality, it will happen (because he said so).
A realistic thinker recognizes that spending a trillion dollars in order to "save money" is like putting on your superhero cape.
The reason most adults do not don capes and jump off roofs is evidence. They may have tried it as a child and have the painful evidence in memory of a broken leg. They may have read in the newspaper or seen on TV the evidence of what happened to a child who tried it. They may simply consider the centuries-old evidence about gravity and deceleration trauma.
Is there any good evidence about health care, evidence that Washington has ignored living in its magical fantasy world? Absolutely!
HR 3590 will "save money"! Practically every entitlement program Congress ever enacted has a) cost more than projected and b) spent money we did not have or do not have. No entitlement program has ever saved money. There is overwhelming evidence to prove this. For instance, there is the GAO report issued 25 years after passage of Medicare showing that it cost 854% of what was projected.
One of my personal favorites is the president's assurance that "HR 3590 will provide care for 30 million uninsured Americans." This is magical thinking in three parts.
Part I: In January 2010, the official estimate of uninsured Americans was 45 million. Between 12 and 15 million were, inconveniently, illegal residents. So...they just magically...disappeared from White House radar. Magical thinking turned 45 million into 30 million.
Part II: "HR 3590 will provide care[.]" Congress may authorize or even fund health insurance, but only people called providers can give care. Will they do this as a result of HR 3590? What does the evidence reveal?
Consider Medicare. Even before HR 3590, doctors were refusing to accept Medicare patients because the payments were lower than the doctors could afford. HR 3590 reduces already insufficient Medicare reimbursements by an additional 21%, so now it is certain that doctors will not accept Medicare patients. Despite the president's magical thinking, if the doctor won't see you (because she cannot afford to), all the Medicare insurance in the world will not get you care.
Part III: It is magical thinking of the highest order to think that legislating insurance coverage and reducing providers' reimbursements to below cost-of-doing-business will encourage doctors and nurses to stay in, or even enter, the field of health care. Evidence shows a 20% fall-off in applications to U.S. medical schools. Forty percent of physicians in their prime are considering early retirement. Over 500,000 nursing positions in the USA are presently unfilled. So even if you have insurance, and even if it paid well, you cannot get care if there are no nurses or doctors. Having insurance does not equal receiving care, and magical thinking will never make it so.
"HR 3590 will reduce errors and improve quality." This is more magical thinking -- or worse, a WMDc (weapon of mass deception). To do either -- reduce errors or improve quality -- providers must learn. That means taking risks and having ready access to lots of data, including bad outcomes. Evidence shows that the tort system, the security tightening in HR 3590, and FDA draconian regulations are killing health care's ability to try new things, to learn and to do better tomorrow than what is possible today.
Want more evidence? (Probably not.) Try the State of Massachusetts, which already has its own form of Obamacare (what HR 3590 will do to the rest of us). Costs have continued to escalate, forcing Governor Deval Patrick to reduce other social services -- public schools, police, roads, etc. -- to pay for mandated health care. With government mandates, new taxes (penalties by any other name), and rising private insurance premiums, business, especially small -- the engine of recovery, growth, and competitiveness -- is being crushed.
HR 3590 must have been magical thinking by the Democrats and the White House. How else can they call themselves representatives of the American people while passing a bill that more than 50% of the population opposed, and without a single Republican vote in either House? The only explanation, other than magical thinking, would be hubris raised to Olympic levels, and we can't have that!
Magical thinking by children can harm them. Magical thinking by Washington can kill us. Those with power in Washington are not children, but they think like children -- magically -- and ignore mountains of evidence.
We tolerate magical thinking by children; that is part of childhood. Why do we tolerate such behavior in our "representatives" in Washington and the White House?
Deane Waldman, M.D., MBA is the author of "Uproot U.S. Healthcare," a professor at the University of New Mexico (Medical and Management Schools), and an adjunct scholar for the Rio Grande Foundation.