PROFILES IN POLITICAL COWARDICE: OBAMA, PALIN and HEALTH CARE. It’s a bad sign that the media continues to take Sarah Palin seriously. Perhaps she still has a following; perhaps she’s not through with politics yet. Not a good thought.

Ms. Palin recently kicked the already overheated health care debate up a notch with her comment about “death boards” and how Obama’s reform scheme might result in the denial of care to her son with Downs Syndrome. The President responded to Palin at his recent town hall appearance in New Hampshire, when he denied that his plan would involve any form of triage or rationing and asked that we “disagree over things that are real, not these wild misrepresentations” (i.e., the death boards). Palin seems to have struck a nerve with Obama. Another not-so-good sign.

Unfortunately, what Palin says is not entirely devoid of merit (although the way that she says it definately is). I believe our President when he says that there is no mechanism in his health care plan to decide who gets what level of care. On the face of it, that statement is true. HOWEVER, Obama’s plan will involve the federal government in the health care and insurance industries to such a degree that it will not be able to avoid making decisions that have a life-and-death impact on individuals.

Obama is trying to craft a plan that can run between the Scylla and Charybdis of achieving universal coverage while not wrecking the economy with unsustainable costs and taxes. A lot of analysts think that this cannot be done without, at some point, denying someone’s request for additional health care. There may never be a “death board”, but there could well be a set of boring, impersonal “priority formulas” embedded deep within the gray pages of the Federal Register (the publication announcing all new federal regulations), which will do about the same thing. Under Section 123 of the House reform bill, a Health Benefits Advisory Committee would be established; that sounds like the kind of agency that could quietly slip such a mechanism into our medical S.O.P.

When I first heard Ms. Palin’s statement about the hypothetical “death board”, I wanted to ask her what she thinks about the current mechanism for rationing life-sustaining health care. There certainly is such a mechanism in America, and it is based on an individual’s financial and career capital. I.e., if you have enough money, or if you have sufficient training and experience (and luck) to hold a job that provides decent health insurance, then you will receive such care. If you are unlucky enough to be poor and hold a job that doesn’t provide such coverage, then you will get “last resort” care in an emergency-room, e.g. when you or your kids are bleeding or unconscious. Too many people can’t get routine treatment for things like diabetes or high blood pressure or chronic pain, and thus live shortened and less productive lives. They don’t face a death board, but they die early nonetheless.

Under Obama’s plan, the working poor will probably do a whole lot better than they are doing now with regard to health care. However, the middle class will likely experience some reduction in health care quality in certain instances, as a result of federal health care regulation. That reduction will probably only effect a small percentage of people in limited circumstances (and may hardly be any worse than what insurance companies are now doing when limiting or denying coverage). But there no doubt will be cases where someone will be denied a procedure under federal guidelines that would have been available under the old scheme, and it will no doubt be publicized and blown out of proportion by opportunistic politicos like Sarah Palin.

Unfortunately, President Obama is not being honest with us. His proposals actually do require that the middle class take some risks (i.e. care limitation in certain instances) and possibly make some sacrifices (higher taxes), such that working-poor families can be better off. (Obviously, the rich will be just fine no matter what happens, even if they do get pinched a little more on their taxes). But he is relying on his golden tongue to avoid the word “sacrifice”. I myself believe that the required sacrifices would be fairly small, and that life would go on for people like myself pretty much as it does now.

The benefits to waitresses, store clerks, nursing home attendants and other service workers who presently go without ready access to health care would, by contrast, be very significant. These benefits would eventually feedback into the national economy, e.g. less sick time, less emergency room treatment, more worker productivity, etc. And despite some potential instances where cost controls might limit the degree of care that I would receive relative to what a rich guy with a “gold-plate” insurance policy will get, there may well be more instances where the Obama plan would insure that I would receive care (i.e. more protection against loss of coverage from job lay-offs or because of insurance company claim denials).

Unfortunately, “sacrifice” is no longer part of our political lexicon. If a politician in America today were to repeat Winston Churchill’s “blood, sweat, toil and tears” speech, they would risk impeachment. I believe that President Obama has to take that risk; and so far he has not done that. He wants progressive health care reform, but he seems to believe that his oratory skills (which were powerful enough to get him elected, admittedly) can build consensus. Personally, I’m tired of hearing his pseudo-twangy refrain “if you like your present health insurance, you can keep it”. Lately it reminds me of a broken record.

I am looking for something more from Mr. Obama. If he is going to ask me to take a risk, I want to him to take a risk too. I want him to be honest. I want him to say yes, this scheme might involve cost controls that in a small number of instances could affect your level of care; but on the whole, you and people less fortunate will generally have more assurance of getting adequate care while avoiding personal bankruptcy, and the nation overall will be better off. And the rich too will be asked to do their part, with higher taxes. I want him to say, yes, there will be changes; we cannot avoid making some changes and taking some risks if we are going to eventually come up with something that is better for the nation.

I want the President to call health care reform what it is: an EXPERIMENT. It seems terrible that you and your family would be put into a test tube, and the GOP would make much hay with this notion; but it’s even worse to pretend that the re-forming of something so complex and morally vexing is a sure bet. An experiment is something that you closely watch, and if harm results you immediately change things to ameliorate it. If Obama wants me to wander into uncharted territory with my physical health, I first want him wander into uncharted territory regarding his own political health.

Thus far, Obama seems to be playing it safe. If that continues to be the case, then why shouldn’t the average person also play it safe and take Sarah Palin’s warning about death panels seriously. Unless Barack Obama finds some real political courage real soon, I doubt if our nation will see any real health care reform anytime soon.

P.S.: More signs of worry today amidst the Obama faithful! Maureen Dowd assessed the state of President’s health reform campaign in her NY Times column, and observed that

The young grass-roots army that swept Obama into office has yet to mobilize now that the fight is about something complicated rather than a charismatic hope-monger. No, they can’t? President Obam
a has proven quicksilver instincts, but not in this case . . . he may be running out of time.