Our View: ‘Speak Truth to Power’

The buzz about “ObamaCare” continues, as the public grumbles and the administration mumbles.
The President, addressing the AFL-CIO in 2003, has made clear his goal: “I [am] a proponent of a single payer universal health care program … and that’s what I’d like to see. But as all of you know, we may not get there immediately.” That’s really what the fuss is about, and how it’s resolved will have tremendous impact on Sonoma Valley and our hospital.
Here are timely comments from Mike Nugent, past chair of Sonoma Valley Hospital’s board of directors. He has served our community faithfully for many years and, in our view, speaks with earned wisdom.
I know angry crowds.
But after 16 years as an elected official I also know a lot about healthcare economics, government policy and understand the importance of getting your facts right. The President has his wrong.
I sat stoically through endless public hearings as good people vented real anger directed at me and at my fellow board members. We stirred up a hornet’s nest trying to build a new hospital.
The Quakers in an important 18th-century pacifist manifesto encouraged people to “speak truth to power.” The American people do. We are the final reservoir of power in this country, and our values and expectations set the limits for those who exercise authority.
This is after all a nation that grew out of distaste for a king and his parliament. We are the ornery successors to a real and bloody revolution. It is the way our system is wired. In America, if a politician is not available, we enjoy our national pastime and boo the umpires.
Rude is not a crime. And harboring an incorrect opinion is not, either. An angry outburst is not the preferred form of dialogue, but it comes from the heart and while sometimes illogical, it is sincere. You can learn from it if you listen.
In our society anger is like a thermometer. It points to an underlying problem. The mood of the country right now does not need to be measured by pollsters. People are more frightened than angry. Seniors love their Medicare. They want it preserved. And they know that health insurance needs reforming. But they suspect that the politicians do not have it right in Washington.
I think the angry elderly at the town meetings have it right: the politicians do have it wrong.
President Obama made this clear last week at a speech in New Hampshire. Take it from a Medicare wonk. He does not understand the way doctors are paid. And because of this, he cannot have a workable plan to cut waste out of the system.
This is what Obama said in relationship to saving money by rewarding care that prevents disease: “Let’s take the example of something like diabetes, one of … a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family … if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, and $50,000 – immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.)”
This sounds very plausible. But it is not true. It varies around the country, but here is what Medicare actually pays the surgeon in Sonoma who amputates a diabetic foot: $637. It is not negotiable. It is not $30,000 or more, as the President suggested. It is $637. It is a fact. It is in the Medicare regulations. It is law.
How could Obama be so wrong? Could he have been referring to what the hospital gets paid for its services? But that is only $12,565. His entire reform premise rests on an assumption of shrinking waste. But to do that, you have to identify waste and understand the system. He obviously does not.
The thought is good. The intention is great. But the math has to work. Rhetorical excellence alone will not do it.
And, giving the President the benefit of the doubt, had he had his facts straight, I doubt that he would have said it. Unfortunately, confidence, once lost, kills any hope of insurance reform.
Those Democrats, Republicans and Independents who are frightened, loud and rude have it right. They should be afraid. We need to listen to them, for something is very wrong.