On the eve of Barack Obama's nationally televised health care news conference, reporter David Leonhardt's "Economic Scene" column on Wednesday's front page laid out a path for the president topersuade Americans who are showing increasing skepticism about his health "reform" push.
Leonhardt's neo-liberal instincts (during the campaign he claimed Obama looked like a fiscal conservative ) come through in "Real Challenge To Health Bill: Selling Reform - Pointing Out Disguised Costs in Medicine ."
What's in it for me?
Current bills would expand the number of insured - but 90 percent of voters already have insurance. Congressional leaders say the bills would cut costs. But experts are dubious. Instead, they point out that covering the uninsured wouldcost billions.
So the typical person watching from afar is left to wonder: What will this project mean for me, besides possibly higher taxes?
Barack Obamawas able to rise from the Illinois State Senate to the presidency in large measure because of his ability to explain complex issues and then to make a persuasive argument. He now has a challenge worthy of his skills.
Leonhardt is right that today's health care system is grievously flawed, bureaucratic, and wasteful. He also lamented that America spends "about $6,500 more than in other rich countries, on average."
But is spending a lot of money on health care an automatic negative? An aging country is going to demand more and more of it and is willing to pay for it, and Leonhardt himself admitted that for all that money Americans "get cutting-edge research and heroic surgeries."
Leonhardt also signed on to Obama-style health-care rationing.
One thing we don't get is better health than other rich countries, whether it's Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. "The fact that we spend all this money and don't have better outcomes than other countries is a sign of how poorly we're doing," says Dr. Alan Garber ofStanford University. "We should be doingwaybetter."
Leonhardt's sources echoed Obama's focus on parceling out care:
One proposal would pay doctors based on the quality of care, rather than quantity, but it's a pilot project. Doctors who already provide good care may well opt in; doctors providing wasteful but lucrative care surely will not. The bills would also finance research on which treatments are effective. ButMedicareofficials would not be prevented from continuing to spend taxpayer money on ineffective treatments.
On Thursday, Mr. Obama will visit another example he likes to cite, the Cleveland Clinic. Its successes capture what real reform would look like. Like Mayo, the Cleveland Clinic pays its doctors a salary, rather than piecemeal, and delivers excellent results for relatively little money.
"I came here 30-some years ago,"Delos Cosgrove , a heart surgeon who is the clinic's chief executive, told me. "And I have never received any additional pay for anything I did. It never made a difference if I did five heart operations or four - I got paid the same amount of money. So I had no incentive to do any extra tests or anything."
I had to read Cosgrove's account twice to be sure he was actually being complimentary, not critical, of health-care rationing, which is a sign of how fraught the issue is. Yet Leonhardt doesn't question the Obama-influenced wisdom of doctors having "no incentive to do any extra tests."
Of course, no one, right or left, wants to pay for "ineffective" treatments - but no one knows if a treatment is ineffective until it's tried. And under Obama-care, who would decide in advance what's an effective (and thus allowable) treatment and what's not? A government bureaucracy. Leonhardt shares Obama's laser-like focus on cost containment at the possible expense of quality treatment.