Every family has a favorite joke or two. One of ours went this way – unsurprisingly, given my dad’s interests and pedigree, it is Borscht Belt meets US Army. Here goes:
An army drill sergeant receives word that both parents of one of his enlisted men have died tragically in an accident. Although the sergeant is tough as nails, he struggles with how to break the news to the fragile Private Schwartz. Finally, just before the morning mail call, he seizes on an idea.
At mail call, his troops assembled, the sergeant bellows, “OK, everybody with parents, take one step forward.”
“Not so fast, Schwartz.”
Every year, I give a keynote address to close the Society of Hospital Medicine’s annual meeting. Larry Wellikson, SHM’s president, flatters me by saying that my talk helps keep people from leaving early. I believe that my placement helps ensure that I annoy the fewest possible attendees. Whatever.
This year, I decided to entitle my address for the upcoming meeting, “How Health Care Reform Changes the Hospitalist Field…And Vice Versa.”
Not so fast.
I won’t add to the Massachusetts post-mortems filling our collective in-boxes (I particularly like the stuff on The Healthcare Blog, such as this and this). I’ll focus instead on what the Fenway Flabbergaster means for the healthcare bill, and in turn for America.
My guess is that reform is dead for this year – it is hard to believe that the Dems can get 60 votes for anything more complex than a referendum on whether the sky is blue (and even that would get politicized). Adding to the headaches, they’re teetering on a classic legislative tightrope – if they veer any more right in a (probably futile) effort to pick off a stray Republican, they’re sure to lose somebody on the left.
Moreover, the lesson the Republicans must be taking from the experience of the last year is that hard-line, unblinking nay saying is a political winner. After the Boston Massacre, why would they even think about altering their playbook?
Of course, the bill’s failure (I’ll use the singular “bill” here, recognizing that the Senate and House versions needed to be reconciled) to truly address the cost/quality conundrum (notwithstanding Atul Gawande’s surprisingly positive spin in last month’s New Yorker), its sidestepping of the malpractice mess, its too-wimpy efforts to bolster primary care, and the Nebraska Purchase (of Senator Nelson’s vote) were particularly disappointing and unsavory.
That said, the bill did address some of the most heinous aspects of our present insurance system, and did so without colliding with America’s antipathy for Big Government or busting the budget. Flawed, sure, but the bill deserved to pass, and then to be improved over time.
Life will go on. The problems in healthcare will worsen and ultimately need to be addressed, somehow. What scares me about this is what it says about our political process. If things do stall out, I believe that the bill will have been brought down by two major forces: the growing distrust of experts and elites, and a series of lies that gained purchase because they are fundamentally more interesting than the truth. These are two powerful, and dangerous, trends.
David Brooks recently observed that the defining characteristic of today’s political age is the mistrust of elites – a populist surge that elevates morons like Sarah Palin and Glenn Beck while tarring the Obamites as being out of touch with the concerns of real people. Noting that the Tea Party now polls better than either Democrats or Republicans, he writes:
The tea party movement is a large, fractious confederation of Americans who are defined by what they are against. They are against the concentrated power of the educated class. They believe big government, big business, big media and the affluent professionals are merging to form self-serving oligarchy — with bloated government, unsustainable deficits, high taxes and intrusive regulation…
The Obama administration is premised on the conviction that pragmatic federal leaders with professional expertise should have the power to implement programs to solve the country’s problems. Many Americans do not have faith in that sort of centralized expertise or in the political class generally.
Of course, those of us who live in San Francisco recognize that we live in a bubble, the rest of the country far redder in both face and politics than we are, but now it turns out that Massachusetts – a place we thought was ensconced in The Bubble with us – more closely resembles the rest of America. I don’t get it. Seething about Wall Street bonuses and arrogance – fine, I understand (and agree). But getting angry about a healthcare bill that is generally moderate, sensible, and incremental. Huh?
Which brings me to the second issue. The only way to get truly pissed about this bill – if, in fact, that is what the Massachusetts vote was really about (and you can’t convince me that it was simply about a weak candidate; hell, in normal times, Paris Hilton could have held Ted Kennedy’s seat) – is to accept the lies and spin of the right: Death Panels, Obama the Socialist, Government Take-Over. Whether you like the bill or hate it, these labels don’t just torture the truth, they waterboard it. Yet, for a sizeable portion of the public, they stuck. Why? Because, let’s face it, they have more sizzle than the truth. They attract eyeballs, and hits, and Tweets. In a nation with an insatiable thirst for News-ertainment, a battle between Rush Limbaugh and Washington Week in Review is not a fair food fight.
The hope for the Dems is that the Massachusetts vote is Obama’s ‘94 – a wake up call like the one that shook, and ultimately energized, Clinton when Gingrich’s army took the Congress by storm. It’s clear that Cool, Balanced, and Professorial is no match for Shameless, Nasty, and Self-Certain. The Prez is going to need to take it up a notch.
Ultimately, Massachusetts was a victory for “none of the above” – for “I’m Mad As Hell and I’m Not Going to Take This Anymore!” Thoughtful folks, on both sides of the aisle, realize that, while cathartic, this answer doesn’t help us tackle our nation’s growing list of really sticky problems. But I guess we’ll just have to deal with those tomorrow.
Speaking of problems: What the hell am I going to talk about at the SHM meeting? Anybody with a topic for his keynote speech, take a big step forward.