“Laws are like sausages. It’s better not to see them being made.”

This quote, generally attributed to Otto von Bismarck, though perhaps incorrectly so, has never been more apparent to the American public than in the current drive towards Health Care Reform.  We have seen boorish behavior, outright untruths, demonization of opponents and political cronyism rampant throughout the summer.  And the “fat lady” is yet to take the stage.

Along these lines, a few choice observations from the week in review serve to illustrate why Doctors are so adamantly opposed to further Government intrusion into the care of people, which is after all what we (and not they) do.  This list is not about medical care.  It’s not even directly about medical legislation.  It is, however, an example of how things REALLY work, how the “stakeholders” attempt to influence legislation to their own benefit while claiming to have the highest set of ideals.  In a supporting piece we will see how “medical research” is also being used to advance agendas, often in near complete dissociation from reality.  Some may find this line of inquiry cynical, we prefer to see it as realistic.  Those divorced from reality will be captured by the special interests, often to your/our detriment.  As we have so often said; medical care is just too important for this to occur.

The Chamber of Commerce

Conflict between Obama Administration officials and the US Chamber of Commerce has been brewing all summer, coming to a head last week when antipathy erupted into overt warfare.  Energy Secretary Chu feels it is “wonderful” that some large businesses have left the Chamber in protest to its’ opposition to  “Cap and Trade” legislation.  While many are aware that the Waxman-Markey bill was voted out of the E&C Committee last May, far fewer realize that this legislation contained 390 pages of amendments, known only to the Democrat’s legislative aides, which were added at 3AM the morning of the party line vote.  These amendments contained language that supporters were determined to protect from public scrutiny and analysis.

To the surprise of few, the Chamber is opposed to the bill as written.  However, there are quite a few large companies who were/are supportive of the bill, and even some who have resigned from the Chamber in protest for its’ position.  Let’s have a closer look.

• Enron: Nearly forgotten after its’ spectacular fraud and implosion, Enron was one of the chief proponents of “Cap and Trade” as currently embodied in the Waxman-Markey bill.  Between 1994-1996 Enron contributed $1 million dollars to the Nature Conservancy, $1.5 million to other environmental groups and lobbied the Clinton administration vigorously for carbon regulation.  Enron insiders gloated that carbon trading would “do more to promote Enron’s business than almost any other regulatory initiative”.
• DuPont: In 2007 the Chemical giant allowed customers to contribute $4/ton to reduce carbon emissions from its’ Kentucky plant.  It turns out the equipment to do so is relatively cheap, and that Dupont expects to earn a 900% return on investment from this intitiative.  Friends of the Earth agree calling the effort a “greenwash”, but this pales in comparison to the Indian company who netted $600 million selling carbon credits from an equipment investment of $3 million, using the proceeds to build a refrigerant plant that produces HFC-143a, a compound 1,300 times as potent as CO2 in heat retention.
  
• Exelon Energy: A large producer of Nuclear Power, Exelon estimates a revenue boost of $1.1 Billion annually if the Waxman-Markey bill is enacted. They are one of the “wonderful” companies who dropped from the US Chamber over its’ opposition to Cap & Trade. Whether one believes CO2 or nuclear waste is a greater threat to humanity, it’s hard to see these folks as honest brokers with such a financial windfall at stake.
• Apple Computer: A quintessential silicon valley company and thought leader, Apple’s position, and resignation, from the board of the US Chamber is a stinging rebuke.  Or is it?  James Sensebrenner (WI) views it differently, seeing Apple as somewhat “disingenuous” in its’ criticism, “while manufacturing their products in countries that consistently refuse mandatory emission impacts.”  While we’re on the topic, last year China eclipsed the US as the largest emitter of Greenhouse Gasses, and they are not part of regulatory schemes.  However, companies which manufacture in China will reap a competitive advantage over companies that manufacture in the US, avoiding the increased energy costs of this legislation.  Is this corporate “altruism” or an example of a “beggar thy neighbor” mentality?   And what effect will this have on overall employment here in the US when competitors seek lower energy costs in India or China?  Whose side are these guys on?

Whether US Government officials should or should not relish the waning power of a key interest group is a matter for others to decide.  But it is important to learn this lesson:  self interested players may try to influence public policy, to push through legislation that improves their bottom line, while camouflaging their own interests behind a veil of politically correct altruism.

It is a concept to remember as health care legislation advances through the Congress.  By the way, while the Chamber announced a $100 million campaign to “promote free enterprise” the SEIU announced a $89 million campaign in opposition.  Beginning to feel like a pawn in the process?

Government sponsored Wind Farms and Chinese Profits

This article in the WSJ describes how what will be one of the largest wind farm projects in America, already the largest wind power producer in the world,  will be supplied exclusively by turbines made in China, financed by the Chinese government, and which will create 85% of jobs in China rather than the US.  China’s own trade policy dictates that “70% of all components in Chinese turbines be domestic.” We obviously have no such stipulation.  As we’ve been told, the countless billions being spent under the stimulus package are designed to “create or save” millions of US jobs.  Apparently these will not be among them.

Ethics and Earmarks

Of course the juxtaposition of “ethics” and “Congress” is inherently incongruous.  However, this article is shocking even for the most jaded among us.  The new Ethics Panel probe is investigating whether law makers ran afoul of House ethics rules by trading earmarks for campaign contributions in a quid pro quo.  Seven Congresspersons are under investigation; nearly half of the defense spending sub-panel of the House Appropriations Committee.  What I found most appalling is that while these shenanigans may have violated ethics rules, “It isn’t illegal for lawmakers to craft earmarks that direct federal dollars to entities that donate money to their campaigns.” Who knew?

Health Care Reform

By now you may be asking yourselves why I have taken you on this exercise in “Government”?  But I imagine you can also predict my response.  Things are often NOT what they seem. When DuPont is donating to the Friends of the Earth, be wary; there’s something there that just doesn’t pass the smell test.

By analogy:

• When WalMart is out in front in favor of health care reform, something is amiss.  Could it be that they employ a disproportionate number of seniors already covered by Medicare and will therefore gain competitive advantage as their “mom and pop” competitors are forced to provide coverage?
• When the AARP seems unconcerned about $500 billion in Medicare cuts, usually a move which would invoked “crisis” mobilization, one needs to look deeper.  How many millions does AARP generate annually from MediGap policies, administration of drug plans and other middle man efforts? Update: I found the answer- The AARP netted $650 million in royalties in 2008 from sale of insurance policies and credit cards bearing the “AARP approved” designation.  This amounts to over half of the organization’s total revenue.  Why is this no surprise?
• When AMA backs reform, could it be elimination of SGR rather than pure altruism that guides their position?  Now that the “Doc Fix” has failed in the Senate and been introduced into the House, perhaps we shall soon see.
• When the insurance companies agreed to eliminate “pre-existing condition” exclusions was it about doing the right thing, or about government promises to require young healthy Americans to purchase policies, at several times the current cost, to subsidize high cost “lives”?  Millions of new (coerced) customers is a pretty tempting pay-off.
• Similarly, when the Hospital Association, PhRMA and medical suppliers all agreed to monetary concessions in closed door meetings with Obama administration officials,  was it really an effort to help, or was it done with an eye on the bottom line, and awareness of the millions of new “customers” this legislation would create?

This is not to suggest that all deals are bad.  In fact, perhaps such concessions from drug companies are both reasonable and appropriate; a way to reduce the costs of an expansion in coverage, while simultaneously protecting their shareholder interests, which is after all their real fiduciary duty.  Just beware, and remember that things are more complicated than we are being led to believe.

Being a cynic is rarely the way to popularity, but it is often the honest course.  There are huge power blocs in health care, many of which seek legislative language that serves their own parochial interests.  I would suggest that it is incumbent on our leaders to be honest about these competing forces, the compromises we all will face in their desire to expand coverage.  Simultaneously I recognize that they will not.  This blog is designed with that central goal in mind.  Namely to be honest about the debate, to inform others what we see as “industry” insiders, and to hopefully put pressure, through an involved readership, on elected officials to behave in a similar fashion.

When Medicare was founded, average life expectancy for a male was 64 years of age.  This means that HALF of Americans never survived long enough to receive the benefit.  Also, due to the post-war baby boom, there were nine workers per retiree to fund the system.  Now we face a life expectancy of 80 years, a declining worker base and a wave of boomers reaching the age of “modern maturity”. Despite what we hear in the media, it is in fact the success of the medical system which threatens the current structure.

With a $39 trillion projected deficit in the Medicare program alone, substantive changes are going to occur.  Some will be unpopular, some will have winners and losers.  It is up to us, each and every one, to insist these changes are made in an honest manner, with time for consideration and above all, transparency.  Our current elected leadership is failing on these counts.  From an attempt to push legislation through before the August recess, with the public reeling from financial crises, to the current lack of transparency, where legislation is being written behind closed doors totally excluding the minority party, to a process where opponents are attacked in a manner consistent with political campaigns rather than governance, we need and deserve better.  We are in the home stretch, that fat lady will take the stage this fall and Congress is determined to push legislation through by year end.  As practicing physicians, we implore you to become as informed as possible, to hold our politicians accountable and make your feelings known.  Failing that we will all wake to discover a scheme created in dark (formerly smokey) rooms, driven by the desires of those with the power to extract concessions, and serving the connected in a boondoggle of historic proportions.