Edward Irving Koch
I continue to be a supporter of President Barack Obama. He has had several outstanding successes. The major one has been a positive change in the economy due primarily, I believe, to his hand-picked team of economic advisers who, from all indications, have fashioned an effective economic recovery plan. The recovery still has a long way to go, but using the language of my doctors at the hospital in which I recently spent six critical weeks recovering from open-heart surgery, “All the numbers are going in the right direction.” I also believe his reaching out to our allies and those not allied with us has somewhat calmed the world’s roiled waters.
Yet, strangely, the President’s support is waning. A recent CNN poll gave him a C-minus after 200 days in office, whereas at the end of his first one hundred days, he got almost universally a B-plus.
I think most people would say that the President’s standing with the American public has suffered as a result of his handling of health care policy. During the election, Barack Obama promised to speedily deliver universal health care. However, to date President Obama has presented no health care bill to the Congress and that legislative body has come up with a number of proposals for which he is being held responsible. Furthermore, the President has seemingly caved on important aspects of his health care agenda such as not restricting private insurance coverage and obtaining volume discounts from drug companies.
In order to keep costs from rising, most people acknowledge the need for some kind of limitations on spending. Rationing of public monies makes sense, e.g., should public monies be used to give a kidney or heart transplant to a 90-year-old patient, when it is necessary to reduce the costs of Medicaid and Medicare to keep them solvent? Both programs are totally government funded and operated. I would say no. Then the question becomes what about private funds being used by an individual willing to buy gold-plated insurance to provide unlimited medical expenditures for their health and survival? Should the government be able to limit such expenditures? My answer would be no.
I speak from personal experience. I have been told that the cost of my hospital care, including the services of 20 doctors and 72 nurses and medical technicians over a six-week period may ultimately cost a million dollars. My private insurance policy is paid for by my law firm, Bryan Cave LLP, and because I still work full-time, that insurance policy is my primary one, not Medicare, even though I am 84 years old. Will that continue to be the case under any law signed by President Obama or will I be denied the right to spend my own money and my law firm’s for such unlimited coverage?
The President, I believe, has said that there will be no restrictions on private insurance coverage, other than to expand that coverage for all by, for example, denying the insurance companies the right to reject persons with prior existing medical conditions. But he has not spoken loudly enough, nor has there been any discussion on the premiums that companies will be able to charge in such cases.
Most alarming for people like me, who at 84 years of age recently needed a quadruple bypass and aortic valve replacement, are the pronouncements of President Obama’s appointee, Dr. Ezekiel Emanuel, brother of Obama’s Chief of Staff Rahm Emanuel, who, according to a New York Post op ed article by Betsy McCauley, former Lt. Governor of the State of New York, stated, “Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, ‘as an imperative to do everything for the patient regardless of the cost or effects on others’ (Journal of the American Medical Association, June 18, 2008).” He also stated, “…communitarianism’ should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those ‘who are irreversibly prevented from being or becoming participating citizens…An obvious example is not guaranteeing health services to patients with dementia.’ (Hastings Center Report, Nov.-Dec. ’96). “
Opponents of Obama’s health care proposals raise the specter of a panel making decisions on who should receive health care. I am not aware of any proposed panel. However, an article in today’s New York Times, referring to a Senate bill, stated, “The legislation could have significant implications for individuals who have bought coverage on their own. Their policies might be exempted from the new standards, but the coverage might not be viable for long because insurers could not add benefits or enroll additional people in non compliant policies.”
So, where lies the truth? I don’t know. But I do know that I want the continued right to purchase and have available insurance that will permit me, no matter my age and physical condition, to purchase with my own money all the medical care I can afford.
Perhaps the most egregious mistake the President has made regarding health care was the statement by a White House spokesman on the subject of using volume discount pressures on the drug companies in order to save money on Medicare prescription drug purchases which now cost over $800 billion a year. The spokesman for the drug industry, former Congressman Bill Tauzin, recently announced that the drug industry had entered into an agreement with the White House in exchange for its support of universal medical coverage. Under the agreement, the drug companies would contribute $80 billion over a 10-year period to defray the cost of universal medical coverage, while the White House has agreed not to require the drug industry to make any further financial contributions, meaning no change in the law barring the use of Medicare volume discounts and probably continuing the prohibition against importing American-made prescription drugs from Canada which are sold there at up to 50 percent less.
On August 6th, The New York Times reported, “Pressed by industry lobbyists, White House officials on Wednesday assured drug makers that the administration stood by a behind-the-scenes effort to extract cost savings from them beyond an agreed-upon $80 billion,” over a 10-year period which confirms the Tauzin statement.
Following that statement, Speaker Nancy Pelosi and a number of Congressmen, including Henry Waxman of California, said they would not be bound by the White House agreement. According to The Times, Waxman “vowed to fight the White House, asserting that it was conceding too much to the powerful drug industry lobby PhRma.”
Incidentally, why wouldn’t the drug industry support universal medical care under any and all circumstances? With such legislation will automatically come more people covered by insurance that will provide prescription drug coverage to more people, creating an enormous new market for them. Volume discounts at only ten percent with existing expenditures by the government will bring in more than $80 billion a year, as opposed to the drug companies’ offer of $80 billion over 10 years, or $8 billion a year.
President Obama might not be persuaded to rethink some of his positions on health care because of the protests of moderates like me who support him, but he surely has to be alarmed by the comments of his most ardent supporters like New York Times columnist Frank Rich who, discussing the pending health care legislation warns, “It’s in this context that Obama can’t afford a defeat on health care. A bill will pass in a Democrat-controlled Congress. What matters is what’s in it. The final result will be a CAT scan of those powerful Washington interests he campaigned against, revealing which have been removed from the body politic (or at least reduced) and which continue to metastasize. The Wall Street regulatory reform package Obama pushes through, or doesn’t, may render even more of a verdict on his success in changing the system he sought the White House to reform…The larger fear is that Obama might be just another corporatist, punking voters much as the Republicans do when they claim to be all for the common guy.”
Love, we know, is never having to say you’re sorry. When falling out of love, hopefully, a reversible process, saying one is sorry is not enough; change is required. Why do so many of our heroes ultimately have clay feet?
The Honorable Edward Irving Koch served New York City as its 105th Mayor from 1978 to 1989.