Monday, September 22, 2008
Or at least that's what the health care policy debate felt like.
My school invited E. Richard Brown Ph.D., Director of the UCLA Center for Health Policy Research and Senior advisor to the Obama campaign to debate Dr. Donald Kurth, M.D. Chief of Addiction Medicine at the Loma Linda University Behavioral Medicine Center, Mayor of Rancho Cucamonga, and Chair of the Health Care policy committee for the McCain campaign.
I don't know which speaker did more to advance Obama's ideas for increased government involvement in medicine. For those who argue that competence in running a campaign is more significant than a candidate's actual policy proposals, then today's spectacle might solidify such people's support for Obama. Let me caveat that I am a hard-core free-marketer, who believes that McCain's health care plan is actually one of the highlights of his candidacy (had he also promised to bring our soldiers home from Iraq, and had eased up on some social issues, I would have been writing this from his campaign volunteer headquarters).
Dr. Kurth seems like a kind gentleman, who cares for his patients, and supports his political positions because he believes they will improve patients' lives. Nevertheless, he presented McCain's plan by reading off the McCain/Palin brochures that had already been left on our auditorium seats. He spent a few too many minutes talking about his own professional degrees and experience. His only argument against government-controlled health care consisted of a personal story working for the U.K. National Health Service thirty years ago, in which his advisor, a surgeon, didn't make lots of money, and some patient he met had to wait a few years before receiving his hip replacement. When asked questions about the McCain plan, he admitted that he didn't know the details, and instead continuously repeated the same emotional mantra "Do you want the government to get between you and your patients?" That line was the answer to about seven different questions (admittedly challenging, sometimes antagonistic, questions- this is Obama Country, after all).
After Dr. Kurth's very short presentation, Dr. Brown barely had to open his mouth to "win" the debate. But he went much further than even describing Obama's plan. All parts of McCain's plan that Dr. Kurth was unfamiliar with were explained in detail by Dr. Brown, before he summarily refuted them with facts and figures, rather than personal experiences. It was like watching Lennox Lewis take on my old Tae-Bo instructor.
Without a real sparring partner, Mr. Brown talked for about a half-hour, and got away with quoting every questionnable statistic, and its intepretation as fact (i.e. "48 million Americans don't have health insurance," without a mention that this includes illegal immigrants, whose health costs ought not to be subsidized any more than those of any given world citizen- and I even support immigration reform). If free-marketers believe that socialists advance their causes through romantic emotionalism, rather than rational data, they would be disappointed to see who are currently carrying each movement's torch. Here was one guy, the so-called "Marxist" who came across as professional, fluent in policy, and well-prepared. Then there was the other guy, the "Capitalist," who seemed to have a verbal tic in his constant repetition of "I believe in the free market" and described, very generally, that he has some problems dealing with the government bureaucracies in his medical practice.
(As an unrelated aside, my audience question to Dr. Brown was as follows: "There are many controversial cultural issues in medicine, including abortion rights, medical futility, and transgender surgery. How do you feel that the existence of a National Health Insurance Exchange might affect the debate regarding cultural issues? More specifically, in the case of medical futility, who would decide when the plug is pulled? The patient's family or the people footing the bill, who may not have made the patient's decision for themselves?" The line to pitch questions to the Obama representative consisted of: Me. The line to ask questions of the McCain consisted of at least 6 upset people).
After the "debate," we discussed the two health care plans in our classroom. Considering the overwhelming support for Obama in my medical school, as well as the poor performance of the McCain representative, I have to give my fellow students a lot of credit. They asked a lot of the important questions that made me realize that there are knee-jerk liberals, and liberals who ask and consider probing, relevant questions. In our classroom discussion, some people queried, "How would these plans be paid for?" "How would we insure that costs don't go up if there are coverage mandates? How do we prevent increased premiums for healthy people (or a healthy person exodus from costly plans), once insurers are required to disregard "pre-existing conditions"? Would illegal immigrants be eligible for free care? If not, who would be left to pay for their medical expenses?) Despite my constant feeling of being a political minority in my medical school, I do admire and respect my classmates. It's just a shame that the one opportunity for many people to hear a cogent argument on behalf of the free market was was so devastatingly wasted.