I cannot recall an occasion when I have praised New York Times’ columnist David Brooks. And I’m not quite ready to start today.

But I would draw your attention to yesterday’s column.  In some ways Brooks understands Obama’s strategy for passing health care reform better than many more liberal pundits. 

Brooks describes the first-step as “table-setting: You will spend the first several months of your administration talking grandly about the need for reform. You will invite all interested parties to the table . . . You will talk about things that no sentient person could possibly disagree with — about the need for better information technology and for more preventive care . . . you are getting everybody talking. You are building relationships.”  Obama did this very well.

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For an excellent, detailed and in-depth response to the critics of the Dartmouth research who have suddenly emerged from the woodwork, (after more than twenty years and more than 100 peer-reviewed publications supporting the work done by Jack Wennberg, Elliott Fisher and others) see Amitabh Chandra’s piece on the Health Affairs Blog.

Chandra is now a Professor of Public Policy at the Harvard Kennedy School of Government and was formerly a Professor of Economics at Dartmouth College.

Growing up in suburban New Jersey,
my father was a hematologist; most of his patients suffered from leukemia. In
the 1960’s and early 70s, there were few effective treatment options for many
of them and my father spent a lot of time running to the hospital in the middle
of the night to provide blood transfusions for those who were in crisis;
offering support and personal attention to each of them.

These patients were mostly working-class or indigent men and
women who lived in Newark and the
gritty industrial towns that surrounded that tattered city. I don’t know what
kind of insurance my father’s patients had or whether they paid mostly out of
pocket for their care, but I was vaguely aware that an unofficial barter system
had developed over the years in lieu of some payment. That barter system, born
not only from need, but also gratitude toward a devoted doctor, served our
family well.

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President Barack Obama is stepping forward to take ownership of healthcare reform.  Today, in a speech to the American Medical Association, he pulled no punches, emphasizing that while we spend far more than other developed countries, the “quality of our care is often lower.”

In effect the president was telling the AMA: “The U.S. does not have the best healthcare in the world.”

But we do have the most expensive care. Spiraling healthcare bills are “a threat to our economy,” the president declared. “To say it as plainly as I can, health care reform is the single most important thing we can do for America’s long-term fiscal health. That is a fact.” If we don’t rein in runaway health care inflation, he warned, we will be looking at “lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.”

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In President Obama’s speech to the American Medical Association today he stood strong on all the elements of health care reform that he’s championed since the election. And in front of a tepid audience that has yet to drink the Obama Kool-Aid, the President sought to divide and conquer the larger population of physicians—reaching out to those who reject the long-term fear tactics that raise the twin specters of “socialized medicine” and “rationed care.” The AMA establishment has used these scary phrases to oppose past efforts to reform health care and recently, they’ve used them to warn against a public option for insurance.

Today, Obama reminded physicians that “you entered this profession to be healers,” not “bean counters.”

As has become increasingly clear since the AMA’s position became public, they do not speak for all doctors. First of all, the notion that the AMA represents all doctors, or even a majority, is just plain wrong. With 225,000 members, AMA membership represents just 25% of practicing U.S. physicians. They may have the loudest voice right now–and by spending $11 million on lobbying efforts last year, the dollars to make their voice heard by legislators—but others are quickly gaining ground in the fight over the heart and soul of reform.

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This morning, Dr. Atul Gawande spoke to student graduating from the University of Chicago’s Pritzker School of Medicine, calling on them to join in the “battle for the soul of medicine.”  Unlike many who say “we  must do something,” he offered some very specific examples of how doctors can “resist the tendency to see patients as a revenue stream.”

      Below, excerpts from his address:

. . . I want to tell you the story of a friend I lost to lung cancer this year. Jerry Sternin was a professor of nutrition at Tufts University, and with his wife, Monique, he’d spent much of his career trying to reduce hunger and starvation in the world. He was for awhile the director of a Save the Children program to reduce malnutrition in poor Vietnamese villages. The usual methods involved bringing in outside experts to analyze the situation followed by food and agriculture techniques from elsewhere.

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Health Wonk Review, a round-up of some of the very best health-care blogging, was posted today on Managed Care Matters. There, host Joe Paduda has done an outstanding job of  pointing to the diversity of opinion in the blogosphere. He opens with a letter from Senator  Dorgan, Chairman of the Senate Democratic Policy Committee (DPC), addressed to HWR’s readers. (The Review has been getting attention from policy-makers in Washington.)
Click here and enjoy.

The American Medical Association has announced
its opposition to a public-sector health plan that would compete with private
insurers. Why? Because the AMA fears that Medicare E (for everyone) might not
pay some specialists as handsomely as private insurers do now. 

Why do private
insurers pay more? Because they can pass the cost along to you and I in the
form of higher premiums.  Medicare E has
no one to pass costs on to—except taxpayers. And taxpayers will already be helping
 to subsidize those who cannot afford
insurance.

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There’s a battle brewing over bisphenol A (BPA)—an ubiquitous chemical compound that is found in baby bottles, beverage containers, and in the lining of canned foods, as well as in hundreds of other consumer products. It’s a battle that might offer the first real test of the Food and Drug Administration’s new pledge to “put science first” when making decisions about potentially harmful substances. It’s also a battle that highlights serious deficiencies in the nation’s ability to control toxic substances in the environment.

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