Is it all over for health care reform? Is it true that "the fix is in" as my colleague Marcia Angell, M.D., has put it? Is the Baucus plan -- the one that manages the improbable feat of making the developed world's most expensive, least effective health care system even worse -- indeed the only one with a prayer of passage? Are both parties now permanently prostrate before the moneyed interests?
Frankly, I don't know. Predicting political outcomes is outside my ken. But as a physician, I do know something about how to handle self-destructive behaviors, and that's what Congress is displaying.
Perhaps the greatest threat to health in America today is resignation; a belief that "this pathetic performance is the best I can muster." I spoke recently with a home-care nurse from North Carolina who spent her days treating people who had the same dual diagnosis: type 2 diabetes and emphysema. In other words, she attended to housebound, morbidly obese smokers, people who were literally killing themselves through terrible lifestyle choices.
She wondered: What should a physician do with such people?
Well, one option is to murmur soothing words, then carefully, skillfully amputate their necrotic toes (then feet, then legs), provide potent inhalable steroids to coax a little more oxygen uptake from their blackened lungs, and generally spare no expense or effort to keep them as comfortable and happy as possible as they kill themselves slowly.
But every good physician knows that this is wrong. Good physicians, when confronted with people like these, get angry and show it. They point out that while addictions may be comforting, slow suicide is ultimately a selfish act, and that, as dedicated professionals, they have better things to do than spend hours and dollars caring for patients who are taking the lazy path to early death. It is, frankly, an easy "performance" for most physicians to muster, because they really feel it.
And it is frequently exactly what the patient needs to hear. A doctor's anger is often the only message that can penetrate an addiction that is ultimately ruinous.
President Obama's Sept. 9th speech on health care reform to Congress was like a kindly doctor's first consultation with an overweight, one-pack-a-day patient who is still ambulatory and functional. The president was reasonable and restrained, pointing out that Congress needs to make a better choice, one that reflects the centrist view.
But it did not work because the president, a rare politician who seems essentially immune to political greed, misjudged how much insurance and pharmaceutical funding has corrupted both parties. The center, as it turned out, has moved so far right that it sits smack in the middle of a self-destructive kleptocracy. Congress has, via the Baucus bill, essentially told the president that "this pathetic performance is the best we can muster." Numbed by an addiction to easy money, the politicians lack the will even to save themselves -- because I guarantee, if Congress does not do better than this, if it really enacts an egregious plan that sends the nation's health and finances down the drain, then these senators and congressmen will not only be booted out, but they will earn the historic distinction of being the people who sold out the country.
So it is time for another speech. It is time for President Obama to get angry.
He can get angry at Blue Dog Democrats who abandoned the single payer system, not even using it as a bargaining chip, and who now refuse to stand firm even for a public option. And he can turn particularly withering scorn on Republicans, who, in rejecting any public option, seem hell-bent on sacrificing the health of Americans to keep rivers of money flowing into a few, select pockets.
I can't guarantee that a tirade by President Obama would succeed. When a physician reads the riot act to a patient, it does not always work. Some are so far gone -- so comfortable in their decline, or so persuaded of their own weakness, or both -- that the words don't penetrate. Nothing will.
But I don't believe this country, or this Congress, is hopeless. l believe that an angry speech by President Obama can work.
This president is generally an affable guy, but he knows how to show and use anger effectively. I am thinking particularly of his election-night victory speech, when one might have expected him to be smiling and jubilant like the merry Chicago crowd he addressed. But he was grim, focused and urgent. He even seemed a little aggravated.
He needs to recall that emotion, and crank it way up. Like a doctor getting angry at a patient, I think he can do it, because I am sure he feels it.
And he needs to do it soon. Because this patient is quickly slipping away.