ObamaCare Versus the Old ClintonCare: A Major Step Backwards(Plus: Mortality-Behind the Baby Count)

On September 22, 1993, President Clinton, in an impassioned address to a joint session of Congress, unveiled his Health Security Act to the American people. He laid out six principles: security, simplicity, savings, choice, quality and responsibility, and explained in unambiguous language how each of these principles were embodied in the Health Security Act.

Clinton, despite his failings, which were only human failings, had something that Obama didn’t have although he thought he did and many in the media gave him credit for having. Clinton truly had a transformational vision for health care and that vision was masterfully expressed in this address to Congress that evening. It was probably one of the best speeches, if not the best speech he ever gave. Obama could have used these same six principles if he wanted to. They are worthy principles that all Americans want to achieve in any health care reform. One in particular needs to be examined very carefully, Clinton’s fifth principle, quality. Although the other five are as worthy of mention when comparing Clinton’s vision to Obama’s, quality is the most important and most valuable attribute whenever one encounters the health care system and it is over quality that Obama’s vision makes it most drastic departure from Clinton’s.

Of quality, Clinton said, “If we reformed everything else in health care but failed to preserve and enhance the high quality of our medical care, we would have taken a step backward, not forward. Quality is something that cannot be left to chance. When you board an airplane, you feel better knowing that the plane meets standards designed to protect your safety. We must ask no less of our health care system…” In his own words, high quality care will be the safest care possible, as safe as flying in an airplane. He went on to say, “…More efficient delivery of health care does not decrease quality, and may even enhance it.” Again, his own words describe quality as the most effective care necessary to produce the best medical outcomes. Cost is only secondary; hence high quality care would be the most cost effective care possible.. He went even further by saying, “…Our plan will guarantee that the highest quality health care is available in even the remotest areas of our nation… Our plan will ensure quality by effective prevention and treatment measures for cancer, for AIDS, for Alzheimer’s, for heart disease and for other chronic diseases. Our plan safeguards the finest medical care in the world, and makes it even better.” Therefore, for Bill Clinton, high quality care will be universal, ensuring every American treatment for cancer, for AIDS, for Alzheimer’s, for heart disease and for other chronic diseases without raising the specter of how those suffering from these disease would contribute to society after treatment is rendered. These attributes of quality are an awesome vision, one that every American, every doctor, every politician regardless of party could embrace.

Obama, who some say possesses rhetorical skills eclipsed only by Abraham Lincoln and, maybe, not even by him, and whose genius is unsurpassed by anyone who ever held the office, never said anything remotely similar. The reason why is he does not believe it. On July 15, 2009, he spelled out exactly what he thought of quality and he did so right in the face of the AMA. “Today, we are spending over $2 trillion a year on health care… And yet, for all this spending, …the quality of our care is often lower; and we aren't any healthier.” It is rare for a president to address the AMA and rarer still to tell it that the quality of American health care is second rate. Yet, since Obama’s health care juggernaut began just 8 weeks ago, life expectancy was raised and data showed that survival rates for Americans with cancer, were superior to any European counterpart. However, Obama truly believes what he told the AMA and nothing will change his mind nor his agenda to bring us into his brave new world even if we don’t want to go.

Nothing, though, speaks to the differences between the visions of these two men more than the two bills, themselves. It starts in the preambles of both. The preamble of Clinton’s Health Security Act promises to protect the health security of every American and provide them the highest quality care while at the same time controls the growth of health care spending. The preamble of ObamaCare, in the guise of HR 3200, says only “to provide affordable quality care for all Americans and reduce the growth in health care spending and for other purposes.”

We know that Clinton’s vision of high quality care is the safest, most cost effective care possible available to all Americans regardless of the conditions from which they suffer. On the other hand, what is affordable quality care? The crafters of HR 3200 could have used words like high quality care or most cost effective care but, instead, chose to use affordable quality care. Clearly, they do not mean the same things because, if they do, there would be no need to be so ambiguous. The only conclusion that could be reached is that Obama and the crafters of this bill or any other bill with which they may later be associated, do not hold quality in the same regard as does Bill Clinton. The answer, though, is found in the contents of HR 3200. Affordable quality care is whatever the Comparative Effectiveness Research Commission created by this bill says it is, and is whatever physicians, who are now agents of Accountable Care Organizations also created by this bill, are told it is, and is whatever the criteria for quality adjusted life years for those with cancer, AIDS, Alzheimer’s, heart disease and other chronic diseases determines it is. It is no more and no less. If safety and cost effectiveness are factors, it is only by accident. Cheap and mediocre, though, are by design. Universality remains to be seen and will be determined by how members of Congress behave whenever they or their family members need medical care.

But, there are those, like Ezekiel Emanuel, a medical ethicist and chief health care advisor to President Obama, who would tell us we are wrong, This is not contained in the bill at all. With the conviction of a holy warrior, they will correct our misinterpretations. After all, these steps are not rationing; what is happening now is rationing. Rather, these steps are rational - absolutely necessary when medical resources are scarce. We have to be utilitarian in our approach to health care reform because ultimately the end does justify the means - sacrifice few to save many. Doctors take the Hippocratic Oath too seriously and, by so doing, they spread precious resources too thin. You know what? He’s right – in a post apocalyptic world - but we are not facing an apocalypse and a health care system worth $2.3 trillion has plenty of reserves. We do not have to sacrifice people to save money and this is precisely what ObamaCare will accomplish. This is affordable quality care.

August 19, 2009, 4:23 pm
U.S. Life Expectancy at All-Time High
By Tara Parker-Pope

(SNIP)United States death rate continues to drop. In 2007, there were 760.3 deaths per 100,000 population, down from the 2006 rate of 776.5. And 2,269 fewer people died in the United States in 2007 than 2006.

Nearly half the deaths in 2007 (48.5 percent) were due to heart disease and cancer. However, fewer people overall died from heart disease-related problems like stroke, diabetes and high blood pressure.

Among the 15 leading causes of death, mortality rates dropped for 8 of them. In 2007, fewer people died of influenza and pneumonia (8.4 percent decline),
homicide (6.5 percent decline),
accidents (5 percent decline),
heart disease (4.7 percent decline),
stroke (4.6 percent decline), diabetes (3.9 percent decline),
hypertension (2.7 percent decline)
and cancer (1.8 percent decline).

Additional Sources: International Data Base Population Estimates and Projections Methodology

Earlier Chart Per Country Age Expectancy

Higher Gas Prices = Less Driving = Fewer Accidents

America's Best Hospitals report [2]

Life expectancy is skewed by infant mortality rates, and they are calculated differently throughout the world: "While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States reports every case of infant mortality, it has been suggested that some other developed countries do not.."

"...effects on life expectancy figures caused by including abortion as cause of death"---The deadly years

"A 2005 report (PDF) from Global Health Watch, a collaboration of community and health advocates, notes regional offices also do not escape politics. The report found that regional directors must contend with a "politically charged environment, the corrosive effects of power and status, and their desire to ensure they are re-elected.."

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