Whether the American voters realized it or not, arguably the single most important result of the 2012 Presidential election had to do with the future of what President himself has now termed “ObamaCare”. Apparently admitting that resistance to ObamaCare is as futile as assimilation into The Borg, House Speaker John Boehner announced that “ObamaCare is the law of the land” and that House Republicans would cease offering bill after bill trying to repeal it.
A great deal has already been written about ObamaCare and its many moral, medical and economic hazards. Americans for Tax Reform has a web page listing over 20 new taxes that will be levied as a result this law, many of them hitting all Americans directly and/or indirectly rather than just the middle-class. (This list does not include the implicit tax levied on all Americans by forcing them to buy health insurance policies that include a hefty assortment of mandatory coverage items that they will be unlikely to ever use.) There are even whole books that have been written on “Why ObamaCare is Wrong for America”, “The Truth About ObamaCare”, and “The ObamaCare Disaster”.)
Yet it doesn’t seem as if any of this information made any difference to the outcome of the recent Presidential election. Why? Because, let’s face it: the vast majority of people don’t read much, (or at all). And they certainly are not about to waste valuable television, Wii and texting time learning about something as boring as what the President and a willing Congress have done to the future of American healthcare.
One of the great travesties and tragedies of the 2012 election season was the complete lack of any serious discussion of the philosophy, nature and underlying structure of ObamaCare. Voters were treated to the usual talking points about how this massive law “insurers millions of Americans” on one hand, and “cuts $716 billion from Medicare” on the other hand. Yet the vast majority of voters don’t know anything more about what’s in Nancy Pelosi and Harry Reid’s bill now than they did at this time last year or the year before. The media certainly hasn’t helped to educate them. Hard questions appear to be beyond the capability of the average 21st century reporter, while actual journalistic research and investigation is something that we can only read about in history books. Heck, media “fact checkers” can’t even seem to distinguish between actual facts and their own interpretation of what a given candidate was trying to say.
Now that it looks as if ObamaCare may be the law of the land for the foreseeable future, it’s even more important that Americans really, truly understand it. The reason should be obvious: this law is going to influence virtually everything that happens when our loved ones get sick or interact with the healthcare system from now on. Things don’t get much more serious or profound than that. That is why every American, regardless of their politics, should read or listen to Dr. Richard Fogoros’ new book, Open Wide and Say ‘Moo!’: The Good Citizen’s Guide to Right Thoughts and Right Actions under Obamacare. We’re serious. Every single American.
Moo! Is a remarkable book on several levels. For one thing, Dr. Rich (as Dr. Fogoros is known from his Covert Rationing Blog) wrote it at a rate of one chapter per week, posting each completed draft on his website for comments from readers. For another, the book is actually easy and interesting to read – at least for the first 12 chapters or so. This alone is unusual for a book dealing with the normally headache-inducing world of healthcare policy.
But most importantly, Moo! is remarkable because it does what no other work has bothered to do throughout the whole multi-year history of ObamaCare: it explains why the mysterious, anonymous people who wrote the Affordable Care Act (ACA) legislation designed the law in the way that they did.
The average person who looks at the actual ACA law is unlikely to be able to decipher much of anything that it says. The average person who knows something about the structure and function of healthcare delivery might (with great effort) be able to understand much of the actual text, but will be perplexed by the apparent illogic of the measures mandated by the law. How can it possibly make sense to mandate that 46 million more Americans have insurance, much of it provided through Medicaid plans that do not even pay the actual cost of the care provided, but make no provision for increasing the number of doctors available? How can Congress mandate that the Independent Payment Advisory Board reduce Medicare costs by $716 billion, but simultaneously insist that Medicare benefits shall not be reduced? And if our insatiable demand for healthcare goods and services has created situation in which the country is being bankrupted, why does ObamaCare increase the number and types of mandated insurance benefits instead of reducing them? On the face of it, it makes no sense.
In Moo!, Dr. Rich manages to illustrate not only the structure but the function of ObamaCare, by explaining the philosophy and intent of the Progressives who wrote it. In some parts, the book actually reads like a detective story as Fogoros goes all the way back to the 1990s HillaryCare legislation to unearth the roots of specific passages and provisions. As Moo! explains, the folks who created ObamaCare have a world view that has been well-defined and consistent for decades. Their perspective is one in which what’s “best” for society trumps whatever might be best for individuals. In addition those with “progressive” views are the people best qualified to decide what is “good” and “bad” from a societal perspective. In other words, those crafting this law truly believe that they can do a better job running the healthcare system than anyone else, and that the passage of ObamaCare has given them the opportunity to remake the American healthcare system as they see fit. The system that they prefer – and that ObamaCare inexorably implements – is one in which decisions about how, where, when and under what circumstances healthcare goods and services will be delivered are centralized. Once made in the minds of government regulators, they will ultimately be shared with the rest of us in a top-down fashion.
“But hang on there, Cowboy!”, many will say. “This sounds like one of those right-wing nut job conspiracy theories about a ‘government takeover’ of medicine! Why should we be expected to read that sort of drivel?”
One great thing about the way Moo! is written is that Dr. Rich simply suggest a hypothesis that appears to fit the facts, and then presents the indisputable real-life attributes of the ObamaCare legislation. We are then allowed to draw our own conclusions about whether these facts actually fit the theory. And while the author openly invites us to come up with an alternative hypothesis for why the law forces providers and patients to do this or that, for us it is darned difficult to come up with an different explanation that makes nearly as much sense. But don’t take our word for it; read it for yourself. We’ve love to hear if you can do better.
The latter portion of Moo! deals with the author’s recommendations about what patients and providers can do to protect themselves and their families against the very real hazards presented by the top-down “socially optimized” administration of healthcare that we’ll be dealing with from now on. (Or at least until this legal and social mess is repealed by a more enlightened, economically and medically realistic Congress.) This is where Fogoros’ story becomes tougher follow, although probably through no fault of his own. For one thing it is easy to become so depressed by understanding exactly what the average patient and clinician are in for, that the solutions proposed seem inadequate to cope the mess. Indeed, it’s not hard to conclude that the only real solution is to get rid of the damned law entirely rather than try to escape its insidious affects as individual – almost fugitive – doctors and patients.
Regardless, we believe that Open Wide and Say Moo! is one of the most original, interesting and most provocative works on the subject of healthcare in general, and ObamaCare in particular, that has come along in many years. It should be mandatory reading for everyone, but particularly anyone who is involved in healthcare, training for any position that will deal with healthcare, and especially every legislator and government official in the world. Perhaps if they see how impossible it will be to produce a satisfactory result with a top-down approach, they will summon the courage (and the cojones) to find a better way.