Wednesday, March 11, 2009

Obama health plan: We need details

Los Angeles Times writer Bob Rosenblatt characterized President Barack Obama's strategy for his health care proposal as, "Give me a bunch of money, and we'll figure out the details later how we are going to manage this thing." In other words, the plan's key element is vagueness.

The problem with such vagueness is that any informed public policy decision has to be based on specific proposals. Absent concrete details, which is where the devil lurks, no one - including those proposing a "reform" - can judge how it would fare or falter in the real world. So when the president wants approval for a $634 billion proposal which offers too few details for evaluation, we must ask why.

Like salesmen, politicians strive to present their wares as attractively as possible. Unlike salesmen, however, a politician's product line consists of claimed consequences of proposals not yet enacted. Further, politicians are unconstrained by truth-in-advertising laws, they have fewer competitors keeping them honest, and they face "customers" - voters - far more ignorant about the merchandise involved than consumers spending their own money.

These differences explain why politicians' "sales pitches" for their proposals are so vague. However, if vague proposals are the best politicians can offer, they are inadequate.

If rhetoric is unmatched by specifics, there is no reason to believe a policy change will be an improvement, because no reliable way exists to determine whether it will actually accomplish what is promised. Only the details will determine the actual incentives facing the decision-makers involved, which is the only way to forecast the results, including the myriad of unintended consequences from unnoticed aspects. We must remember that, however laudable, goals and promises and claims of cost-effectiveness that are inconsistent with the incentives created will go unmet.

It may be that President Obama knows too little of his "solution" to provide specific plans. If so, he knows too little to deliver on his promises. Achieving intended goals then necessarily depends on blind faith that Obama and a panoply of bureaucrats, legislators, overseers and commissions will somehow adequately grasp the entire situation, know precisely what to do about it, and do it right - a prospect that, given the painful lessons of history, should attract few real believers.

Alternatively, President Obama may know the details of what he intends, but is not providing them to the public. But if it is necessary to conceal a plan's details to put the best possible public face on it, those details must be adverse. If details of a plan made a more persuasive sales pitch, a politician would not hide them; they would be trumpeted at every opportunity as proof he really had the answers.

Claiming adherence to elevated principles while keeping detailed proposals from sight also has a strategic advantage: It defuses criticism. Absent details, any criticism can be parried by saying "that was not in our proposal" or "we have no plans to do that" or similar retorts. It also allows a politician to incorporate alternatives proposed as part of his evolving reform, as if they were his idea all along.

The new administration has already put vague proposals on prominent display. However, adequate analysis cannot rest upon such flimsy foundations. That requires the nuts and bolts so glaringly absent. In the private sector, people don't spend their own money on such vague promises of unseen products. It is foolhardy to act any differently when political salesmen withhold specifics, because political incentives guarantee that people would object to what is kept hidden. So while vagueness may be good political strategy, it virtually ensures bad policy.


British ambulance bureaucracy kills woman

Ambulance staff were unable to save a mother-of-two who died from a heart attack after a simple trip to the dentist went tragically wrong, an inquest was told. They were not qualified to give Marian Carrick, 46, a shot of adrenaline which could have saved her life after she suffered a severe reaction to a antibiotic Amoxicillin pill. Her neighbour, Charles Gallimore a former GP with 40 years experience, begged them to give her the drug but they refused.

It was only 30 minutes later that a second ambulance arrived at her home in Wing, Rutland, with a qualified paramedic on board who administered the drug. By then it was too late and Mrs Carrick was later pronounced dead at hospital.

The tragedy happened on the the same day she had collected the medicine from her dentist in Uppingham, Rutland, an inquest in Loughborough, Leics, was told. Pathologist Dr Angus McGregor said Mrs Carrick had taken Amoxicillin before with no ill effects but on this occasion suffered a severe reaction. He said: "The cause of death was a severe anaphylactic reaction, a severe allergic reaction. "That can lead to shock. That can lead to massive circulatory failure, and the heart and circulation fails." Mrs Carrick's medical records showed no evidence of previous allergy to any drugs.

East Midlands Ambulance Service arrived to find former doctor Mr Gallimore with Mrs Carrick and he advised them to give her adrenaline to restart her heart. But the ambulance technicians, who are qualified just below the level of full paramedics, were not permitted to administer adrenaline. Her brother Steve Jones told the inquest he thought the technicians should have used adrenaline earlier to try to save his sister. He said: "There was half an hour between the first and second ambulance. "For half an hour, they carried on with giving cardio-vascular therapy, but never thought to give her adrenaline when there was a doctor of 40 years' experience begging them to do it. "The technicians weren't qualified to deal with the situation."

Dr Colin Reid, a consultant in emergency medicine for the University Hospitals of Leicester said: "This would have been a difficult situation for the attending crew. "They would have had no way of knowing if Mr Gallimore was medically trained. "They acted appropriately and professionally, and provided the best medical care they could."


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