Obamacare Is Now Beyond Rescue

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Illustration by Thomas James

Wednesday, January 15, 2014

With the disastrous launch of the HealthCare.gov website, critics of the Affordable Care Act, or “Obamacare,” were given more fuel for the fire. Is this political hot potato's inevitability once again at stake? And is the medical community really on board with the law, or resisting (rewriting?) it from the sidelines?

  • Scott-Gottlieb-90px

    For

    Dr. Scott Gottlieb

    Practicing Physician & Former Deputy Commissioner, FDA

  • McArdle90x90px

    For

    Megan McArdle

    Writer and Columnist, Bloomberg View

  • JonathanChait90px

    Against

    Jonathan Chait

    Political Commentator and Columnist, New York Magazine

  • Kamerow90px

    Against

    Dr. Douglas Kamerow

    Family Physician & Former Assistant Surgeon General


    • Moderator Image

      MODERATOR

      John Donvan

      Author & Correspondent for ABC News

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For The Motion

Dr. Scott Gottlieb

Practicing Physician & Former Deputy Commissioner, FDA

Scott Gottlieb, M.D., is a practicing physician and a resident fellow at the American Enterprise Institute. From 2005 to 2007, he served as the FDA deputy commissioner for medical and scientific affairs and before that, from 2003 to 2004, as the FDA’s director of medical policy development. He left the FDA to work on the implementation of the new medicare drug benefit as a senior adviser to the administrator of Medicare and Medicaid Services. Gottlieb is an editorial board member of the journal Value Based Cancer Care and the Food and Drug Law Institute’s Policy Forum, and he writes a regular column for the Wall Street Journal. He is also a clinical assistant professor at the New York University School of Medicine.

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For The Motion

Megan McArdle

Writer & Columnist, Bloomberg View

Megan McArdle is a Washington, D.C.-based blogger and journalist who writes about economics, business, and public policy. Currently a columnist for Bloomberg View, she was previously a special correspondent for Newsweek/The Daily Beast, the business and economics editor at The Atlantic, and a writer for The Economist. She also founded the blog Asymmetrical Information. Her book, The Up Side of Down, will be published by Viking in February 2014.

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Against The Motion

Jonathan Chait

Political Commentator & Columnist, New York Magazine

Jonathan Chait is a daily columnist at New York magazine, where he contributes lead pieces of political commentary to nymag.com, along with short and longer form pieces for the print magazine. His influential writings are regularly among the most highly trafficked stories on the site. Previously, he was a staff writer at The New Republic for fifteen years, writing their signature TRB column and then running his own eponymous blog on their site. An influential voice on politics and policy, he was the winner of The Week’s “opinion award” for columnist of the year in 2010 and a 2009 National Magazine Award finalist for columns and commentary. Chait is the author of The Big Con: Crackpot Economics and the Fleecing of America (2007), and has been a guest on MSNBC, CNN, NPR, and WNYC, among other outlets.

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Against The Motion

Dr. Douglas Kamerow

Family Physician & Former Assistant Surgeon General

Doug Kamerow, M.D., is a family doctor and specialist in preventive medicine; a chief scientist in health services and policy research at RTI International, a large, non-partisan research institute; and a professor of clinical family medicine at Georgetown University, where he teaches medical students and family medicine residents. He is also an associate editor of the global medical journal BMJ, for which he writes a regular column on health policy, and he recently published a book of essays titled Dissecting American Health Care (2011). Previously, Kamerow spent 20 years in the U.S. Public Health Service, leading a range of clinical, health policy, and research activities, and retiring as an assistant surgeon general in 2001.

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Declared Winner: For The Motion

Online Voting

Voting Breakdown:
 

57% voted the same way in BOTH pre- and post-debate votes (13% voted FOR twice, 40% voted AGAINST twice, 4% voted UNDECIDED twice). 43% changed their minds (2% voted FOR then changed to AGAINST, 1% voted FOR then changed to UNDECIDED, 9% voted AGAINST then changed to FOR, 4% voted AGAINST then changed to UNDECIDED, 11% voted UNDECIDED then changed to FOR, 16% voted UNDECIDED then changed to AGAINST). Breakdown Graphic

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    38 comments

    • Comment Link Rollin V Benson Monday, 10 March 2014 16:36 posted by Rollin V Benson

      I just got ObamaCare. I work 45 hours a week in a high labor job, while I go to college full time (3.94 GPA out of 4). My company doesn't offer insurance and I don't make great money. I live ok and my hours work with my schooling. I'm also a Minimalist. No credit cards, no car payments, and no mortgage. I rent. I was accepting patient assistance and paying on a sliding scale. I felt ashamed. Although I could have stayed on this program, I couldn't. I wasn't raised that way. ObamaCare allowed me to feel like a productive citizen again. I love handing out my health insurance card. I do it with pride.

      P.S. I'm 43 and I'm White. I know that means something to some people still.

    • Comment Link Brijesh Wednesday, 19 February 2014 09:24 posted by Brijesh

      I get that you have to stick with the format, but the numbers imply the For side disproportionately misrepresented themselves initially to achieve the bigger swing in the final poll. When you have the Against side winning a majority of the Undecideds, but the For side winning 9% from initial Against and Against only winning 2% of initial For, doesn't this smack of one side of the audience gaming the system? Are we to actually believe that the "undecideds" found the For argument more compelling while the "For" side found it so lacking that they disproportionately switched? I appreciate that the full numbers are available on the website, but when they don't really add up, and the topic is charged enough to inspire gamesmanship, I wish that the incongruity of the results was mentioned in the broadcast. I realize that it is not as clean as just declaring a winner, but the audience needs to be rebuked at some point, or the format stops functioning and produces meaningless results.

    • Comment Link Richard Bustamante Sunday, 09 February 2014 12:55 posted by Richard Bustamante

      I see others have made mention of this but I thought that Jonathan Chait made the sort of cheap arguments that one can hear all the time on the airwaves - arguments that are far below the standard of Intelligence Squared.

    • Comment Link Thomas Luedeke Thursday, 06 February 2014 17:36 posted by Thomas Luedeke

      Jonathan's analogy of somebody remodeling their house and running into unanticipated problems isn't quite right.

      A better analogy would be the government coming to help a poor person down the road patch up their roof, but instead come into your house, insist on an unwanted remodel to a floor plan you don't want, botch it up to an incredible degree, then accuse you of "wanting poor people to die" if you raise any complaint...

    • Comment Link triclops41 Tuesday, 28 January 2014 22:50 posted by triclops41

      Having an obnoxious partisan hack like Chait on IS does not fit at all. It's beneath a program that usually has smart guests who don't argue in bad faith. There are plenty of smart, articulate, honest people who would defend ACA. Was there a last minute vacancy?

    • Comment Link Hukum Singh Khalsa Thursday, 23 January 2014 03:10 posted by Hukum Singh Khalsa

      McArdle on intelligence squared?

      please refer - http://shameproject.com/profile/megan-mcardle

      clearly not credible.

    • Comment Link johnny Wednesday, 22 January 2014 12:55 posted by johnny

      ObamaCare beyond rescue, agree/disagree/don't know
      prior to the debate: 53/16/31
      after the debate: 59/32/9

      That's quite a shift for an audience on THE UPPER WEST SIDE. And note the debate topic: it wasn't asking if people liked ObamaCare or wanted it to be improved, but whether or not it was beyond rescue.

      Ouch.

    • Comment Link Paul Fraker Wednesday, 22 January 2014 10:23 posted by Paul Fraker

      My sister is an Endocrinologist who sees a lot of Type-2 diabetics. Many of them just want to get on an insulin pump and don't want to change their diet habits. Type-2 can be reversible; they show no interest. Guess they are some of the "young invincibles". Point is: These are the kind of people who are making healthcare costs increase due to behavioral choices. The obesity epidemic represents a society that is quite literally sick. There is now an attempt to medicalize obesity, which in some cases is justified. For the most part it is not. Furthermore, there are many HBP patients who refuse to take their medication, ensuring they will get kidney disease and require dialysis. No wonder so many Americans don't like the idea of paying for their choices.

    • Comment Link Evan Madianos, MD Sunday, 19 January 2014 09:54 posted by Evan Madianos, MD

      Suggestion for upcoming debate:

      "Free Market Heatlh Care Reform: the Alternative Reform Solution to Government Control of Doctors and Patients that Liberals and the Media Try to Deny. Can it Work?"

      The Doctor's Prescription for health care reform in the US :
      http://docs4patientcare.org/prescription

    • Comment Link rose Saturday, 18 January 2014 22:46 posted by rose

      The insurance companies did not step up in time to offer a product that was profitable for them and inclusive to all. This is not a political issue but a commercial issue and the insurance lobbyists have missed the boat.

    • Comment Link Andrew Caudell Friday, 17 January 2014 00:15 posted by Andrew Caudell

      Erin's attitude disturbs me greatly. You don't think you should have to pay for someone's diabetes because you yourself happen to be healthy? Your wording ('fat slobs', I believe) implies that you think unhealthy people are unhealthy because of their own choices. Apparently you haven't considered the great many people in our nation who are born with inherited genetic maladies. How lucky you are that you weren't born with cystic fybrosis, muscular dystrophy, epilepsy, or autism. If you had been, or if (by a failure of natural selection) you had a child who was born with such a condition, I guarantee your attitude would be different. Faced with medical bills so high you would be buried in debt until your bones turned to dust in your coffin if you were required to pay them, and unable to enroll in a private health insurance policy because of your preexisting condition, you would find yourself in line for taxpayer-funded assistance like everybody else.

    • Comment Link Mike H Thursday, 16 January 2014 23:14 posted by Mike H

      @Steve Paridon MD: US currently has 0 out of 3.

      I understand the format of the debate, but I don't think the anti-Obamacare crowd can call this as a win... 59% of the audience ultimately disagreeing with the proposition.

      I'm not one for conspiracy theories, but it wouldn't take much to organize a sandbagging of the initial survey at these debates.

    • Comment Link Elizabeth Thursday, 16 January 2014 21:08 posted by Elizabeth

      This whole website and email seems biased against the ACA, which, while flawed is a good start towards addressing a problem, rampant medical costs and inaccessible care, that has plagued and embarrassed our country for years. Let's work together to make it better rather than try to pick it apart.

    • Comment Link Aquifer Thursday, 16 January 2014 20:29 posted by Aquifer

      James - actually it's rather simple - Medicare for All HR 676
      If "I squared" wanted to have a really good debate on healthcare, it would be on Single Payer - Maybe "Resolved, that Medicare for All would be the best way to cover all at the lowest cost" or some such. That is a debate we have needed to have for a long time - when physicians tried to raise it in the Sen chambers during hearings, they were arrested ...
      "I squared" could do us all a real service if they would host such a debate, one of the panel members on the "for" side could be Dr. Margaret Flowers - a participant in the debate with Baker referenced in my post below ...

    • Comment Link Thomas S. Dietrich M.D. Thursday, 16 January 2014 19:42 posted by Thomas S. Dietrich M.D.

      The two fundamental problems with our healthcare system are:
      1) Fee-for-service motivates providers to provide unnecessary services at great cost and to the detriment of patients.
      2) Our method of resolving patient injury claims is inequitable and expensive, but much more costly is the "defensive medicine" resulting from this system.
      The costs of these two issues are grossly underestimated.

      Thomas S Dietrich M.D.

    • Comment Link Windy Thursday, 16 January 2014 16:22 posted by Windy

      Republican Health Care. DON'T GET SICK!

    • Comment Link seth Thursday, 16 January 2014 15:42 posted by seth

      I disagree with Bruce K above. I guess this is one of those cases where it depends on your point of view. I think the title of the motion skews things the other way. "Beyond Rescue" makes this a really strong statement with a pretty high burden of proof. If the motion were something like "Obama Care is Really Bad Legislation" the case for it would be much simpler. But to say it is "Beyond Rescue" is tougher and maybe impossible to prove.

    • Comment Link Evan Madianos MD Thursday, 16 January 2014 13:02 posted by Evan Madianos MD

      Aquifer:

      "Apparently you took a different Hippocratic Oath than I did ...."

      Apparently so. Mine says that the doctor-patient relationship is the proper foundation of medical care- and that the physician's focus is on the individual patient - an individualist perspective.

      Yours apparently views the indvidual as inconsequential - and merely as a faceless number- a cog in the wheel of society. It defines the doctor's duty as toward society and the government- as if the individual didn't exist.

      In your collectivist view, the individual- whether doctor or patient- can be sacrificed - for whatever society or its leaders or the masses deem to be "the greater good".

      Your view is represented by people like Dr. Ezekial Emanual:

      Dr. Ezekial Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree."

      http://tinyurl.com/lwv9ldd

      You apparently want to work for the government.. My view is that doctors work for individual patients:

      "America was founded on the principles of freedom and individual rights. Applied to medicine, the law must respect the individual rights of doctors and other providers, allowing them the freedom to practice medicine.

      This includes the right to choose their patients, to determine the best treatment for their patients, and to bill their patients accordingly. In the same manner, the law must respect the individual rights of patients, allowing them the freedom to seek out the best doctors and treatment they can afford"

      http://www.westandfirm.org/index.html

      My view is also that government run medicine is a conflict of interest and violation of the doctor-patient relationiship:

      "When medical students graduate from medical school, they take an oath—the Hippocratic oath—in which they solemnly swear, above all, to use their best judgment in treating their patients. Doctors hold this oath as sacrosanct; they regard upholding it as morally mandatory, and violating it as out of the question.

      But in order to uphold this oath, in order to practice medicine in accordance with their best judgment, doctors must be free to practice in accordance with their best judgment. Unfortunately, U.S. politicians are working feverishly to prevent doctors from upholding the Hippocratic oath. How so? By implementing government-run health care.

      Politicians’ efforts to impose government-run health care include their goal of “guaranteeing” health care to everyone. But whenever the government attempts to “guarantee” health care, it must also control the costs of that service—which means, it must dictate how doctors may and may not practice. "

      http://tinyurl.com/lwqs33j

    • Comment Link Steve Paridon MD Thursday, 16 January 2014 09:47 posted by Steve Paridon MD

      Everyone wants the same three things from healthcare:
      1. Highest quality care
      2. Universal coverage
      3. Affordable cost.
      You can have any 2 out of the 3 but not all 3.

    • Comment Link Bruce K Wednesday, 15 January 2014 23:45 posted by Bruce K

      It occurs to me that the way these topics are usually worded, that the "ObamaCare is beyond rescue" phrase is a sticky phrase, which is right along with the Republican strategy or using every underhanded subconscious trick in the book to undercut the Democrats and try to manipulate the American people.

      Why not title this "ObamaCare, not really the mess it's portrayed to be?" At least mix it up a bit from time to time. I get tired of what amounts to always being on the defensive from every line a Republican utters, and the media should not be assisting in that, especially public media.

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