Saturday, September 29, 2012

The trouble with second terms

For the past half-century, history hasn't been kind to American Presidents who were fortunate enough to be elected to second terms. Whether through their own hubris or regression to the mean, re-elected Presidents seem unable to escape personal health issues, scandals, or disastrous domestic or foreign policies. Dwight Eisenhower suffered a stroke early in his second term and later fumbled through the embarrassing U-2 incident. After completing JFK's first term, Lyndon B. Johnson won a second and promptly passed Medicare and Medicaid, but finished his presidency hopelessly entangled in Vietnam. His successor, Richard Nixon, resigned in disgrace midway through his own second term rather than be impeached for his role in Watergate. Ronald Reagan won again in 1984, but his second term was marred by the Iran-Contra Affair, colorectal cancer, and (possibly) the onset of Alzheimer's. Bill Clinton fell to Monica Lewinsky and the Starr Report. George W. Bush: Iraq and the collapse of Wall Street. So in addition to asking if our current President deserves a second term, undecided voters might consider what stumbles he would make if he wins.

I didn't vote for Barack Obama in 2008. I thought that he had neither the leadership experience nor the political stature to unite the nation, and the events of the past four years haven't changed my impression. Any hope his campaign may have had of earning my vote in 2012 was dashed by two incidents that occurred when he was my boss (and I, a federal employee): trotting out the Secretary of Health and Human Services in November 2009 to disavow the USPSTF's new recommendations on screening for breast cancer, effectively throwing the Task Force under the health reform bus; and again permitting politics to trump science by cancelling the Task Force's November 2010 meeting to delay the release of a similarly damaging statement about screening for prostate cancer - then adding insult to injury by covering it up.

Do I have a higher opinion of Obama's competitor, an oft-caricatured tax-evading multimillionaire who wrote off 47% of Americans who pay no income taxes and wants to "end Medicare as we know it"? I guess it's all about perspective. Mitt Romney is a flawed man, but it's hard to believe that his motivation for pursuing the Presidency is to only make life better for the so-called one percent. If Romney had wanted to amass a greater fortune and not be lampooned by late-night comedians, he would have stayed put at Bain Capital and passed on saving the Salt Lake City Olympics or becoming Governor of Democratic-dominated Massachusetts. (He also could have chosen to hang on to more of his supposedly tainted earnings, rather than giving to his church and charities as much money each year as many others - even those in a similar income bracket - do in a lifetime.) Whatever Romney's view of the Affordable Care Act is, he worked with political polar opposite Ted Kennedy to pass a bipartisan health care plan 4 years before the ACA. As for his running mate throwing Grandma off the Medicare cliff, that advertisement may sway a few voters in the critical swing state of Florida, but could, like the original Harry and Louise ads, move this country even farther from tackling the problem of skyrocketing health costs.

I admit to hesitation and second-guessing about using my blog, which I think has earned a reputation for being evenhanded on the most politically charged of health care issues, to explicitly endorse a Presidential candidate. Perhaps some of you will think less of me or, worse, post all sorts of vitriolic comments, although I hope not. But for what it's worth (which isn't much at all, since I live in the District of Columbia), this Common Sense Family Doctor will cast his ballot for Mitt Romney for President on November 6, 2012, and encourages all who are reading to do the same.

9 comments:

  1. I am truly shocked by this. I can't believe you have come to the conclusion you have. It doesn't make any sense. Obama is certainly flawed, but given the world he has to operate in, he hasn't done half badly. Romney really has no experience dealing with people, with complex issues, with much more than making money with companies which must appear to him as abstractions. He survived being governor of Massachusetts, but Massachusetts was low on the list of job creation during his tenure. He won't own the one thing he might get credit for, his health insurance legislation which allowed my daughter to pay for cancer treatment without declaring bankruptcy. During the campaign, he has knocked environmental issues, wants to lower taxes for the rich, etc. etc. etc. For just a start. Are you sure you're not letting your bitterness about what happened to your task force? I had several very worthwhile jobs and several hard knocks in them, but you should be able to rise above the seeming lack of wisdom and look at why things happened as they did and whether perhaps Mitt Romney really would have done better. After having read your blog often, I can't tell you how disappointed I am.

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  2. I'm sorry to disappoint you, Esther. I want to assure you, though, that I'm not voting out of bitterness or a desire for revenge for how my federal job ended. Unlike many people, I will be voting FOR Mitt Romney, not against President Obama. I've followed Romney since he was the governor of Massachusetts, when it became clear to me that he was the Republican leader with the best understanding of how U.S. health care works (and doesn't), and how to fix it. I've read both of his books, Turnaround and No Apology (as well as Obama's The Audacity of Hope), watched both national conventions, and done my best to ignore the attack ads from both sides. The counterfactual of what would have happened in health care had Mitt Romney been elected in 2008 is of course unknowable, but looking at his record in Massachusetts, I wouldn't have been surprised if something resembling the ACA had passed, with support from both political parties. That he has been forced by some elements of his party to run against the ACA is unfortunate, but his chief advisor Mike Leavitt (another former boss, previous Secretary of HHS) is on record as supporting state health insurance exchanges to expand insurance to persons who don't qualify for Medicaid but still need help to afford insurance. All in all, I'm going into this election with both eyes open. Thank you for reading my blog, for being honest about your opinions, and for contributing to a worthwhile dialogue about the future of this country.

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  3. By way of background - surgeon in NH. Intellectually I agree with you, but I just can't get over the fact that Romney seems to be the perpetual consultant/salesman. Governor of a "liberal" state? Pass universal healthcare, support gay rights. Talking to the well heeled? Disparage the "47%". Running for president of the republican party? Deny climate change, adopt extreme positions on women's health/abortion. So I will not be voting for Romney since I don't know which Romney I am going to get. He tells the audience what they want to hear, like any good consultant. BTW, I used to be one.

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  4. As a physician in a swing state that does not allow second terms for the governor- Virginia I couldn't agree more regarding second terms. It is amazing how our governors in the 10 years that we have lived here have actually focused on doing what is right for the state and not what will get them reelected. Overall term limits in all areas of government would go a long way from keeping others from becoming career politicians and spending most of their time trying to keep their job instead of doing their job. Our current president is a good example. In the face of an ambassador's death he was more interested in flying to Las Vegas than addressing the terrorist attack. Shame on him. Our founding fathers set up the constitution for limited government and protection of individual liberties. I believe they knew what they were doing so would encourage others to consider who represents that choice in the upcoming election versus large government and loss of liberty. If we make the wrong choice, our opportunity to actually vote may be lost in the future. . .

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  5. I am also a physician residing and practicing in the "swing" Commonwealth of Virginia and will be voting for Mitt Romney. I find it hard to believe that ANYONE would support a second term for the charlatan currently occupying the White House. To stand and defend Barak Obama's actions in office is an incredible exercise in denial. It is not intellectually honest to judge Romney as a dishonest flip-flopper without attaching the exact same label to Obama, who has repeatedly pandered to his own special interest groups while breaking promise after promise to the same people. He has provided America with a glaring example of why term limits are needed across the entire spectrum of our political system.

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  6. http://the-scientist.com/2012/10/01/obamas-science-report-card/ You might also want to consider this link.

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  7. Thanks, Esther. I think that the grades are generous (an "A" for the ACA for extending insurance coverage and making preventive services free, but no comment on not addressing the mismatch between physician supply and demand, and interference in the process for designating which preventive services are beneficial or not). Still, interesting reading, along with this link with the candidates' answers to scientific questions: http://www.sciencedebate.org/debate12/

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  8. Could you explain why you think the grades are generous? I tend to see Obama entangled in a web of bureaucracy and opposition which he has managed to reach through at least a little bit to accomplish some meaningful change. As I think I said, I don't at all like his attitude towards civil rights, those of people in the US or those abroad.He seem mechanistic to me. But then, so does Romney.

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  9. Sure. I worked for DHHS for 4 years, two under Bush and two under Obama. The latter were much more bureaucratic and intellectually frustrating than the first, even allowing for the additional political scrutiny brought on by health reform legislation. I sometimes tell friends that I don't know what the government was paying me to do in 2010, since every project I was working on (not just prostate cancer!) was being actively suppressed for political reasons.

    President Obama told citizens when elected that they'd be getting the "most transparent administration in history" and, indeed, they created a number of websites where people could see raw data on the effects of the stimulus, and so forth, but where transparency really mattered - to reporters speaking with government scientists about their interpretations of such data, for example - his administration did just the opposite. Again, I'm not solely generalizing from my experience at AHRQ; the nonpartisan Association of Health Care Journalists has protested numerous times during Obama's term about practices such as making scientists unavailable without public information officers present, and in some cases threatening journalists for accessing public databases.

    Here's one example from HRSA last year: http://healthjournalism.org/blog/2011/09/ahcj-other-journalism-organizations-protest-removal-of-data-from-public-website/

    The comments are interesting, too: one reporter actually writes that "this is what I would expect from a Republican administration." No "liberal media bias" here - just a well-documented case where the perception of the President as being open on science did not match reality.

    Romney's social awkwardness has been a clear obstacle to people seeing him as a reasonable President. I think that the Obamas would be much more fun at a dinner party or sporting event, and I understand why people continue to be drawn to him despite a notable lack of progress on issues that they consider to be important (e.g. the economy). But when I look at Romney's record (not necessarily his rhetoric), I see that he's taken on some very difficult situations (a bankrupt and scandal-ridden Olympic games, a free-spending state facing a several million-dollar budget deficit) and performed admirably. He isn't the second coming of Ronald Reagan (or for Democrats, Bill Clinton), but in my mind he's clearly the better choice.

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