TRUTH AND CONSEQUENCES

Most
of my blogs have either directly or obliquely addressed numbers 1 through 3. I
would like to discuss number 4 just a bit.

Usually,
on Capitol Hill, when unintended consequences are spoken of, it is in the
negative. One of the unintended consequences of the Patriot Act has been the
on-going argument as to how to protect American’s expectations of privacy while
it co-exists with their equally fervent expectations of safety from terrorism.
It’s a tough call. Undoubtedly, when you combine the increases in secrecy and
invasions of privacy that accompanied the Patriot Act and then add the power of
the internet, it should come as unsurprising even if unintended, that a
consequence might look like Edward Snowden and Wikileaks.

But
there is one other kind of unintended consequence that is rarely foreseen. That
is no consequence at all.

For
example, is the President of the United States really of consequence when his
greatest legislative accomplishment is passing a bill fewer than half the
country wanted and even fewer want now with absolutely no support from the
other political party? And what about his ordering the killing of US enemy #1
10 years after UBL perpetrated his heinous crime? (Please note 9/11 was a
criminal act not an act of war. For it to have been an act of war, the attackers
needed to be from a real country and wear uniforms let alone have their own
planes. Like Pearl Harbor was. It should be no surprise that the solution
looked more like a SWAT team than an armored battalion).

I
believe that both the elections of 2008 and 2012 had an unintended consequence
of weakening the Presidency. Who would have thought that a putative leader as
eloquent as President Obama would leave the construction of his signature piece
of legislation, the ACA, in the hands of Congress? The real unintended
consequence of the Obama election is his virtual inconsequential list of
achievements. (Hell, he won the Nobel Peace Prize for doing nothing and then
accepted it. Who knew a Nobel was like the cup they give all the 6 year olds at
the end of the soccer season for showing up)?

A
further example of an inconsequential consequence is ObamaCare itself. While gallons
of ink have been spilled not to mention airtime filled with diatribes for and
against this piece of legislation, the truth is, its effects on most Americans
is minimal and those it does effect seem worse off, although those with
pre-existing conditions or those under 26 on their parent’s insurance are
better off.  A recent Wall Street Journal
editorial  (ObamaCare 2016: Happy Yet? by
Bradley Allen on Oct. 23) attributes to the ACA a host of downward trends in
medicine from higher premiums to concierge docs decreasing the available doctor
pool and putting access out of the reach of many. Bull feathers! All that stuff
in that article was secondary to changes in medical economics as everyone in
the health care-industrial complex tries to preserve his revenue stream, cut someone
else’s costs, and claim superior quality with no objective evidence (Making Cancer History, my eye). The real secret of the
ACA’s consequences is that relative to the storm produced by the politics, its
effects on health care in the aggregate will probably be minimal. The
unintended consequences of the ACA is that it basically changed nothing of
consequence with regard to the practice of medicine or, for that matter, the
fashion by which services are reimbursed. (It’s still mostly
fee-for-service).

Finally,
there’s the president of MD Anderson, a position previously viewed as all
powerful. The president of Anderson has his hands on the controls of all of the
resources of a $3.3B operation. That should make him consequential, right? Not
necessarily.

MD
Anderson’s major role in the world is still caring for sick people with
malignant diseases. Research, education and cancer prevention are worthy
missions, but the rubber hits the fiscal road in the clinics for 85% or so of
the revenue it takes to run Anderson is generated by about 1000 or so clinical
faculty, some 5% of the work force. They are the engine and one would think
that the man with his hands on the tiller of the ship of state would make sure
there was plenty of gas, oil and STP in the engine that fuels his attempt at a
moon landing. (Again I got over-indulgent with my metaphors. DePinho brings out
the metaphoric in me).

On
the contrary, he has neglected to show any appreciation for those that keep him
in research funds and many of the best of them have left (if not fired). How
then is the current president of MD Anderson of consequence to the major work
of the cancer center? Got me. I think the place is working (if it is) despite
him not because of him.

The
four principles of the book are usually inviolate and, unfortunately, all too
common in the America of 2013 that finds so many areas of previous American
excellence so wanting for leadership. (Here are some singular leadership heroes
for you: Lance Armstrong, A-Rod, Anthony Weiner, Eliot Spitzer and Ted Cruz;
who do you want your daughter to marry or your son to grow up to be)?

From
the White House to the 20th floor of the Pickens Building it’s not
the wrong-headedness that is so apparent. It is the unbridled inconsequence as
the unintended consequences of the decisions made by the American people and UT
Board of Regents stare us all in the face. Blankly!