Barack Obama has a vision for healthcare. Everything is better and costs less. No one has to give up anything. Only things that work will be used. Bad practices will be eliminated. Panels of experts will ensure all these great outcomes.

The President is right that our current system is unsustainable. We must reform. We must reform soon. His press conference on Wednesday was a visit to Obamaland. Here, there are no sacrifices to achieve universal coverage and better care for all. When asked what Americans will have to give up he said only the things that do not work. In Obamaland that means whatever the government standards say does not work.

Clearly, rationing of services, drugs, procedures, and tests will be part of Obama’s reform. You want that expensive MRI for those agonizing pains in your back? In Obamaland, we will ask you to try some exercises first. You want a branded pill? No, that 10 year old generic works pretty well. Try that first and see if it works. Rationing may in fact be necessary to contain costs and I do not object to some rationing. We clearly cannot continue to pay the cost of extending life of the elderly by a few months. Both my dad and my father-in-law were beneficiaries of care that extended life by a few weeks but at costs of hundreds of thousands of dollars. Neither really wanted the care at that final stage but since Medicare paid, the hospitals and doctors made sure all the body parts were checked daily.

I object not to Obama’s goals. I object to his fantasy and sugar coated statements that avoid telling Americans the truth. We should cover more people. We should ensure portability of coverage. We should prevent medical bankruptcy. Obama needs to just tell the truth that Americans will give up a lot under reform. The country can handle the truth. Obama is playing Jack Nicholson with us. The Few Good Men line is wrong here. Americans may be better off with less tests, more primary care, less surgery, watchful waiting, more generics, etc. Of course he evaded the truth in his press conference and several reporters tried to get a direct answer but failed.

Obama always presents his plan as a choice between status quo and saving our health system from bankruptcy. No one I know wants status quo so he presents this false choice as if Republicans want to do nothing. His deadline is nonsense and America deserves full information on what specifically will change, the unbiased costs of the plan, and the realities of choices on services. If it is such a good plan after full disclosure, the electorate will support it. Obama was evasive in his press conference thinking long answers using his excellent rhetorical skills would cover up his lack of candor. Obama, however, is becoming a daily fixture on television convinced that his rhetoric is so powerful we will be mesmerized into agreement. Sometimes less is more and this President needs less exposure.

I supported Obama so I am not some right winger bashing him. I want him to succeed but I ask him to listen less to Pelosi and more to his own moderates. We can wait another year for the right plan, widely supported, and widely vetted.

I regularly watch CNBC in my home office as I sit and write about or study DTC issues. The two activities are not related since I watch CNBC to track my investments(mostly energy) not to find DTC information. Today, on 7/15, I was unpleasantly surprised around 2:30 pm. Erin Burnett, an anchor I usually find very competent and one of their best, decided to ask some guest Congressmen to comment on some ideas to reform health care. She showed each idea as a chart that was stated in a problem solution format and promoted these ideas as specific ways to save money. I assume these are ideas she or her producers developed themselves or read about. The first idea was to end obesity as a covered anti-discrimination category under the disabilities act allowing employers to “encourage” weight loss. The second was to mandate living wills so people can choose to die earlier and avoid costly life maintenance procedures in those final few months.

The third idea was to ban DTC. Burnett said it would save $4 billion a year and end the practice of encouraging expensive brands over generics. She said it was outrageous that drugs are advertised. I was expecting big ideas on cost savings so I was shocked that DTC would make CNBC’s list. Ms. Burnett said jokingly we need to kill all the lobbyists since they inhibit change.

Ms. Burnett then posited her DTC cost saving idea to a Republican and Democratic Congressman. Would they ban DTC she asked? Democrat Frank Pallone said no. His rationale was very pragmatic. He tried in the past and said First Amendment and media company lobbying made that a no go. The Republican, John Fleming, a practicing M.D. said he feels we should not ban DTC advertising because it brings in people who are then diagnosed and educated on important medical conditions. I was relieved that a frequent industry critic like Pallone had put a ban on DTC off the table on both theoretical free speech grounds and very pragmatic media company constituent lobbying grounds. I sensed Frank Pallone has had enough of the DTC ban discussion for quite a while. The latest reform bill out of Congress does not have punitive tax treatment of DTC in the bill. I suspect the lobbyists used the First Amendment argument to discourage that idea.

Ms. Burnett seemed annoyed that such a practice could not be banned. First she needs to understand that banning DTC would not save $4 billion. Drug companies would not return that money to consumers but instead use it for other promotion or to add to profit for shareholders. Second, she assumes DTC leads to choosing branded drugs over equally effective generics. In fact she asked the Congressmen if generic Lipitor is worth using as a preventative. There is no generic Lipitor and her lack of awareness indicates the problem. Brands are usually prescribed because they are improvements over generics. Most doctors and most patients want to use generics when they become available. It is just that many of the newest medicines are not available as generics. It is true that some brands are no better than older versions available as generics. That cost/benefit decision is up to the doctor and of course the patient. DTC does not make a doctor or consumer choose a brand over a generic.

Ms. Burnett, by discussing DTC as one of three big cost saving ideas, once again shows how the media over plays the impact of drug advertising. That $4 billion spent is about 1.5% of annual drug sales in America. It adds about $8 billion in sales incrementally based on an ROI of 2 to 1. That $8 billion motivated by DTC is less than one third of one percent of our $2.4 trillion annual health care spending. DTC is not a cost problem in our health care system. It is rounding error at most. I keep telling the critics that DTC is an effective but minor promotional tactic. Just because you see it in prime time does not mean it is important. It is very important to me, ad agencies, media companies, pharma marketers, managed care but not to the health care system overall. Highly visible does not always mean highly important.

DTC is just one small part of the prescription drug information system, albeit information meant to sell more of the advertised drug. Do you really think the government plan currently proposed will provide only information meant in the best interests of its patients? No, that system will try to save cost by promoting cheap drugs that are adequate, not necessarily the best. DTC is designed to offer alternative information that is as subjective as government information will likely be. No information source is totally objective, as everyone has an agenda. Government wants to save money; insurance companies want to add to profit, doctors are influenced by habit, detail reps, insurers or peers. No one is unbiased so therefore consumers must take the final decision in their own hands after evaluating multiple points of view. A ban on DTC will just remove a portion of that biased information, leaving the cost mavens to push cheaper, but perhaps less effective drugs.

The health care reform debate has a new version of DTC, not meant for consumers to influence doctors on drug choice, but instead to voice their opinions to Congress. The pro-Obama plan supporters and the anti-government involvement groups are doing mass media aimed at influencing Congress. The commercials are designed to get consumers to contact Congress and are also designed to show Congressmen that their vote will be a campaign issue in the future.

According to an Associated Press story this week, $31 million has been spent so far on lobbying ads. Ads for Obama’s plan have bought $15 million in media, anti-Obama $4 million and PhRMA has spent $12 supporting reform, but not specifying how to do it.

The approach of the anti-lobby has been to point out that government controlled health care takes decisions away from your doctor and puts government bureaucrats in charge. The pro-reform ads talk about unaffordability and lack of universal coverage. One anti-plan ad has a Canadian woman who said she had to come to the U.S. to treat her brain tumor because of delays in treatment in Canada. The Wall Street Journal, in an editorial July 7 against Obama’s plan, shows how the U.K. rations health care and expressed concern about America adopting a similar plan. They say the real Obama plan will lead to rationing despite that fact being absent from any of his speeches. There is truth to both sides but neither is right.

The anti side is using the usual big brother will control your health care argument. That is a very simplistic view of Obama’s plan. The pro side is using the unsustainable high cost argument, blaming high costs on insurance companies and providers. That is also unfair. The goal is to cover more people and reduce the inflation of medical costs so consumers and government can afford them. These types of DTC ads pander to partisan views that do not advance the issues. What we need is more coverage of the real issues and the true pros and cons of reform.

Obama is wrong that massive cost savings will come from encouraging more competition between government plans and private plans. Government and private plans must both ration coverage, a fact that is never mentioned by the proponents of the plan. Private insurers cannot offer plans that cover all pre-existing conditions without restricting benefits. Government cannot afford to have an affordable plan which is as generous a Medicare. The high end plan can only be offered if Americans accept significant tax increases which they cannot afford. The Europeans spend less by rationing. That is not necessarily bad policy but comes at a trade-off in speed and depth of care.

Cutting back on next day cat scans, elective surgeries, expensive drugs, and specialist visits may not be a disaster. On the other hand some Americans will die because of these cutbacks. Grandpa may be denied expensive care in the last few months of life. Someone with a severe headache may have to wait months to find out they have a brain tumor. Costs will be contained but at a price. I am not against rationing but I am against sugar coating this new system.

We may be better off with more centralized cost control. It may be the only way to afford care for everyone. As long as Americans know the truth I am content to accept more government control. Neither side of the debate is leveling, however, with the American public.

Obama is counting way too much on the cost savings of prevention and increased competition. The anti side is using old arguments that free markets will solve all our problems. They have not to date so why will they in the future? We do have too many diagnostic tests, too many specialist visits and a milking of the system by many for profit providers.

The DTC ads for or against reform are not doing the issues justice. I am for their right to do the ads, but I also urge the media to give the reform issue as much coverage as they do the death of Michael Jackson. Like it or not the American people need to get involved and our politicians owe them the facts of the new plan. Obama’s reforms have some positives, but also some serious flaws.

What I would like to see is some public interest group running ads calling for delay in reform. Obama wants a bill by October but I contend it is the wrong October. 2009 is just too soon, and having a full year to study and debate with the goal of reform by October 2010 is more advisable. I want reform, so do most Americans on all sides of the political spectrum. Having a broad bi-partisan consensus can be achieved, but not if the Democrats want to ram it through this year.

I do not have faith that a rushed Congress will get anything right, given their long horrendous track record on a host of critical issues. I watched the C-SPAN coverage of Chris Dodd’s committee on reform. It was not a pretty sight. These Senators are by and large intelligent folks, but are outmatched by complexity of major changes. Given a year of study and debate, I think they can do it right. Expecting them to complete this in a few weeks will lead to a complex, cumbersome, and faulty bill. I know Obama’s advisors want him to move while he has maximum political capital. If he is wrong, as I think he is, he will eat up that capital once the public discovers the numerous faults of his plan. The latest comments from his spokespeople say they will compromise in order to get a bill passed this year. That likely means a bill that uses a band-aid approach rather than the major surgery needed. The old carpenter’s saying of measure twice, cut once applies here.