president Promotes ObamaCare Amid Republicans Delaying Efforts

Republican lawmakers are trying hard to block the implementation of the Affordable Care Act popularly known as ObamaCare, which aims to provide affordable coverage for millions of Americans without health insurance. The law also aims to provide more comprehensive coverage and lower costs eventually.

House Republicans have a new strategy to block Obama Care—a compromise to raise the debt ceiling, but they are pushing for a vote to delay the health care law this weekend. Last week, the Republicans forwarded a bill to the Senate seeking to defund Obama Care.
On Thursday, House Speaker John Boehner maintained the position of his fellow Republicans. He said, “The American People don’t want the President’s health care bill.”

President Obama promoting ObamaCare

On the other hand, President Barack Obama is aggressively promoting ObamaCare prior to the implementation of a major provision of the bill on Tuesday, October 1, wherein government-regulated insurance exchanges are set to open.
In his speech at Maryland Community College, President Obama condemned “misinformation” surrounding the law, but he pointed out that Republicans failed in every step they take to stop it. “The closer we got to this date, the more irresponsible folks opposed to this law have become,” according to the President.

What you need to know about Obama Care

Under ObamaCare, most Americans should have health insurance by March 31, 2014. Government regulated insurance “exchanges” will be open for people who do not have health insurance from their employers. Through the “exchanges” people can purchase health insurance from competing insurance companies.
The exchanges will categorize the plans by tiers such as platinum, gold, silver, and bronze. The average cost for a silver plan is around $328 per month. The government will provide a subsidy for those whose incomes are 400% below the poverty level ($94,200 for a family of four) and ($45,960 for an individual).
Insurers cannot penalize people with underlying health conditions. They might be able to save money under the Obama Care if they are currently paying more because of their medical condition. The choice of doctors and hospitals maybe limited compared with their current insurance plans.
Americans who will not be able to buy insurance by March 31, 2014 could face a penalty of more than $95 per adult or 1% of household income in their 2014 tax bill. The penalty will climb to as much as $695 or 2.5% of income by 2016. People paying more than 8% of their income for health insurance and poor adults living in states not expanding Medicaid are exempted.
The health care law does not affect Medicare. Enrollment at government-regulated exchanges starts on October 1, and coverage starts by January 1, 2014.

The compromise: raising debt ceiling, delaying ObamaCare

This week, the House Republicans will propose a bill that would raise the federal government’s debt ceiling, but it contains a provision that would delay implementation of ObamaCare for one year. The bill will also include a provision for future tax reform, and the approval of the Keystone pipeline. The Democrats strongly oppose any budget bill that would defund the health care law.

What the White House's Diffidence Over Syria Teaches Us About Complex Medical Decision Making

Talk about a no win situation.  After seeing his "red line" go rudely unheeded, the President is facing the prospect of appearing weak if he does nothing or warmongering if he launches an attack.

Medical decision scientists ask: how did it come to this?

Mr. Obama is correctly admired for his "no-drama' informed style of decision-making.  And good physicians, says medical science, should operate the same way.  According to this recent New England Journal article, consciously deliberative and logical approaches to diagnosis and treatment selection are far more reliable than the intuitive shoot-from-the-hip pattern recognition that used to rule the bedside.

Psychologists describe the latter as "Type 1" processing while the former is "Type 2."   Think George W. Bush's gut instincts over Iraq's weapons of mass destruction versus Barack Obama's disciplined rationality when he decided to attack the Bin Laden compound. He undoubtedly used the same methodology when he was pondering Syria.

But, thinks the Disease Management Care Blog, there are limits to brainy decision-making when the choices are overwhelmingly numerous.  In this retail business-oriented TEDTalk, Sheena Iyengar points out that dozens of options lead to procrastination followed by bad choices followed by low satisfaction. 

It can also apply to foreign policy. Given the vast array of pieces and potential moves on the Middle East chess board, little wonder that Mr. Obama would procrastinate for days saying he has "not made a decision," then apparently select an attack option disdained by even the New York Times and then engender even more second guessing by the very Congress that the President has repeatedly criticized as unreliable.

Ditto health care.  The downside to shared decision making is that an overwhelming number of testing and treatment options can lead befuddled patients to a "you decide, doc" mentality that leads the physician to regress to "Type 1" decision-making.

The DMCB isn't too sure how TEDTalk's Dr. Iyengar's suggested solutions can help the folks in the White House Situation Room, but the DMCB wonders if the national security staff shouldn't have done a better job of presenting the Commander in Chief with 1) a limited number of choices that were 2) more "concrete," as well as 3) arranged into categories with the 4) low complexity options offered first. 

That 4-fold approach could help docs and patients too.  The DMCB looks forward to additional research in the area.

In the meantime, there is one additional medical rule that has withstood the test of time that may also be useful in dealing with Syria. The DMCB offers it up to business and politicians alike: primum non nocere.