Have you ever seen Kiss of Death, the 1947 film noir cult classic? It has an explosive scene wherein the psychotic Richard Widmark shoves an elderly wheel-chair bound woman down a flight of stairs to her death. He’s laughing all the while.

Well, it seems that this powerful imagery has found its way into the health reform debate. A group called AmericanDoctors4Truth  has launched a television ad showing President Obama, played by an actor, pushing an elderly woman in a wheelchair off a cliff as she begs for mercy. As the press release dutifully accompanying the spot notes: “The ad uses Obama's own voice and words from a televised health care forum on how the Independent Payment Advisory Board (IPAB) would determine medical care: ‘Maybe you are better off by not having the surgery, but taking the pain killer’ in response to a question about how bureaucrats would determine who qualifies for what medical treatment.” In the ad, the senior needs a pacemaker—the demonic Obama then pushes her off the cliff.

The ad openly mimics another commercial produced last May by a left-wing group showing House Budget Committee Chairman Paul Ryan (R-WI) depicted by an actor, also pushing Granny off the cliff. This spot was a crude attempt to scare seniors into believing claims that Republicans wanted to end Medicare.  In contrast, in the new AmericanDoctors4Truth ad, trusted doctors catch “Granny,” rescuing her from “ObamaCare and government bureaucrats newly empowered to override doctors' decisions on medical care for their patients.”

I’ve watched both videos and they make me wince—but not in the same way Richard Widmark did. In these modern day iterations, the main thing being thrown over the cliff is rational discourse. The tasteless spots do nothing to inform an otherwise complex issue. Instead, they propagate the simplistic worldviews of the left and right wings. The videos typify the polemics that have framed so much of the public debate over Medicare and health care spending in general.

It’s a debate underscored by a great deal of fear and uncertainty—the customary underpinnings of demagoguery. Of course, there is good reason for anxiety. The United States faces a serious economic dilemma in its rising health care costs. And the Medicare budget is only part of the problem. A growing spate of costly, chronic illnesses—often exacerbated by our increasingly inactive lifestyles—threatens our long-term productivity. According to one estimate, the annual tab for direct medical care for chronic conditions will reach $685 billion annually by 2020. A recent analysis in the Annals of Family Medicine says that if current trends continue, health insurance premiums will surpass average household income by 2037. Now you can find fault I’m sure in these studies. But good luck finding an affordable health care plan.

Our capacity to absorb rising health care costs is not unlimited. And that’s a theme I’ve heard sounded again and again at recent conferences—from both payers and providers. The industry’s steadily emerging financial crisis is a big driver behind the government’s I.T. incentive program. For meaningful use to succeed in its push to promote quality and constrain costs via clinical data exchange, an unprecedented level of collaboration will be required. Both payers and providers are starting to understand that. Pragmatists at heart, they are managing to shed the “us versus them” mentality that runs so rampant in the political world.

To them, the person in the wheelchair is a real patient—not an actor hired to rile up the electorate.

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