Archive for October, 2009

Glimmers of Understanding?

October 17, 2009

In the last several days, a vague understanding of the health care disaster we face seems to be coming from an unlikely source – Senator Harry Reid.  On Thursday, Senator Reid stated that the cost of the proposed health care reform “bill” would be “two trillion dollars.”   In view of the fact that no actual legislation has been drafted and that the initial CBO scoring was based on pure guesswork, with some creative accounting thrown in, Senator Reid’s guess is a much more honest assessment.  (Part of the fudge factor in the CBO estimate is the immediate counting of tax revenues, whereas the expenses do not start until 2013 – thus there are 10 years of taxes and only 6 years of expenses in the CBO estimate, making the proposal appear more sustainable than it truly is). 

Yesterday, Senator Reid penetrated to another level of the problem – the fact that the proposed reform counts on fee cuts of 25% to doctors performing Medicare procedures.  These cuts, in fact, are at the heart of the proposed system – forming its basis for fiscal solvency; but more than that, as Mr. Reich pointed out in his now famous audio clip, one of the three essential philosophical pillars of the program is “We’re gonna let you (Seniors) die.”  If you have any doubts about that, look at  Dr. Ezekiel Emanuel’s resource curve published in the Lancet in January, 2009.  This curve shows your probablility of receiving costly medical intervention as a function of your age under Dr. Emanuel’s “socially responsible” medical system (for more information see “Obama’s Health Rationer in Chief” in the links section) :

 

 [mccaughey]

As you can see, Dr. Emanuel’s vision is that seniors would be about half as likely to receive therapeutic intervention as a 10 year-old, and about one-fourth as likely to receive treatment as a “productive” 20 to 40-year old.   This is not just some byproduct of the reform measures – Dr. Emanuel is a key Obama advisor, and his vision informs the Administration’s philosophical approach to health care reform – this “cost effective” apportionment of resources is the very essence of the envisioned reform effort.

Yesterday, Senator Reid stated that the short-changing of doctors fees under the proposed reform measures would lead to Seniors being unable to get adequate care, or perhaps even to see a doctor.  He also stated that this situation needed to be “fixed.”  Even Speaker Pelosi agreed that doctors fees needed to be revised “over ten years.”  The problem?  This pricetag for maintaining doctors’ fees is $200 billion to $300 billion, and would ruin the vaunted “revenue neutrality” of the Baucus “vapor bill.”  The solution?  Senator Reid intends to bury the doctor fee put-backs in a separate bill that will follow later – after Public attention has moved on to another subject.  Perhaps Democrats are unaware that there are folks like myself who will insist on calling Public attention to this tactic, but, more likely, they just calculate that what the Public thinks simply doesn’t matter.  

UPDATE:  The Doctor fee put-backs were actually voted on in a separate Senate bill on Thursday October 21, and the bill went down to defeat 53-47 with all 40 Rs and 13 Ds voting “no” on a motion to bring the bill to the floor (13 votes short of the 60 required for action). This defeat was largely based on reluctance to embrace the $247 billion pricetag.  Unlike other pundits, however, I do not see this as a resounding defeat for the Administration.  Congress still intends to go forward with some separate bill which addresses the doctor fees, they will just do it in smaller increments of 1 or 2 years to keep the apparent costs low, and to deflect public attention from the fact that health care reform will not save any money.   

While I am somewhat encouraged that there appear to be at least some lawmakers who are starting to understand the reality of the system and who are starting to become alarmed at how it will impact our access to treatment, it is still discouraging to see how they are trying to hide this reality and the true costs from the public.  Clearly, the Doctor fee issue should be folded into any health care reform bill, including its cost for the full 10 year CBO scoring period.

Nevertheless, two months ago, such an admission by Senator Reid regarding reduced access by Seniors would have been impossible, and if the Congress had acted at that time, we would now be stuck with a truly horrible bill.  As I have stated before, we critics  have actually won the health care debate.  We are just having difficulty getting the word out.  We can only hope that more honest conversation will continue, and that ultimately pragmatism will prevail sufficiently to spare our lives, our economy, and our freedoms.

The Skeptic

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Endgame for Health Care Legislation

October 2, 2009

We have now come to the beginning of October and all sensible debate on the health care issue seems to have ended.  In the last several weeks, the conversation has degraded to a debate whether the critics of health care reform are primarily motivated by racism.  Now a Democratic Representative has claimed that Republicans simply want patients to die (although he has not addressed the views of opponents, the Skeptic included, who are actually Democrats, who are critical of the proposed plans.  Do we also want patients to die?  If so, what is our motivation?  For the record, the Skeptic was surprised at the Representative’s statement since, to most of us critics, it appears that it is the Democratic health care scheme that  considers the early demise of the elderly as economically and socially prudent -see “Obama’s Health Rationer-in-Chief” in the links).

Apart from these political side-shows, the end of debate was also signaled by surprising new trends in media coverage.  Newsweek Magazine had a cover story “The Case for Killing Granny.”  The Washington Post had an article describing rationing as a sensible approach to cost control.  MSNBC on-line had a story musing about whether the U.S. has too many MRI machines which cost too much money.  The CBO chief’s testimony to the Senate, in which he stated that the anticipated Medicare cuts would not just cut out overpayments and misuse, they would indeed result in reductions in coverage and increases in costs to patients, could not be ignored and was widely reported.  Also widely reported is the mandatory nature of insurance coverage and the penalties to citizens for noncompliance.   The common thread in all of this new media coverage is that the advocates of health care reform, and their friends in the media, have basically dropped their aggressive claims that there are no problems with the health care reform proposals and that critics are merely spreading misinformation.  Gone also is the pretense that health care reform would  only be positive and would give  us a system very similar to what we currently have, only better –  that reform would simply “fix” our “broken” system.    

The new media take seems to be a grudging admission of what many Americans have come to realize – unless you are in Government, or in a union, or in a large insurance or pharmaceutical company, these reform efforts entail almost “pure pain”  – rationing, lowered standards of technology and care, reduced access to care for the elderly, the need to choose cost-effectiveness over compassion, increased out-of-pocket expenses for many etc.  Mostly, the new media coverage seems like  a belated attempt to inoculate the Public regarding the downside of health care reform.  “OK, so there’s some truth to the criticisms,” they seem to say, ” Sure, we will lose some aspects of what we have, but we have too big and wasteful a system to begin with.  Less is more.”  Naturally, this sort of message is difficult to sell to the Public because people don’t like to think about hardships, especially when they were originally promised some sort of utopian vision. 

So, now that we have come a long way toward reaching a rough National consensus on the huge impact the envisioned reforms will have on our health care system, it’s easy to see that the whole debate was ineptly framed by the Administration from the beginning.  They needed to inspire Americans that these undeniable hardships are sacrifices which are  necessary in order to have a more sensible and fair allocation of scarce resources.  This argument has never really been properly developed and discussed.  It has taken a dismal last-place behind insulting, placating, demonstrably false idiocy such as “You will be able to keep your insurance.”  Cost-saving was also emphasized – but that was hardly an inspirational argument, especially in a year when bail-outs and pork in the $trillions has flowed out of Washington.  With such Government largesse on display, the Public has had a hard time understanding why, exactly, it is an urgent priority that, out of all the bloated Government spending (much of it unmandated-going to entities to whom we owe nothing), it is only  health care spending (and benefits) that need to be cut.   To put a new spin on the old phrase – “Bad Fiscal planning on your part does not create an emergency on our part that can only be solved by letting you screw up our health care.”

For some time now,  President Obama has been requesting an end to the health care debate.  Now that we are approaching the end, it is ironic that this seems to signal that the Administration has essentially lost the debate.  From here on, reform legislation will almost inevitably become increasingly unpopular.  So where do the Democrats go from here?  Will they simply try to push through a partisan bill although they know it may mean defeat in 2010?  Will they pull some dramatic stunt like reconciliation, or the newly hinted at parliamentary procedure to vote cloture on an unrelated  “shell” bill and then amend it to include the health care reform bill which can then be approved with a straight up 51 vote majority?  (see the link “Reid’s Trick to Bypass Congressional Opposition to the Health Care Bill” )  This latter option holds the slight promise of some sort of “cover.”  Senators in vulnerable states could vote “yea” on cloture, and then vote “nay” on the final bill and try to convince their constituents they voted “no” on health care reform. 

The Skeptic has no expertise in these matters, but in the current absence of any real bill to discuss, we might as well speculate.  My guess is that not enough Senators will endorse such a non-democratic course of action on a matter that holds the Public interest, and even passion, to the extent that this issue does.  Flouting Public sentiment to this extent would probably not fit the image of the senior, deliberative legislative body that the Senate sees when it looks in the mirror. 

I predict that Congress will still try to get some Republican support for the final product.  The result? –  a truly messy piece of legislation that even proponents will have a hard time supporting, but which they will support, nevertheless,  if only to save face for the President.   There are few good options in sight at this point.  Frankly, no bill at all might be the best possible outcome, but this is politically untenable after all this effort.  Realistically, I believe the best we can hope for is a bill that provides optional methods for compliance, and which has relatively few enforcement teeth.  Hopefully, such an approach might reduce the intrusion of Government into our lives and freedoms, and might leave us an outside chance to still receive quality health care.  But, I must admit to you, such a positive outcome is probably a longshot at this point. 

The sad thing is, that, after all is said and done, the resulting bill will probably not do anything substantial to solve the real problems that we will face in the future regarding health care access and costs.  The reason?  Because most of the economically realistic solutions were never even considered during the process of drafting these bills!  Even while, in the Public debate,  truth is gradually triumphing over spin, Ideology has still defeated practicality at every turn in the proposed health care legislation.


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