Glimmers of Understanding?

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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