Free Markets, Free People


So are we in “death panel” territory here?

David Leonhardt spends about a 1,000 words in the New York Times banging around the edges of what has to be done by government to cut health care costs. Or, as he calls it “In Medicine, the Power of No”. He wonders if we can every really learn to say “no”. And, of course, he’s talking about saying no to sick people, to patients – denying them care.

From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.

So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. “Being able to say no,” Dr. Alan Garber of Stanford says, “is the heart of the issue.”

Maybe I’m reading to much into this, but what is being said here is “the new agencies” which will be “in charge of carrying out reform” need to learn to “say no”.

Huh? I thought all this reform was about leaving such decisions about treatment between your doctor and yourself and not those evil, mean insurance companies. Who are these agencies – these “new” agencies – and why are they in they charged with “saying no?” If they’re “new” they’re a creation of the HCR monstrosity and if they have the ability to say “no” aren’t they strangely like the supposed mythical “death panels” Sarah Palin commented on?

Of course any sane person reviewing the claims of those pushing this piece of garbage known as health care reform knew that to drive down costs, rationing and the denial of care was not only possible but absolutely necessary. And, like so many other aspects of this bill, what was promised to gain support is almost the opposite of what was passed in the legislation.

Leonhardt knows where he’s going with his piece, but he is loath to actually say it. So he dances all around it, but if you read carefully you understand that despite all the rigmarole about bringing patients in on the decision and his belief that if they’re informed they’ll choose the least costly methods, he understands that as he says in his title that someone in authority is going to ultimately have to say “no” to make this work. And that pretty much means, much to the chagrin of the left, that Sarah Palin was right.

~McQ

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41 Responses to So are we in “death panel” territory here?

  • Medicare denies more claims than any private insurer.  That’s what we’ll be headed for in order to reduce costs.
    Unfortunately, the people who think others should pay for their health care don’t understand that means others decide what health care they get.
    My advice:  your financial planning MUST now include the assumption that you will have to pay for all of your health care out of pocket as you age.  I’m 40, and I’m assuming that I’ll means test out of Social Security (it’s coming) and will have to go to a private market sans insurance (legal or not) to get my healthcare when I retire, if not sooner.

  • Insurance companies say no quite often, often with deadly results.  They deny coverage for numerous conditions, refuse to pay for some procedures they deem ‘experimental’ or they can find an excuse not to cover, and they won’t cover those who can’t afford to pay.   The insurance company and the market, by your logic, represent death panels already in existence.   Tens of thousands die each year, thanks to their ‘death panel’ decisions.   Take away the profit motive from insurance companies like they have done in Germany and Switzerland — where companies still compete and operate effectively — and you’ll get fewer, not more, irrational “no” responses.

    • Again, you simply have no clue about the dynamics of power, and the differences between private contract and a contract with the government where the government can alter the terms as it sees fit.

      You can always shop around for another health insurer and accept or reject the terms of coverage. You can’t shop around for another government, and you will have no say whatsoever over the terms of the coverage.

      What was needed was more market in health insurance, not less, and certainly not more government bureaucratic authority.

      • And if push comes to shove, you can pay out of pocket.

        That won’t work as well after Obamacare drives up costs, however.

    • If an insurance company says no, does that legally bar you from said treatment? It does not, they could only refuse to pay it. If the government says no, they can refuse to allow you to receive it. Big difference, very big difference. All pretense accepted, insurance companies are bankrupty panels, not death panels.

    • So, what is the rate of denial for Switzerland and Germany? Zero? I doubt it.

      • Perusing on-line the Swiss law says what is covered and what is not.
        Thus, they too have a death panel. I wonder if aromatherapy is covered?

    • You just can’t bring yourself to admit you fell for the lie like the foolish little liberal twerp that you are, and now you’re going to rationalize.  Didn’t take nearly as long as I thought.

      You can sue private companies and jury awards as we know can be quite startling (and frequently ridiculously excessive, hence much of our problem) let me know how that works with the Government.

      Enjoy the great new plan that brings us up to par with the rest of the ‘civilized’ world.

    • Take away the profit motive from insurance companies like they have done in Germany and Switzerland — where companies still compete and operate effectively — and you’ll get fewer, not more, irrational “no” responses

      >>>Um…take away the “profit motive” from insurance companies and you’ll see fewer insurance companies.  Or is what’s going on in MA not enough proof for you?

    • ” And that pretty much means, much to the chagrin of the left, that Sarah Palin was right.”

      And by the way, THIS was the point, the mockery made of Palin by the left.  Now you’re headed down the path to excuse the fact that you recognize her perceptions were WAY better than yours because she saw it as inevitable, and that it would be controlled by GOVERNMENT.  WE ALL KNEW IT (because we’re adults, and pay bills, and understand the most fundamental economics, as opposed to your lofty poly sci economic understandings) and you were busy waving your hands in a dismissive fashion when you were told it would come to this.

    • “Take away the profit motive from insurance companies ”

      Perhaps you should learn more about the health insurance market before you pontificate about it. There are numerous non-profit health insurance companies, Kaiser and Blue Cross for example.

      “Take away the profit motive from insurance companies like they have done in Germany and Switzerland — where companies still compete and operate effectively”

      Why, then,  do they compete? 

      “and you’ll get fewer, not more, irrational “no” responses.”

      I assume you have some proof that all those responses are ‘irrational”?

      Didn’t think so. Just more blather.

    • “Insurance companies, blah blah blah, (insert anecdotal story here.). “  At least with an insurance company you can take them to court or at the very least cause them bad public relations, at least you have choice.

      When this Obamacrap takes full swing all those options will disintegrate. You will be limited in your ability to sue, you will be increasingly limited in choice, and in time it is designed to lead to a single payer, and of course that single payer will deny many many more claims, because of course, we cannot afford any of this crap.

      It is sad that your common sense takes flight because you have an ideological animus against the free market.

  • An ugly little fact about health care: like any other service, there is only a finite amount.  Even if there were more of it than were needed, and there isn’t, there would still be only so much of it.  And like any service, there are two ways of allocating it: let the market muddle through it with buyers and sellers arriving at some sort of equilibrium, or bring in the government to parcel it out. Which means the rise of some sort of bureaucratic method of determining who gets care and who doesn’t. It may not look like Palin’s death panels, and maybe there isn’t even a physical “committee” as such, but some apparatchik somewhere calls the shots.

  • Note how it’s the collectivist “We” that must learn to say “No.”

    In fact, America is based on the individual’s capacity to say “No.”

    Leonhardt, last year, wrote a defense of Nazi economics for the Times vis a vis the then just rising national socialism of Obama.

    In this new formulation by Leonhardt, which has clearly been implicit to this health care fiasco all along, individuals are essentially treated as part of “illness demographics.”

    Recall my own formulation about how this would go: eugenic editing in utero at the beginning of life (mass “therapeutic” abortion to preventively ease unnecessary stress on the “system”), enthusiastic euthanasia at the end of life to eliminate wasteful care, and “wise” rationing in between.

    Everything will be programmed for the “success” of the system. The target market will be the healthy, who will be happy, until they get sick and have to face the reality of it. But the numbers will be smoke and mirrors to keep the healthy feeling secure.

  • I’m sure the  good little totalitarians will soon say, these measures will only be necessary “until the emergency passes”.

    Other possibilities from the Excuse Machine Of The United States
    “We didn’t realize it was this critical”
    “There were unexpected costs involved”
    “If it had been passed when we originally proposed it”
    “In order to be fair”
    “It’s all George W. Bush’s fault” – oh, wait that can’t…well, maybe we can, but not just yet.
    But you have to admit, it didn’t take them long to start nudging the meme towards reality.  The ink on Imeme’s signature is barely dry.

    • You missed the most important one: “If only Barack knew.”

      • Heh, I used to think he was bright, but frankly Martin, he’s too caught up in how wonderful he is to figure it out on his own.  He’s the kid that everyone thinks is smart but constantly makes excuses for failures and never seems to accomplish much.  I don’t know what version of social reality he lived in prior to being President, but it wasn’t the one most of the rest of us live in where the consequences of life are always a short step behind most decisions we make.

      • Heh, PS, I got this great looking paper back in the mail yesterday by some guy who’s using your name as a pseudonym.

  • If millions of more people out there are getting insurance they didn’t receive before, then any kind of rationing is a still a net gain.  What am I missing here?

    bb

    • That health care provision is finite and that insurance does not guarantee access.

      • For those without insurance, health care is extremely finite and access is damn-near impossible.

        Maybe some folks would take a death panel over certain death any day of the week.

        Cheers.

        • Really – so who are all those people in emergency rooms, then?

          And how much of what you aren’t willing (or able) to pay for do you normally get? In my world, not much.

          Or do you subscribe the the theory that you have a prior claim on the “finite” abilities of health care providers whether you can compensate as they demand they be compensated or not?

          As for death panels, the question remains – does what Leonhardt describes fill the bill?

        • Pogue, that’s just BS.  I know of one person w/o insurance who’s kid needed surgery, etc. and worked out a plan to pay it off over time.  I doubt she’s the only person who does this and every bill I’ve ever received from a provider states that payment plans can be arranged.

        • For those without insurance, health care is extremely finite and access is damn-near impossible.

          You clearly don’t know what you’re talking about.  I’m without insurance (by choice) right now, and I have no problem getting access to health care when I need it.  It’s as simple as picking up the phone and calling my doctor (who is more than willing to offer me a discount for saving him the trouble of billing insurance).

          • Clearly, I was referring to people who can’t afford health care out of pocket, or even in installments.  Anyone with means can get all the health care they want, with or without insurance.  Don’t play dumb.
            For people who do not have means, and do not have emergencies, their ability to acquire health care is limited by simple finance.

            Folks with chronic ailments, and fall between qualifying for medicaid and earning just enough to pay the rent and bills, most often just have to live with it.  And if one is already on medicaid or medicare, the health care is already rationed as it is… so nothing new there.
            Faults with Obamacare start and stop with “we can’t afford it.”  No need to make silly arguments about “death panels.”

          • Keep up Pogue – people without insurance who can’t afford medical care go to emergency rooms for routine care because emergency rooms can’t turn them down or make them pay. If that’s too complicated for you, that means they get it free. The whole argument is that costs taxpayers more so we ought to give them insurance. Unfortunately insurance doesn’t guarantee access. So, as MA has learned, they still go to the emergency room and the numbers haven’t dropped a bit. But no one -anywhere- is denied medical care if they seek it. They just have to wait for hours on end in an emergency room instead of a comfy doctor’s office listening to Muzak. The upside -for them- is they don’t have to worry about that annoying demand they actually pay for the services they received.

            The “death panel” argument, which apparently went over your head, is contained in the article cited. So the question remains: does what Leonhardt describes fill the bill? Is he describing new decision making process which has the power – through various panels – to deny care? Remember, the promise was those decisions would be left up to you and your doctor. What he describes doesn’t promise that at all. So, are what he describes virtual “death panels”, in that they can proscribe certain care and deny treatment which that body may deem too expensive or of only “marginal” value? If so, why wouldn’t that be a virtual “death panel” since it would be engaged in making treatment and care decisions that would be potential life and/or death decisions?

            So, does Leonhardt describe such a system?

          • McQ - [P]eople without insurance who can’t afford medical care go to emergency rooms for routine care because emergency rooms can’t turn them down or make them pay. If that’s too complicated for you, that means they get it free.

            I had a chat a few months ago with an ER nurse from one of the smaller cities in western No. Carolina.  He described exactly what you say, with the added twist that he felt like a family nurse to many people because they were routine patients he’d been treating for years.  In other words, they were deliberately using the ER as their primary care.  Not only did they never pay a dime, they often got quite extensive and expensive testing because the ER docs, fearful of being sued by these freeloaders, were taking no chances.  To add insult to injury, these people also refused to practice the sort of “preventative health care” that the doctors would tell them to do.  Imagine seeing a patient demanding free care for a bellyache even while he’s chomping on a bag of chips and sucking down a super-sized Coke.

            Who pays for all this?  Answer: the regular patients of the hospital who had their bills jacked up with an unwritten “freeloader tax”, as well as the rest of the people in the community had had hospital resources diverted from improving facilities, hiring more staff, etc. AND providing a safety net for people in real need.

            I realize that this story is anecdotal, but I suspect that a study of ER expenses around the country would show that billions are spent each year not only providing health care to the uninsured, but also to the outright freeloaders among us.  Natch, neither the government nor MiniTru had any interest in this sort of information during the debate, when the narrative was evil insurance companies, greedy doctors, and poor folks dying in the streets because they just can’t get health care.

          • Sorry, Pogue but Faults with Obamacare start and stop with “we can’t afford it” may be your take on ObamaCare – but from my perspective it is far simpler than that:
            What is it really going to cost?

            After so much BS with the double counting, the Doc Fix, Cutting Medicare or not cutting Medicare, the elimination of fraud in the system or not,  and the list goes on and on – the democrats did a singularly masterful job at one thing – Obscuring the cost of ObamaCare.

            And the only reason they would do that is because the cost is so astronomical, they can’t afford to let anyone even have a hint at what the true cost will be.

            I got no problem with providing safety nets to those who cannot help themselves.  I got no problem with reforming the system so that individuals with pre-existing conditions are not segregated from health care access.   I got one singular problem – the democrats purposely hiding the true cost because just maybe “we can’t afford it.” 

          • “Clearly, I was referring to people who can’t afford health care out of pocket, or even in installments. ”

            It wasn’t terribly clear. 

            “For those without insurance, health care is extremely finite and access is damn-near impossible.”

             

          • “Clearly, I was referring to people who can’t afford health care out of pocket, or even in installments.”

            No, it was not clear. Do not blame your confusion on others. Health insurance is still not health care, no matter how many times you say it. And clearly, you have never heard of medicaid or private charitable institutions. 

        • “access is damn-near impossible.”

          Horse hockey.

  • So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform.

    Note the statist, Orwellian instinct of the lefty: don’t try to figure out how to make a system work.  Rather, try to figure out how to package and market failure so that the proles will keep buying it and think that they’ve gotten a great deal in the bargain.

    Why do I have visions of “Home” in Soylent Green?  Do you suppose there’ll be a government panel to help us choose the music and images that we want while we (ahem) “bend the cost curve down”?

    • From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing

      >>> Yes, because “saying no”  to save resources  ISN’T RATIONING  the same way the individual mandate to buy policies ISN’T A MANDATE because it’s really some other word game they use to mask the true intent.

      Docjim hits the nail on the head.  It’s not “rationing” we’re “simply saying no”

      And either way, as  Obama himself said, Grandma gets the pain pill instead of the surgery (and the pain pill will be eliminated in time, look to the NHS hospital horror stories for examples of what our grandkids will have to deal with when they get old)

  • And in case you didn’t see people now want to know where they’re “Free” insurance can be obtained.

    And any misapprehension that it’s ‘free’ is, according to some, a result of the people fighting it claiming it was socialist.  Yeah, uh huh, it was the guys who didn’t WANT it that convinced people it was going to be free.

  • I was thinking about these other European systems. I am curious, how many pages were the bills that created them? It would be interesting to see if they needed 2700 pages to get them passed.


  • McQ[P]eople without insurance who can’t afford medical care go to emergency rooms for routine care because emergency rooms can’t turn them down or make them pay. If that’s too complicated for you, that means they get it free.”

    and that was supposed to be the bleedin argument behind this horror show bill – that these people would NOW have insurance, with which they could pay these bills, which would “reduce the cost’ of medical care by properly shifting the cost of ‘free’ medical care that has routinely been passed on to all the other people who DO pay the bills.  That’s the crux of this tremendous project – cost containment.  Imeme and pals peddled insurance ( = medical) costs to both private payers and GOVERNMENT (Medicare/Medicaid) as if GOVERNMENT was paying the whole damned bill in the first place.  They consistently and constantly quoted figures that led people to believe that all these costs were born by government and we needed to address it.

    And in the process, constantly, and consistently implied that NO INSURANCE meant NO MEDICAL TREATMENT.  WHICH IS BULLSHIT.

    But since the media was complicit in the deal, and since otherwise intelligent people decided to turn off their brains during the discussion we now have this.  Which will be no better, except for the distinct possibility that you’ll no longer be able to buy treatment, no matter how much cash you have, because the government may be able to regulate who gets what treatment,  when,  and occasionally has to ‘just say no’ for the good of society.

    So congratulations, hornswaggled when electing this inexperienced arrogant little turd, and hornswaggled again with his medical insurance plan.   “Fool me once, shame on you, Fool me twice….”

    How many times will the country buy into his,  and his party’s,  quickly broken promises?

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