I don’t use the “L” word very often but in this case it seems completely appropriate.
Would a government-run health plan upend the employer-based health insurance system used by 160 million Americans?
The Democrats claim the answer is ‘no’.
Sens. Edward Kennedy, D-Mass., and Chris Dodd, D-Conn., say their plan would preserve employer-sponsored insurance coverage and create an affordable public option for those who need it.
“The … bill virtually eliminates the dropping of currently covered employees from employer-sponsored health plans,” Kennedy and Dodd said in a letter to members of the Health Committee, one of two Senate groups working on health reform.
The bill includes a “pay or play” provision that would require employers to provide adequate coverage for their workers or subsidize a system that will.
“Pay or play” would require companies to pay the government $750 per full-time worker per year ($375 for part-timers) if they don’t offer health coverage, or if they offer “qualified” coverage but pay less than 60% of workers’ premiums. Small businesses that employ fewer than 25 workers would be exempt.
The Congressional Budget Office, which analyzed the legislation, estimated that by 2019 the same number of workers would be covered by employer-based plans as would otherwise be the case under the current system.
“It tracks what we’re seeing in Massachusetts,” a senior Democratic aide on the Senate Health Committee said on a conference call with reporters.
I’ve put the lie in bold. Why is it a lie? Anyone out there have a $750 a year health care plan? Anyone? I don’t know of a plan for an individual that costs only $750. If there is, then there’d be no reason for any of this nonsense would there?
And Kennedy and Dodd (and the Democrats), the supposed “experts” on health care know that very well. This is pure disingenuousness on their part. This is a blatant attempt to launch a lie to get them past a very important sticking point in the public perception of the bill.
But the average – average – individual health care insurance cost in the US is almost $4,000. And then there’s the cost of administering it.
Hypothetical – you employ 100 people. Let’s say your company pays full health care coverage at the national average (for simplicity sake, assume they all have individual policies). You have two people who administer the coverage at $35,000 each. Your total cost each year to cover your employees is $470,000.
If you pay the federal government $750 per employee a year, your total cost is $75,000. But you can let the two people you’ve had administering your health care program go, saving $71,500 (includes -$1,500 for 2 less employees). Total cost of “pay or play” for you? $3,500 the first year ($73,500 vs. $470,000 every year afterward). In reality, however, it is a net savings of $466,500. You don’t have to be a very good businessman to figure out that one do you?
And remember – these figures only involve “individual” coverage. Family coverage is much more costly, but I see nothing from our two Senate experts which even addresses that. So obviously, the cost of the health care of 100 employees could be vastly more than my simplified example.
No wonder we see corporations coming out now to back this sort of a program. For the vast majority of them, $750 per employee is a huge savings not to mention getting them out of the health care provision and administration business. They’ll pay it gladly. If you like your doctor or your plan, tough beans. You’re going on the government plan. And, of course, the administration will be more than happy to blame your problem on “greedy corporations.”
When they do, just consider the lie and the incentive it provides and then lay the blame precisely where it belongs. Not that it will do you any good where it concerns your present doctor and plan.
Just another step along the road to single-payer brought to you by two lying Senators and backed by the CBO.
A couple of quick examples of real world problems with government run health care. South Africa:
KwaZulu-Natal health MEC Dr Sibongiseni Dhlomo has issued an ultimatum to striking doctors, calling on them to return to work on Friday or face the music.
Addressing the media in Durban on Friday, Dhlomo said notices had been sent to all hospitals calling on all striking doctors, dentists and pharmacists to resume their duties no later than 08:00.
The department was also preparing a court interdict to force the striking health professionals to end the strike, he said.
“We as the department of health are designated as an essential service provider and therefore find the action of these health professionals [is] disrupting service delivery and compromising patients’ lives,” said Dhlomo.
He said the department had been more than reasonable in dealing with the unprotected strike.
“This situation is untenable, we cannot continue to put the lives of our people in danger and the government will act,” he said.
Dhlomo said people had died due to the unavailability of doctors, although he was unable give the number of people who died as a result of the strike.
A recent example you’re probably more familiar with from Canada:
A critically ill premature baby is moved to a U.S hospital to get the treatment she couldn’t get in the system we’re told we should emulate. Cost-effective care? In Canada, as elsewhere, you get what you pay for.
Ava Isabella Stinson was born last Thursday at St. Joseph’s hospital in Hamilton, Ontario. Weighing only two pounds, she was born 13 weeks premature and needed some very special care. Unfortunately, there were no open neonatal intensive care beds for her at St. Joseph’s — or anywhere else in the entire province of Ontario, it seems.
Canada’s perfectly planned and cost-effective system had no room at the inn for Ava, who of necessity had to be sent across the border to a Buffalo, N.Y., hospital to suffer under our chaotic and costly system. She had no time to be put on a Canadian waiting list. She got the care she needed at an American hospital under a system President Obama has labeled “unsustainable.”
And this one:
In 2007, a Canadian woman gave birth to extremely rare identical quadruplets — Autumn, Brooke, Calissa and Dahlia Jepps. They were born in the United States to Canadian parents because there was again no space available at any Canadian neonatal care unit. All they had was a wing and a prayer.
The Jepps, a nurse and a respiratory technician flew from Calgary, a city of a million people, 325 miles to Benefit Hospital in Great Falls, Mont., a city of 56,000.
Great Falls was better equipped to handle their case than was Calgary? People like to dismiss these as “anecdotal”, but they continue to describe a system in which decisions have been made that end up endangering the lives of children. It is inevitable when the primary focus of “reform” is “lowering cost”.
Doctor’s strikes. Limited if not completely unavailable neo-natal care. The refusal of the system, based on cost concerns only, to provide certain care that places the lives of those on the margin in jeopardy.
Is that what we have to look forward too?
[HT: Micaela S]
One of the favorite arguments of the government health care crowd is the supposed Medicare low overhead argument – i.e. Medicare is more efficient than private insurance because its overhead is so much lower than private administrative costs.
But the administration of Medicare is a miracle of low overhead and a model, despite all the fraud and abuse, of what government can do right. Three percent of Medicare’s premiums go for administrative costs. By contrast, 10 to 20 percent of private-insurance premiums go for administrative costs. Roll that figure around on your tongue. When you swallow and digest it, you’ll understand that any hope of significantly reducing health-care costs depends on a public option.
Right now, the Medicare average is 3% and private insurance averages 12%. But Tom Bevan points out, some of that difference is an apples and oranges comparison:
But here’s the catch: because Medicare is devoted to serving a population that is elderly, and therefore in need of greater levels of medical care, it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates the appearance that Medicare is a model of administrative efficiency. What Jon Alter sees as a “miracle” is really just a statistical sleight of hand.
Furthermore, Book notes that private insurers have a number of additional expenditures which fall into the category of “administrative costs” (like state health insurance premium taxes of 2-4%, marketing costs, etc) that Medicare does not have, further inflating the apparent differences in cost.
However, when you make an apples to apples comparison, Medicare comes out much worse than private insurance:
But, as you might expect, when you compare administrative costs on a per-person basis, Medicare is dramatically less efficient than private insurance plans. As you can see here, between 2001-2005, Medicare’s administrative costs on a per-person basis were 24.8% higher, on average, than private insurers.
So, contrary to claims of Alter, Krugman, and President Obama, moving tens of millions of Americans into a government run health care option won’t generate any costs savings through lower administrative costs. Just the opposite.
Make sure you click through and check out the real Medicare administrative costs as compared to private industry.
Then there’s waste fraud and abuse. Did you happen to catch that little hand wave at “fraud and abuse” in the first quote touting Medicare’s efficiency? What, pray tell, is one of the primary jobs of an administive system? Would you imagine it to be the elimination of fraud and abuse – or said another way, to ensure that the company pays legitimate claims and avoids fraudulent and unnecessary payments?
How efficient is a system which is awash in both fraud and abuse? And, without profit, what incentive do they have to eliminate it?
John Stossel takes that part of the “Medicare efficiency” myth apart:
But there’s a bigger point – the connection between “low” administrative costs and staggeringly HIGH levels of fraud and waste. As Michael Cannon at the Cato Institute and Regina Herzlinger at Harvard Business School have pointed out, much of the 10 to 20 percent of private insurance administrative costs goes to preventing fraud. Private insurers, you see, care about whether or not they lose money. Medicare, with its unlimited claim on the public purse, does not. It’s only taxpayer money, after all.
The results are predictable, but breathtaking nonetheless: an estimated $68 billion (with a B) in outright Medicare fraud every year (About $3 billion in Miami-Dade county ALONE.) On top of that, according to well-respected Dartmouth researchers, roughly a third of Medicare’s total $400 billion annual spending goes to procedures which were medically unnecessary.
That’s, on average, 68 billion every year. Imagine a private insurance company surviving with loss figures like that. But as Stossel points out, without an incentive to eliminate fraud and abuse, it continues year after year after year, with politicians and Medicare administrators tut-tutting but never really doing anything about it.
That is the reality of Medicare’s efficiency. It is also the probable model any future health care insurance run by the government. Efficiency is an illusion brought about by a statistical sleight of hand and ignoring the systemic waste, fraud and abuse of Medicare.
One more time into the breach. The CBO has issued a warning to Congress about entitlement spending. Again. Here’s a key paragraph:
Almost all of the projected growth in federal spending other than interest payments on the debt comes from growth in spending on the three largest entitlement programs–Medicare, Medicaid, and Social Security.
Most of you know that Medicare and Medicaid have an unfunded future liability of 36 trillion dollars. That’s about 3 times the annual total GDP of the US economy. And they are the very same type of “public option” program – i.e. government insurance – that the left says is so very necessary and crucial to real “health care reform”.
In other words, the left’s argument is that adding at least 47 million (presently uninsured), plus the possibility of adding 119 million who are shifted to the public option from private insurance (private insurance, btw, doesn’t have any effect on the deficit whatsoever since we, the private sector, are paying for it) will somehow make the deficit picture better?
I’m obviously missing something here.
With the public option, we’re adding a new entitlement (47 million who presently supposedly can’t afford insurance, meaning taxpayers will subsidize theirs). Assuming it is set up originally to be paid for by premiums, at some point, like Medicare and Medicaid, and every other government entitlement program I can think of, it will pay out more than it takes in. How can it not? It is a stated “non-profit” program and it will include subsidies. At some point, another revenue stream is going to be necessary as it burns through the premiums with its payouts.
Well, say the proponents of government involvement in your health care, we’re going to save money by doing preventive health care. Yes, preventive care is the key to lower costs because a healthier population is one which visits the doctor less. While that may seem to be at least partially true (you’d think a healthier population would, logically, visit the doctor less) the part that is apparently missed when touting this popular panacea is the cost of making the population healthier (and the fact that the assumption of less visits isn’t necessarily true) doesn’t cost less – it costs more:
If health care providers can prevent or delay conditions like heart disease and diabetes, the logic goes, the nation won’t have to pay for so many expensive hospital procedures.
The problem, as lawmakers are discovering to their frustration, is that the logic is wrong. Preventive care — at least the sort delivered by doctors — doesn’t save money, experts say. It costs money.
That’s old news to the analysts at the Congressional Budget Office, who have told senators on the Health, Education, Labor and Pensions Committee that it cannot score most preventive-care proposals as saving money.
So with that myth blown to hell, we’re now looking at a government plan which will add cost to the deficit by subsidizing the insurance of 47 million and (most likely) many more, plus a plan to use a more costly form of medicine as its primary means of giving care.
But, back to the entitlement report – or warning. The CBO says that unless entitlements are drastically reformed (that means Medicare, Medicaid and to a lesser extent, Social Security) we’re in deep deficit doodoo:
The most frightening findings in this report are the deficit and debt projections. In this year and next year, the yearly budget shortfall, or deficit, will be the largest post-war deficits on record–exceeding 11 percent of the economy or gross domestic product (GDP)–and by 2080 it will reach 17.8 percent of GDP.
The national debt, which is the sum of all past deficits, will escalate even faster. Since 1962, debt has averaged 36 percent of GDP, but it will reach 60 percent, nearly double the average, by next year and will exceed 100 percent of the economy by 2042. Put another way, in about 30 years, for every $1 each American citizen and business earns or produces, the government will be an equivalent $1 in debt. By 2083, debt figures will surpass an astounding 306 percent of GDP.
The report also finds high overall growth in the government as a share of the economy and of taxpayers’ wallets that provides an additional area of concern. While total government spending has hovered around 20 percent of the economy since the 1960s, it has jumped by a quarter to 25 percent in 2009 alone and will exceed 32 percent by 2083. Taxes, which have averaged at 18.3 percent of GDP, will reach unprecedented levels of 26 percent by 2083. Never in American history have spending and tax levels been that high.
Here’s the important point to be made – these projections do not include cap-and-trade or health care reform.
Got that? We’re looking at the “highest spending and tax levels” in our history without either of those huge tax and spend programs now being considered included in the numbers above. Total government spending, as a percent of GDP is now at an unprecedented 25%. And they’re trying to add more while this president, who is right in the middle of it, tells us we can’t keep this deficit spending up forever.
Call in number: (718) 664-9614
Yes, friends, it is a call-in show, so do call in.
Subject(s): Cap-and-trade, health care, Iran/Honduras
Over the years, one of the purposes the sunday news shows have come to serve is a venue from which to launch political trail balloons and see how well they float.
Some get shot down immediately. Some take flak but survive. And other sail right on through with very little notice. David Axelrod appeared on “This Week” with George Stephanopoulos and launched one concerning taxes and health care. Axelrod first said that Obama still believes taxing health benefits is not the way to pay for health care (although during the ABC informercial, he essentially said that if it happened, it would be a compromise (and obviously not a show stopper for him)).
Stephanopoulos pushed a little harder on funding through taxation:
I pressed Axelrod on whether Obama will draw a line in the sand and veto any bill that funds health care reform with tax hikes for people making under $250,000 a year — despite a pledge Barack Obama made during the 2008 presidential campaign not to raise taxes on the poor and middle-class.
“One of the problems we’ve had in this town is that people draw lines in the sand and they stop talking to each other. And you don’t get anything done. That’s not the way the president approaches us. He is very cognizant of protecting people — middle class people, hard-working people who are trying to get along in a very difficult economy. And he will continue to represent them in these talks,” Axelrod said.
“But they’re also dealing with punishing health care costs, and that’s something that we have to deal with.”
Classic. He could have simply said “we’re open to compromise and if that’s what it takes to pay for it, then yes, we’ll raise taxes on the middle class in a New York minute.”
But instead he had to do the “we’re here to protect the middle class, but …” and then tell us how they really weren’t there to protect them in this particular case.
So to those of you who believed Obama when he said that 95% of Americans won’t see their taxes raised by a single dime – well, that’s no longer necessarily the case – if you let this trial balloon float away unimpeded (not that it will matter really – if they pass health care it has to be paid for somehow and there is no possible way only the richest 5% are enough to pay for that boondoggle).
No “gold plated” care for you – unless you’re in a union.
Yes, friends, it’s payback time in the health care legislation world. Bloomberg reports:
The U.S. Senate proposal to impose taxes for the first time on “gold-plated” health plans may bypass generous employee benefits negotiated by unions.
Senate Finance Committee Chairman Max Baucus, the chief congressional advocate of taxing some employer-provided benefits to help pay for an overhaul of the U.S. health system, says any change should exempt perks secured in existing collective- bargaining agreements, which can be in place for as long as five years.
The exception, which could make the proposal more politically palatable to Democrats from heavily unionized states such as Michigan, is adding controversy to an already contentious debate. It would shield the 12.4 percent of American workers who belong to unions from being taxed while exposing some other middle-income workers to the levy.
This is how they manage to get at your health care plan. Baucus wants to tax any health care benefit that is more costly than those provided federal employees. Those costs are about $4,200 for individuals and $13,000 for families. The claim is they again want to go after the “rich” who have “gold plated” plans. And the example in the Bloomberg article is the $40,543 in health benefits paid to Lloyd Blankfein, chief executive of New York-based Goldman Sachs Group Inc., the fifth largest U.S. bank.
Of course that threshold will also affect people much lower on the financial totem pole than Lloyd Blankfein. For example:
It can also affect companies such as Henderson, Nevada- based Zappos.com, where workers’ $11 per hour pay is supplemented by employer-paid health insurance plans worth about $7,500.
So immediately you have an $11 an hour employee liable for $495 at 15% of the difference. But remember, your taxes won’t go up by a dime. Not a single dime.
Why the desire to exempt unions? Well it gets a favored constituency off their back, is a measure of payback for their support and union members can then enjoy their “gold plated” coverage while $11 an hour workers pay the freight. Don’t believe unions have gold plated coverage. Try this example:
Sandra Carter, a retired Pacific Bell Telephone Co. technician from Stockton, California, said her health benefits, worth about $12,000 per year, were negotiated by the Communications Workers of America. She is unmarried with no children, meaning her individual coverage exceeds benefits paid to federal workers by about $7,800. If that amount were taxed at the 15 percent marginal rate, she would owe $1,170.
“I can’t afford the taxes I pay now,” said Carter, who said she suffers from diabetes. “Why should I get taxed on a benefit that keeps me a functioning person?”
Gee Ms Carter, why should anyone? Why is it any business of the government to limit the coverage to $4,200 and tax the rest. Who is Max Baucus, or anyone, to arbitrarily set the insurance limit at $4,200 for individuals and $13,000 for families and punish those who have better plans through taxation?
I would guess, however, Ms Carter is fine with unions being exempted and also fine with others being taxed in her stead.
Most unions, of course, see themselves as the exceptions deserving of such exemptions:
Anna Burger, secretary-treasurer of the Service Employees International Union, said in an interview that workers have often traded salary increases for better benefits in agreements.
Taxes “shouldn’t be taken from the backs of workers who have bargained away wages and other things for their benefits over the years,” Burger said.
But it is ok if others who’ve negotiated the same sort of exchange privately get nailed, eh Ms Burger? It’s not the principle, it’s the exception which is important here apparently.
To their credit, some unions are actually standing on principle:
“Either way, we are against a tax on health-care benefits in whatever form it takes,” said Jacob Hay, spokesman for the Laborers’ International Union of North America. The union represents 500,000 workers, largely in the construction industry.
Special interest democracy – political payback – so blatant now that you don’t even have to wonder if it is being done. Democrats are shameless in their pursuit of it. If you’re in a favored group, your ship has come in.
For new readers the title is that for which the shortened “QandO” stands. This is the second in a series of questions and observations.
- In the “you can’t make this up” department, China will block the sale of Hummer for “environmental concerns”. I guess that’s their nod to the rest of the world after flatly refusing cut CO2 emissions in the future.
- Ezra Klein is suddenly for smaller government, specifically the elimination of the Agriculture Committee. Of course the only reason he’d like to see it given the deep 6 is because it has, in Klein’s opinion, badly weakened cap-and-trade by extracting “a truly mind-boggling array of tax breaks, exemptions, and straight subsidies”. I guess Klein would like to temporarily make government smaller to make it larger.
- Yes, Michael Jackson is dead – but for heaven sake, do we have to devote every minute of the news day to running “Thriller” vid and spreading rumors about the possible cause of his death? Is this what “news” organizations have become?
- Apparently we’re still stalking the North Korean ship enroute to either Singapore or Burma. For those who are waiting for us to confront it and board it, that’s not going to happen. The “tough” UN resolution only provides for boarding if the North Koreans agree. And, while we can demand that they then go to the nearest port for inspection, the North Koreans can refuse that as well. The plan, it seems, is to convince the refueling port the NoKos pull into to refuse to refuel the ship. Then, when the NoKo ship runs out of fuel, put it under tow and then inspect it. As I understand it – they can then inspect it legitimately. Amazing.
- Waxman-Markey, aka cap-and-trade, survived an earlier test vote that moved the bill to the floor for a 5pm vote. As I recall the margin was 5 votes. It is a job destroyer in the middle of a recession. The Center for Data Analysis of the Heritage Foundation figures it will cost 50,000 jobs in the transportation equipment sector alone. Their data for other sectors is available here.
- House liberals have staked out a bit of ground on the health care bill saying they will not vote for it if it doesn’t include a public option – period. That is actually good news as the public option does seem to be in trouble. Any bill showing up without it will most likely not get the 80 members of the Congressional Progressive Caucus to vote for it. Add in the Republicans and the Blue Dogs, and it may be in very serious trouble without just the sticker shock of 1 to 3 trillion dollars of cost.
- Mark Sanford? He should resign. The affair is between he and his family. He should resign because he was derelict in his duty and he misappropriated government funds to pay for his trip to Argentina. Kinda like Bill Clinton should have resigned, not for the affair, but for lying under oath to a grand jury and attempting to obstruct justice.
While I’m sure the specials last night on the deaths of Farrah Fawcett and Michael Jackson vastly outdrew the ABC’s Obama healthcare special the other night (no I didn’t watch it – I was being disappointed by the Yankees/Braves game), there were some very telling moments apparently. And, being the curious type, I found the transcript and read the whole thing.
Let’s say Mr. Eloquent was less than convincing. But he did shed some light on what he’d like to see the final product look like.
Naturally there were some moments that were instantly reported by the media and other bloggers. For instance when he essentially said that if that he’d use his wealth if necessary to go outside any system that denied his family the healthcare he thought they needed. The obvious point is he concedes that his system will do so – i.e. ration care through denial. Of course that’s one of the big complaints he’s had about private healthcare – rationing through denial.
But there were some other things said which only a careful reading of the transcript reveal. Let’s start with this question:
DR. JOHN CORBOY, NEUROLOGIST & MEDICAL PROFESSOR: Well, I think you still have to provide the appropriate care. And I think we all know that there is a significant amount of care that actually is inappropriate and unnecessary.
And the question then is — for you, Mr. President, is, what can you convince — what can you do to convince the American public that there actually are limits to what we can pay for with our American health care system?
And if there are going to be limits, who is going to design the system and who is going to enforce the rules for a system like that?
This question is loaded with key words and phrases. The first is “appropriate”, as in “appropriate care”. Who gets to decide? If you listen to a glib Obama, he constantly says medical decisions should be left to doctors. But this question isn’t being addressed to that point, is it? If there is an “appropriate care” standard, someone is going to have to define it.
And that is precisely what Corboy asks – “who is going to design the system and who is going to enforce the rules?” In fact, who gets to decide what the rules are?
I think you know the answer, but let’s look at the President’s answer:
OBAMA: Well, you’re asking the right question. And let me say, first of all, this is not an easy problem. If it was easy, it would have been solved a long time ago, because we’ve talking about this for decades, since Harry Truman.
We’ve been talking about how do we provide care that is high-quality, gives people choices, and how can we come up with a uniquely American plan? Because one of the ideological debates that I think has prevented us from making progress is some people say this is socialized medicine, others say we need a completely free market system.
We need to come up with something that is uniquely American. Now what I’ve said is that if we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that makes sure that the necessary treatment is provided but we don’t have a huge amount of waste in the system. That we are providing adequate coverage for all people, and that we are driving down costs over the long term.
OK, let’s stop for the moment right there. We begin with Obama in stump-speech mode. That’s a time buyer. He’s fumbling for an answer and is filling time. By the third paragraph he’s beginning to formulate an answer. Of course, I had to laugh because a uniquely American solution would be to have government back off and let the market take the ball and run with it. But obviously that’s not his plan. I think what he’s saying here is he hopes for a Euro-socialist plan with an American twist.
Anyway, in the third paragraph we’re again into some key words – this time “necessary” and “adequate”. Again, who will decide what is “necessary” and what form of coverage is “adequate”? Well, trust me, it won’t be you or your doctor, because his priority is what? That’s right – “driving down costs over the long term”. So “necessary” treatment will be considered in the context of “driving down costs”. I’m sure you figure out what that means.
Then there’s the “we should be able to design a system”. He’s not talking about you or the market here. He’s talking about government. He’s a part of the ‘we’ – you’re not.
Last, of course, is the overriding priority – drive costs down. He claims health care is the reason for the current deficit. So the obvious first priority for this so-called reform is to cut costs.
But let’s add 47 million new insured while driving costs down. Make sense to you? And if it does, then you have to admit that lesser cost, if possible, will have to come from some part of the current health care system. He has his ideas, and we’ll cover that in a different post.
Moving on with the answer:
If we don’t drive down costs, then we’re not going to be able to achieve all of those other things. And I think that on the issue that has already been raised by the two doctors, the issue of evidence-based care, I have great confidence that doctors are going to always want to do the right thing for their patients, if they’ve got good information, and if their payment incentives are not such that it actually costs them money to provide the appropriate care.
Here we find a very critical clue to the plan for your health care – the term “evidence-based care”. This is the new way of saying “we’ll decide for you”. Evidence based medicine claims to use the scientific method to determine optimum treatment decisions. The Centre for Evidence Based Medicine says it is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
Said another way, a group somewhere doing research decides that certain diseases or conditions should be treated in certain ways. Those treatments are then applied to individual cases without any caveat for unique situations. The cost savings comes with uniform procedures and uniform care – no deviations. In other words, for the most part, decisions on how to treat individual cases will most likely have to conform to EBM guidelines or be considered outside the system. So what Obama said with that simple term is “we’ll decide how you will be treated, not your doctor”.
Of course critics of EBM are many and claim that it has some utility in outlining suggested treatment for populations as a whole, but has limited utility when taken down to the individual situation since each is unique.
And then there’s the inference that medicine to this point hasn’t been based on science. As Abraham Verghese said:
“Evidence Based Medicine” is a term which makes about as much sense as “Sex-based intercourse”–Were we practicing based on zodiac signs before EBM came along?
That brings us to the bit about “doctors always want to do the right thing for their patients”. Yes, of course. But what he says next hints that “the right thing” may be what the technocrats think is right, not necessarily what the doctors might think is right. He says doctors will do that “if they’ve got good information, and if their payment incentives are not such that it actually costs them money to provide the appropriate care.”
Anyone know right now instances when “appropriate care” costs a doctor “money to provide”? Yup, Medicare and Medicaid. It’s the reason so many opt out of treating Medi patients.
How then does he plan on changing their payment incentives so it doesn’t cost them money? Well to do that you either change the reimbursement rate or you change what is “appropriate”, don’t you? EBM promises the latter.
That brings us to the final part of his answer:
And right now, what we have is a situation, because doctors are paid fee-for-service, and there are all sorts of rules governing how they operate, as a consequence often times it is harder for them, more expensive for them, to do what is appropriate.
And we should change those incentive structures.
Now this is simply a load of road apples.
Litigation is part of the problem. Obama refuses to address that as a basic health care cost problem. It drives up costs and it also induces doctors to use unnecessary tests in a CYA gambit. Want to “change incentives?” Here’s a great place to start.
The second problem is chronic underpayment by the government through Medicare and Medicaid – something Obama and Congress want to again reduce by up to 20%. That causes cost shifting to the private side of things. But insurance companies have gotten smart and now refuse, in many cases, to pay more than the Medis. That is an artificial distortion of the market introduced by government arbitrarily deciding what a medical procedure is worth.
And the rules under which doctors operate are no less stringent under the Medis than under any private insurance plan.
That’s one question from the staged ABC “town hall meeting”. There was an amazing amount of info in that one question and answer. Enough information that you should be absolutely shaking in your boots, because what he said is he plans on doing precisely what he has been telling you he wouldn’t do – design a system which will decide how your doctor will treat you. It is all there, and no one has even bothered to take the close look it deserves.
I’ll parse a few more questions from the interview as I have the time, but suffice it to say, if you look hard enough you can figure out exactly where this guy wants to take us.
We had a little dust-up this week when I mentioned Ezra Klein’s propensity for government run health care and that he held the VA up as a shining example of what that can be.
Apparently it is a no-no among the crowd that follows Klein to include the government run military hospital system with the government run VA hospital system in a general critique of government run health care. And as is typical of drive-by commenters, they ignored the gist of the post to concentrate on pretending that two government run health care systems were not at all alike (because both have major problems).
So today, we’ll just talk about VA and the latest findings that support precisely what I said in the last post – VA has major systemic problems which are dangerous and, as Rep. Harry Mitchell,(D-AZ) who chairs the House Veterans’ Affairs Subcommittee on Oversight and Investigations said:
“[T]here is no question that shoddy standards — systemic across the VA — put veterans at risk and dealt a blow to their trust in the VA,”
And then there’s the growing controversy over procedures that exposed 10,000 veterans to the AIDS and hepatitis viruses.
What have those interested in veteran care found when they looked at the system?
An official with the American Legion who visits and inspects VA health centers said complacency, poor funding and little oversight led to the violations that failed the cancer patients in Philadelphia and possibly infected 53 veterans with hepatitis and HIV from unsterilized equipment at three VA health centers in Florida, Tennessee and Georgia.
“Lack of inspections, lack of transparency” were likely to blame, said Joe Wilson, deputy director of the Veterans Affairs and Rehabilitation Commission for the American Legion, who testified before Congress this month on transparency problems in a budgeting arm of the VA.
What’s he talking about? Well apparently the VA is discovering standards and procedures that have been commonplace in the civilian health care system for decades. Remember the problem with endoscopic procedures in multiple locations which led to contamination?
But investigations conducted by the VA last month show that systemic problems remain. Under half of VA centers given surprise inspections had proper training and guidelines in place for common endoscopic procedures.
Many believe the state of the VA is due to chronic underfunding:
Richard Dodd, a litigator who has represented veterans in lawsuits against the government, said that poor funding has lowered the quality of care and interest from some physicians.
“They’re generally under-funded … and I think the interest of the doctors suffers to some degree,” he told FOXNews.com. “Generally speaking, the physicians that work at the VA work there because they have no interest in private health care, and in some situations are unable to find jobs in private industry.”
Of course “underfunded” is always the claimed “root cause” of any problems with government run entities, isn’t it? Take education, for instance. But underfunding has little to do with procedural failures. That’s just flat bureaucratic incompetence. It is also a persistent problem for top down, bureaucratic systems like – government run health care.
VA Secretary Gen. Eric Shinseki and senior leadership “are conducting a top to bottom review of the Department,” a VA representative told FOXNews.com. “They are implementing aggressive actions to make sure the right policies and procedures are in place to protect our veterans and provide them with the quality health care they have earned.”
But, of course, Gen. Shinseki, for all his military competence, wouldn’t know a proper endoscopic procedure from a walnut tree. And, apparently, neither to those in the system who’ve overseen the present ones. Or said another way, confidence isn’t real high that an apparently inept bureaucracy can suddenly discover competence.
For example, something as simple as drug inventory:
The Office of Inspector General (OIG) conducted an audit to determine how accurately the Veterans Health Administration (VHA) could account for inventories of non-controlled drugs at increased risk for waste and diversion in its health care facilities (facilities). VHA needs to improve its ability to account for non-controlled drugs to reduce the risk of waste and diversion. VHA cannot accurately account for its non-controlled drug inventories because it has neither implemented nor enforced sufficient controls to ensure pharmacy inventory practices are standardized and pharmacy data is accurate.
How can you tell me how “cost-effective” your pharmacy program has been when you don’t even know what your non-controlled drug inventories are and have never bothered to implement or enforce control over them?
Systemic problem. But this is the shining example of government run health care according the Klein and others. Underfunded, shoddy, overburdened, old facilities and equipment, a lack of transparancy and controls, insufficient training and poor procedures all driven by a top down bureaucracy.
Yeah, sign me up.