Free Markets, Free People

Health Care

Government Health Care – VA’s “Shoddy Standards … Put Veterans At Risk”

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.

~McQ

[HT: Looker]

Government Health Care – A Cautionary Tale

Dale and I once interviewed Ezra Klein about health care on our podcast. Klein held the VA system up as a shining example of good government health care. Of course that was before the shameful condition of Walter Reed had been discovered. Since then other problems (for instance, contaminated colonoscopy equipment in various locations) have been discovered.

A commenter once asked “if VA is good enough for our veterans, why isn’t it good enough for us.” My answer was “it isn’t good enough for our veterans, it is instead what they’re stuck with.”

Today brings another example of the problems this sort of medicine is bound to have. It is a bureaucratic nightmare, even at the relatively small size of VA.

For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans’ hospital in Philadelphia, his aim was more than a little off.

Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate.

It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.

He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.

The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.

That as they say, was the tip of the iceberg. No one reported the problem because there was no peer review. And, this was one of many mistakes made by this doctor that apparently no one knew about:

Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years — and then kept quiet about it, according to interviews with investigators, government officials and public records.

The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.

Six years and no one had a clue. In fact, if you read the article in full, as you should, you’ll see that the discovery of this was essentially an accident.

This is government health care. This is what our vets are stuck with. This is not something we, as a society, should want any part of.

~McQ

Don’t Take Obama Health Care Promises Literally

Jim Lindgren at The Volokh Conspiracy says the White House is backing off of the promises Barack Obama made in his speech to the AMA.

You remember the promises:

If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.

Where I come from those sound like pretty straight-foward promises, wouldn’t you say? But Lindgren cites Mike Gonzales at the Heritage Foundation:

Less than 24 hours after Heritage Foundation President Ed Feulner questioned the veracity of President Obama’s persistent claim that, under his health care proposals, “if you like your insurance package you can keep it”, the White House has begun to walk the President’s claim back. Turns out he didn’t really mean it.

According to the Associated Press, “White House officials suggest the president’s rhetoric shouldn’t be taken literally: What Obama really means is that government isn’t about to barge in and force people to change insurance.” How’s that for change you can believe in?

Depending on how the public plan is designed in Congress, millions of Americans would lose their existing coverage. By opening the public plan to all employees and using Medicare rates, the Lewin Group, a nationally prominent econometrics firm, has said that the public plan could result in 119.1 million Americans being transitioned out of private coverage, including employer based coverage, into a public plan. With employers making the key decision, millions of Americans could lose their private coverage, regardless of their personal preferences in this matter.

So the public plan will see those who have health care plans they like (and doctors) at the mercy of a distorted market (distorted by government intrusion and artificial pricing) which will see employers dump coverage of the present health care plans in favor of the public plan. How such a plan “fixes” anything remains a mystery.

However, for the record Lingren reformulates the Obama “promises”:

When Obama said he “will keep this promise”:

If you like your doctor, you will be able to keep your doctor. Period.

he actually meant:

If you like your doctor, many of you will NOT be able to keep your doctor. Period.

And when Obama said he “will keep this promise”:

If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.

Obama really meant:

If you like your health care plan, many – perhaps most – of you will NOT be able to keep your health care plan. Period. Someone – perhaps your employer – may take it away. It all depends on how things work out.

Hope and change.

~McQ

Liberal Blogger: Slavery and the Health Care Crisis

If ever there was a text book example of a false premise wrapped in an absurd ‘moral’ analogy, Glenn Smith at Firedoglake provides it:

The gravity of America’s health care crisis is the moral equivalent of the 19th Century’s bloody conflict over slavery. This is not hyperbole, though the truth of it is often lost in abstract talk of insurance company profits, treatment costs, and other cold, inhuman analyses.

Today’s health system condemns 50 million Americans to ill health and death while guaranteeing health care to the economic privileged. It cannot stand.

About 18,000 Americans die each year because they lack health insurance. That’s more than a third the number of lives lost in battle during each year of the four-year Civil War.

Heh … you have to love the attempt to wave off this hyperbole by simply declaring it isn’t hyperbole. But I would hope that it is evident to any rational thinker that the attempt here is to equate those who resist the intrusion of government into the realm of health to those who fought to retain the institution of slavery.

This is, instead, a plain old rant against capitalism and the free market cloaked in this absurd moral equivalence Smith invents. Seeing the liberal goal of government run health care being battered by real world realities, he’s decided he has to turbo-charge his argument for such change by defining down the horror of slavery in order to find a moral equivalence he can use as a bludgeon on the dissenters.

Don’t believe me? How about this:

Members of Congress without the moral clarity to recognize this equivalence will be condemned by history. Their spinelessness and lack of will when confronted with the power of the insurance industry is just as morally bankrupt as the American congressmen who bowed to Southern slave-owners.

The morally compromising efforts to pass health care reform that insurance companies might like is as insane as the compromises over slavery.

Or this:

The health insurance industry earns its profits from the denial of coverage and benefits. It’s not so different from the Southern plantation owners who earned their profit from slave labor. The latter had their economic justifications for their immorality. So do the insurance companies.

Of course, this sort of nonsensical thinking muddles important concepts that underlie the inalienable rights of man. Slavery was a violation of man’s right to his own life. Health care insurance is nothing more than a tool that helps pay for a person’s health care. Health care is not “unavailable” to those who don’t have it. More importantly, health care is not a right.

Whereas slave owners physically denied slaves the freedom to pursue their lives, insurance companies do not stop anyone from pursuing their own health care.

But – they have to pay for it because it entails the use of the time, abilities and services of others. That is what people like Smith really object too. Read the nonsense in the paragraph above and that’s clear. And, as many extremists like to do (like those who claim, for instance, that those who don’t agree on AGW are akin to Holocaust deniers), he chooses the most inflammatory but false “moral” example he can choose to demonize his opposition, counting on the dearth of critical thinking these days to win their point.

Unfortunately, it is more successful than I’d like to admit, which is why it is important to refute it immediately when it crops up.

~McQ

Health Care “Reform”: A Little History Is Always Useful

Daniel Henninger gives us a little walk down memory lane to remind us of the effect of our first attempt at “health care” reform.

Back before recorded history, in 1965, Congress erected the nation’s first two monuments to health-care “reform,” Medicaid and Medicare. Medicaid was described at the time as a modest solution to the problem of health care for the poor. It would be run by the states and “monitored” by the federal government.

The reform known as Medicaid is worth our attention now because Mr. Obama is more or less demanding that the nation accept another reform, his “optional” federalized health insurance program. He suggested several times before the AMA that opposition to it will consist of “scare tactics” and “fear mongering.”

Whatever Medicaid’s merits, this federal health-care program more than any other factor has put California and New York on the brink of fiscal catastrophe. I’d even call it scary.

Anyone who has paid any attention to the health care debate know full well that Medicare and Medicaid have become huge black holes with future funding obligations in the tens of trillions of trillions of dollars.

Now, pointing that out and doubting the government’s ability to do any better is apparently “scare tactics” and “fear mongering”. Reminds me of the AGW nonsense.

After 45 years, the health-care reform called Medicaid has crushed state budgets. A study by the National Governors Association said a decade ago that because of “new requirements” imposed by federal law — meaning Congress — “Medicaid has evolved into a program whose size, cost and significance are far beyond the original vision of its creators.”

There is nothing to convince anyone that the same won’t happen with a “public option”. And although the present plan is to have such an option pay for itself through premiums, there’s nothing to stop Congress from deciding the taxpayer should pick up the tab at some point in the future.

In his speech, Mr. Obama said the cost of the Public Option won’t add to the deficit: “I’ve set down a rule for my staff, for my team — and I’ve said this to Congress — health-care reform must be, and will be, deficit-neutral in the next decade.” If we’re honest, that means tax increases are inevitable.

The thing to remember – “deficit-neutral” doesn’t necessarily mean cuts in spending. It means that revenue must equal spending and that obviously means that spending increases must have added revenue – tax increases.

There is some resistance starting to form to the “reform”. The Democrats plan on rushing this through with limited debate. If they succeed, “Son of Medicare” will wander out the government lab and bankrupt this nation much more quickly than now anticipated.

~McQ

Conference on Health Care Reform

Cato Institute is hosting a conference on health care reform today that will be webcast live. It will feature the following speakers:

* Rep. Paul Ryan (R-WI)
* Rep. Michael C. Burgess, M.D. (R-TX)
* Rep. Jason Altmire (D-PA)
* Karen Davenport, Director of Health Policy, Center for American Progress
* Douglas Holtz-Eakin, Former Director, Congressional Budget Office, and Director of Domestic and Economic Policy for the McCain presidential campaign
* Tom G. Donlan, Barron’s
* Karen Tumulty, Time Magazine
* Susan Dentzer, Health Affairs
* John Reichard, Congressional Quarterly

This represents a wide range of views and promises to be much more interesting and informative than the White House/ABC News infomercial scheduled for next week. so if you’re interested in this topic at all, take some time to check it out.

Obama Media

While it comes at no real surprise given how they behaved during the presidential campaign, the MSM has finally decided to go all in with its support for the President. Next Wednesday night, June 24, ABC News will host a program about health care reform from inside the White House, but only one side will be presented — i.e. Obama’s. The Chief of Staff for the RNC is not happy about this decision and sent the following letter to David Westin, the President of ABC News:

Dear Mr. Westin:

As the national debate on health care reform intensifies, I am deeply concerned and disappointed with ABC’s astonishing decision to exclude opposing voices on this critical issue on June 24, 2009. Next Wednesday, ABC News will air a primetime health care reform “town hall” at the White House with President Barack Obama. In addition, according to an ABC News report, GOOD MORNING AMERICA, WORLD NEWS, NIGHTLINE and ABC’s web news “will all feature special programming on the president’s health care agenda.” This does not include the promotion, over the next 9 days, the president’s health care agenda will receive on ABC News programming.

Today, the Republican National Committee requested an opportunity to add our Party’s views to those of the President’s to ensure that all sides of the health care reform debate are presented. Our request was rejected. I believe that the President should have the ability to speak directly to the America people. However, I find it outrageous that ABC would prohibit our Party’s opposing thoughts and ideas from this national debate, which affects millions of ABC viewers.

In the absence of opposition, I am concerned this event will become a glorified infomercial to promote the Democrat agenda. If that is the case, this primetime infomercial should be paid for out of the DNC coffers. President Obama does not hold a monopoly on health care reform ideas or on free airtime. The President has stated time and time again that he wants a bipartisan debate. Therefore, the Republican Party should be included in this primetime event, or the DNC should pay for your airtime.

Respectfully,
Ken McKay
Republican National Committee
Chief of Staff

This comes on the heels of a Politico report about how Obama has been “wooing” the New York Times (as if it needed wooing), and further evidences a disturbing level of acquiescence to the White House. It’s one thing to have a broadcast from inside the White House, although it does strike an appearance of impropriety, but its another thing altogether to so blatantly snub an opposing views when the production is supposed to be one of news reporting. Presenting the view of those in power without question or examination, and refusing to allow any other voice, is pretty much the textbook definition of propaganda.

Since there is sure to be an uproar over this in the blogosphere, however, I’m wondering whether ABC News will back down and either allow some token opposition voice, bring on a known opponent of the President’s plan to raise some issues, or allow some questions of the President from actual reporters (Jake Tapper does still work for ABC News, doesn’t he?). Either way, its awfully pathetic that the MSM can’t seem to figure out how to get it right the first place. They are so blinded by their fascination with all things Obama, apparently, that any semblance of actual news reporting has gone out the window, and is being replaced with unabashed cheerleading for The One.

UPDATE: Oops! I didn’t realize that Bruce was writing on the same topic until after I posted. See his take below as well.

ABC: Absolutely Shameful (update)

Per Drudge:

On the night of June 24, the media and government become one, when ABC turns its programming over to President Obama and White House officials to push government run health care — a move that has ignited an ethical firestorm!

Highlights on the agenda:

ABCNEWS anchor Charlie Gibson will deliver WORLD NEWS from the Blue Room of the White House.

The network plans a primetime special — ‘Prescription for America’ — originating from the East Room, exclude opposing voices on the debate.

If this is indeed the plan then it is simply unacceptable. It flies in the face of one of the media’s self-stated reason for existing – a watchdog, not a lapdog, over the government.

Ken McKay, Chief of Staff of the RNC has sent letter to ABC protesting this. In part he says:

Next Wednesday, ABC News will air a primetime health care reform “town hall” at the White House with President Barack Obama. In addition, according to an ABC News report, GOOD MORNING AMERICA, WORLD NEWS, NIGHTLINE and ABC’s web news “will all feature special programming on the president’s health care agenda.” This does not include the promotion, over the next 9 days, the president’s health care agenda will receive on ABC News programming.

Apparently the Republican party asked to be included and was rejected. McKay concludes:

In the absence of opposition, I am concerned this event will become a glorified infomercial to promote the Democrat agenda. If that is the case, this primetime infomercial should be paid for out of the DNC coffers. President Obama does not hold a monopoly on health care reform ideas or on free airtime. The President has stated time and time again that he wants a bipartisan debate. Therefore, the Republican Party should be included in this primetime event, or the DNC should pay for your airtime.

Obviously McKay has to be somewhat circumspect in how he says things, but I don’t. It will be an infomercial and it is a shameful example of how poorly the media, now led by ABC, has done its primary mission when it comes to this administration and this president.

ABC not only should have the DNC pay for the air time, that should be prominently and permanently displayed at the bottom of the screen throughout this planned infomercial.

And ABC – anyone who works for them should hang their head in shame. They should also avoid associating the word “journalism” with anything they do from now on as well.

UPDATE: ABC’s Kerry Smith responds.  You can read the response in full here.  Essentially they tell the Republicans and opponents to stuff it, that ABC and only ABC will  decide who will provide the other side of the argument:

Second, ABC News prides itself on covering all sides of important issues and asking direct questions of all newsmakers — of all political persuasions — even when others have taken a more partisan approach and even in the face of criticism from extremes on both ends of the political spectrum. ABC News is looking for the most thoughtful and diverse voices on this issue. ABC News alone will select those who will be in the audience asking questions of the president. Like any programs we broadcast, ABC News will have complete editorial control. To suggest otherwise is quite unfair to both our journalists and our audience.

But, of course, ABC isn’t choosing who will be on the pro-government takeover side, are they? Instead, it is Obama’s “townhall” meeting and, one assumes, he will bring who the heck he wants to that dance and if ABC doesn’t like it, I’m sure they were told they could find something else to do that night.

How freakin’ stupid does Kerry Smith and ABC think we are out here!?

~McQ

[HT: Neo]

Obama’s Visit With The AMA

I‘m not sure what part of this Obama doesn’t understand.

On the one hand, he told doctors at the AMA convention yesterday that he was not a fan of tort reform and felt that limits on malpractice cases was a disservice to those who were truly injured.

On the other hand he made this case:

Not long ago, doctors’ decisions were rarely questioned. Now they are being blamed for a big part of the wasteful spending in the nation’s $2.5 trillion health care system. Studies have shown that as much as 30 cents of the U.S. health care dollar may be going for tests and procedures that are of little or no value to patients.

The Obama administration has cited such findings as evidence that the system is broken. Since doctors are the ones responsible for ordering tests and procedures, health care costs cannot be brought under control unless they change their decision-making habits.

Somehow, apparently, he doesn’t understand the linkage. But AP’s Ricardo Alonso-Zaldivar thinks there’s a much more basic reason than Obama not understanding the linkage:

If Obama announced support for malpractice limits, that would set trial lawyers and unions—major supporters of Democratic candidates—on the attack. Not to mention consumer groups.

Somebody has to go under the Obama bus and the apparent choice is doctors.

USA Today led its story about Obama at the AMA convention with this:

President Obama told wary doctors Monday that the nation’s health system is “a ticking time bomb for the federal budget” and said those who call his plan for a taxpayer-funded coverage option a step toward a government takeover of health care “are not telling the truth.”

Of course the one “not telling the truth” in this case is President Obama. Any “public” option funded by taxpayers is not going to be competing on the same level of the playing field as private insurance carriers. Right now there are 1,300 private choices out there. The introduction of a taxpayer funded “public” option will, according to many economic and health care experts, end up seeing employers dump private health care coverage in favor of public health care coverage and eventually see the system become a single-payer public plan.

That’s why there is such fierce opposition to this sort of an option. Even those in favor of the public option know it is a means to single payer and willingly admit it. So to have the President stand up in front of a group of doctors and tell the whopper he told yesterday is disappointing but not unexpected. He’s lowballed the cost, he’s dissembled about how it is going to be paid for and now he’s being totally disingenuous about the eventual end-state a public option would bring.

~McQ