Thursday, April 08, 2010
The NYT is already preparing Americans for bureaucratic rationing of medical care
America will now be getting its version of Britain's much-loathed NICE -- which repeatedly denies drugs to patients who need them -- if the drugs are expensive. Too bad if you die or are disabled: NICE doesn't care. NYT excerpt below:
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.”
It’s easy to come up with arguments for why we need to do so. Above all, we don’t have a choice. Giving hospitals and drug makers a blank check will bankrupt Medicare. Slowing the cost growth, on the other hand, will free up resources for other uses, like education. Lower costs will also lift workers’ take-home pay.
But I suspect that these arguments won’t be persuasive. They have the faint ring of an insurer’s rationale for denying a claim. Compared with an anecdote about a cancer patient looking for hope, the economic arguments are soulless.
The better bet for the new reformers — starting with Donald Berwick, the physician who will run Medicare — is to channel American culture, not fight it. We want the best possible care, no matter what. Yet we often do not get it because the current system tends to deliver more care even when it means worse care.
It’s not just CT scans. Caesarean births have become more common, with little benefit to babies and significant burden to mothers. Men who would never have died from prostate cancer have been treated for it and left incontinent or impotent. Cardiac stenting and bypasses, with all their side effects, have become popular partly because people believe they reduce heart attacks. For many patients, the evidence suggests, that’s not true.
Advocates for less intensive medicine have been too timid about all this. They often come across as bean counters, while the try-anything crowd occupies the moral high ground. The reality, though, is that unnecessary care causes a lot of pain and even death. Dr. Berwick, who made his reputation campaigning against medical errors, is a promising (if much belated) selection for precisely this reason.
Can we solve the entire problem of rising health costs by getting rid of needless care? Probably not. But the money involved is not trivial, and it’s the obvious place to start.
The final step is the bluntest. It involves changing the economics of medicine, to reward better care rather than simply more care. Health reform doesn’t go nearly far enough on this score, but it is a start.
The tax subsidies for health insurance will shrink, which should help people realize medical care is not free. And doctors who provide good, less expensive care won’t be financially punished as often as they now are.
None of these steps will allow us to avoid the wrenching debates that are an inevitable part of health policy. Eventually, we may well have to decide against paying for expensive treatments with only modest benefits. But given how difficult that would be for this country, it makes sense to start with the easier situations — the ones in which “no” really is the best answer for patients.
Health care overhaul spawns mass confusion for public
Two weeks after President Barack Obama signed the big health care overhaul into law, Americans are struggling to understand how — and when — the sweeping measure will affect them.
Questions reflecting confusion have flooded insurance companies, doctors' offices, human resources departments and business groups.
"They're saying, 'Where do we get the free Obama care, and how do I sign up for that?' " said Carrie McLean, a licensed agent for eHealthInsurance.com. The California-based company sells coverage from 185 health insurance carriers in 50 states.
McLean said the call center had been inundated by uninsured consumers who were hoping that the overhaul would translate into instant, affordable coverage. That widespread misconception may have originated in part from distorted rhetoric about the legislation bubbling up from the hyper-partisan debate about it in Washington and some media outlets, such as when opponents denounced it as socialism.
"We tell them it's not free, that there are going to be things in place that help people who are low-income, but that ultimately most of that is not going to be taking place until 2014," McLean said.
Adults with pre-existing conditions are frustrated to learn that insurers won't have to cover them until 2014 (though those under 18 will be protected in late September); then they become both hopeful and confused upon learning that a federal high-risk pool for them will be established in the next few months. "Health insurance is so confusing. You add this on top of it and it makes it even more confusing," McLean said.
Federal Sales tax (VAT) coming to America
We all know it’s coming, but I’m reasonably sure Volcker missed a memo instructing advisors not, repeat not, to mention this publicly until, oh, say, the day after Election Day 2012. As it is, look for Gibbsy’s spin tomorrow to be, “B-b-but he was Reagan’s Fed chairman!”
"Volcker, answering a question from the audience at a New York Historical Society event, said the value-added tax “was not as toxic an idea” as it has been in the past and also said a carbon or other energy-related tax may become necessary."
Though he acknowledged that both were still unpopular ideas, he said getting entitlement costs and the U.S. budget deficit under control may require such moves. “If at the end of the day we need to raise taxes, we should raise taxes,” he said.
Krauthammer’s column on the VAT came out a few weeks ago, but if you missed it at the time, now’s your chance to catch up. Perfection:
"Obama set out to be a consequential president, on the order of Ronald Reagan. With the VAT, Obama’s triumph will be complete. He will have succeeded in reversing Reaganism. Liberals have long complained that Reagan’s strategy was to starve the (governmental) beast in order to shrink it: First, cut taxes — then ultimately you have to reduce government spending.
"Obama’s strategy is exactly the opposite: Expand the beast, and then feed it. Spend first — which then forces taxation. Now that, with the institution of universal health care, we are becoming the full entitlement state, the beast will have to be fed."
Precisely. The One’s perverse insight was that a giant federal expansion of health-care benefits had to be passed before any major entitlement reform could happen. Had he tackled the latter problem first, declaring that America had reached a moment of fiscal emergency and demanding that both parties address the crisis, he would have done his country a world of good but in the process created two problems for himself.
First, the political fallout to his party from cutting entitlements likely would have been devastating, which would have wrecked any chance at passing health-care reform aside from a modest GOP bill.
And second, even if the Democrats survived the electoral backlash, they’d have a hard time trying to sell the idea of a brand new entitlement after the country had sacrificed so much to get its fiscal house in order. No, the only way to get O-Care done was to add it to the entitlement basket first and then wait for dependency to work its magic so that, when the crisis finally hits full force, it’s already a fact of life. That was a fantastically reckless thing to do but he wanted his agenda passed at all costs. And I do mean “all costs.”
I’ll leave you with James Pethokoukis’s piece this morning gaming out a way that the Democrats might try to sell the VAT to the public. Essentially, it’d have to be the fiscal equivalent of comprehensive immigration reform: If the public’s going to be asked to accept the bitter in the form of amnesty or new taxes, it had better get the sweet of border enforcement or fiscal responsibility in the same deal.
Apples and ObamaCare
Let's do a quick thought experiment. The price of apples keeps going up. The government decides that every American must buy apples. But some can't afford them.
Government starts controlling how much apple farmers are paid, it mandates that every single American buys apples and subsidizes those under a certain income level so they can.
Will the price of apples go down, stay the same or go up? Or, in economists' language, if you limit the supply of a commodity and increase demand, will the price of that commodity go up or down?
Did you say "up"? You get an A. But if you did say "up," you surely are not a Democrat.
Democrats have just committed multitrillions of our money, and, as a bonus, sold a big chunk of American freedom down the road, betting that everything a college freshman learns in basic economics is not true. Or, that health care doesn't follow the rules of economics. Because our new health-care system is pretty much the apple scenario described above.
Or, maybe they don't care? Maybe it's not about economics, but about ideology and political power. And that the real issue is freedom. They think we've got too much and that politicians should decide what is fair and who should have what.
A revealing moment during the presidential campaign occurred when, during one debate, ABC's Charles Gibson pushed then-Sen. Barack Obama about his stated intent to increase capital gains taxes. Gibson brandished data showing that when you cut this tax, government tax revenues increase, and when you raise it, revenue drops (punishing investment surely produces less).
"So, why raise it?" Gibson asked. Obama responded that maybe it won't happen that way this time. And besides, he said, his motive was "fairness."
After voters in Massachusetts elected a Republican to replace the late Sen. Ted Kennedy, killing the Democrats' filibuster-proof Senate majority, many pundits wrote that President Obama had to move to the political center.
I wrote then that this wouldn't happen because, unlike President Bill Clinton, who did moderate, Obama is a left-wing ideologue. He didn't run for president to be somebody. He did it to do something. He did it to change America.
As polls showed waning public support for what Democrats were pushing on health care, many assumed they would back off. It was still conceivable that they could stand rules on their head and ram the thing through using the so-called reconciliation procedure. But why would they do it when polls suggested they would be punished in November elections?
But Obama understood that when you are selling dreams, numbers don't matter.
So, as in the housing and financial debacle we just went through, you commit taxpayer money to subsidize a product to make it look cheaper than it is, you get people to buy it, and when it all comes crashing down, it doesn't matter. By then you're long gone.
And, another bonus, as more Americans get herded onto the government plantation -- 30 million more with this new bill -- it's easy to keep them there. So the most likely political outcome going forward is higher taxes and income redistribution to pay for it all, entrenching socialism more.
As I have written before, if you want to know where it all leads, look at our inner cities that were long ago taken over by government compassion. This is our future, my fellow Americans.
Oh, back to the apples. Their prices were rocketing up to begin with because government was already controlling and regulating them.
Republicans are mad. But will they be able to entice Americans off the ever-growing government plantation? Will they propose and succeed in selling the bold ideas necessary to turn the basket case we're becoming around? We'll see.
Overtaxed homeowners start to fight back: "Now that the housing bubble has burst, up to 60 percent of the nation’s taxable property may be overassessed, meaning owners are paying thousands of dollars more in taxes than they need to, experts say. That is leading to a flood of appeals in many markets from homeowners eager to cut their taxes and speed the process of aligning tax valuations with reality.”
Health care’s history of fiscal folly: "The Affordable Care Act — otherwise known as ObamaCare — isn’t the first attempt to expand health insurance coverage in America. Before Washington passed its law, a number of states took smaller-scale cracks at the job — each of which proved far more expensive than planned. As the nation dives further into debt, the destabilizing fiscal effects of those programs don’t bode well for how ObamaCare will shape the U.S. budget.”
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Posted by JR at 7:42 PM