The New York Times Exposes Death Panels

Sarah Palin was widely ridiculed for her use of “death panels” to describe the inevitable rationing of medical care under Obama Care. As Palin famously declared in August 2009:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

An outraged Politifact (a Pulitzer Prize winner, no less) pushed back.

“There is no panel in any version of the health care bills in Congress that judges a person's "level of productivity in society" to determine whether they are ‘worthy’ of health care.”
Politifact seems not to have understood that there was no need to formalize death panels under Obama Care. They will automatically come into play when bureaucratic intervention, price controls, and complicated administrative rules create shortages of surgeons, hospital rooms, imaging equipment, and medication.  With shortages that bureaucracies prevent from being eliminated by market forces, we will automatically have “death panels” or even worse procedures for allocating scarce medical resources.

Indeed, a New York Times’s exhaustive investigation reports that shortages of all sorts of drugs — anesthetics, painkillers, antibiotics, cancer treatments — have become the “new normal” in American medicine. The American Society of Health-System Pharmacists currently lists “inadequate supplies” of more than 150 drugs and therapeutics.” Per the NYT, with such shortages: “choices are …. made in ad hoc ways… resulting in contradictory conclusions, murky ethical reasoning and medically questionable practices.”

The Times delves into the various types of administrative panels that decide which patients receive life-saving medications and which do not. The Children’s Oncology Group’s guidelines (the largest international group of children’s cancer researchers) ration drugs based on added years of life, curability of a child’s cancer, improving survival chances, and participation in clinical research.  The group also advises that allocation rules be made public. The child oncologists are not happy with their foray into rationing: “We’ve been forced into what we think is a highly unethical corner.”

With widespread drug shortages, rationing rules are being applied generally in hospitals and medical centers to decide who gets drugs. The rationing panels are comprised of  physicians, ethicists, hospital administrators, insurance companies, or drug manufacturers and usually use indicators of productivity, worthiness, and even weight (obese patients require more of the drug). In many hospitals, patients are not told that their drug regimen has been changed due to shortages.

The Times seems uninterested in the causes of drug shortages. After all, if the medication is not a “shortage drug” no panel is required to determine its allocation among patients. In its 2,500 word investigative article, the Times authors devote one sentence to the reasons for the shortages, which (they say) range “from manufacturing problems to federal safety crackdowns, to drug makers abandoning low-profit products.”

There is no discussion of measures to create balances of supply and demand – perhaps by making it worthwhile for the manufacturer to produce at a profit. Instead, the focus is on administrative measures to decide who will get the medication. Why does the Times not investigate why, for example, aminocaproic acid, cheap, widely and safely used for decades in open-heart surgery, has become a shortage drug?  Has the increased involvement of the government played a role? It seems that this is a legitimate question, only one the Times ducks.

Of the three reasons given for shortages, we cannot determine the extent to which Obama Care’s bureaucratic intervention in medicine has caused “production problems,” or “safety crackdowns.” Of course, companies will abandon products due to low (or nonexistent) profit margins. But this was the original objection to Obama Care: It would dictate low drug prices, which would not be permitted to rise even with shortages. It seems that laws of economics are supposed to be suspended under Obama Care.

We do not have shortages of cars, electricity, home electronics, airline seats, and so on. Admittedly, medicine is complicated, but it is foolhardy to think that basic economic laws do not apply.

Obama's Spin Doctors Open Up A Pandora's Box With Their CBO Response

The Congressional Budget Office (CBO) report that Obama Care will cost 2.5 million jobs sent the Democrat rapid response teams reeling.  The “non-partisan” CBO has labelled the president’s signature achievement a job killer. What to do?

The Obama team’s first reaction must have been: This must be wrong! Haven’t we been saying all along that employment problems are to be corrected by government spending? With the CBO’s determination that the ACA’s carrot-and-sticks are destroying jobs, we cannot admit that the unemployed and underemployed are victims of misaligned incentives, not of inadequate government expenditures. We need another angle. A voice from the back of the room:  Maybe we can say that, in certain circumstances, job destruction is good?

That was it. The best that Obama’s rapid responders could do for positive spin was that the ACA gives low-income earners new choices. They couldchoose to work fewer hours, or not at all, to keep their incomes low enough to maintain their insurance handout. A blessing instead of a curse, the ACA turns high school dropouts into budding poets, photographers, and writers (per Nancy Pelosi) whom free insurance saves from the drudgery of earning a living.

go to forbes.com

Virtual Insurance: How ObamaCare Saves 30 Million From Being Uninsured While Leaving 30 Million Without Coverage

Obama supporters cite the 30 million who stand eventually to gain health insurance coverage as the most compelling reason for not abandoning ObamaCare in its time of troubles. Despite a string of disappointments and broken promises, ObamaCare critics do not push back against this  claim. After all, the 30 million who will gain insurance is a calculation of the “non-partisan” CBO.


go to forbes.com

Weak World Economy, Not ObamaCare, Is Bending The Cost Curve

Obama’s central planners are latching on to what they think is a rare  ObamaCare “win.” Harvard professor and ObamaCare guru, David Cutler (The health-care law’s success story: Slowing down medical costs) proclaims that ObamaCare has “bent the health care cost curve down” as a consequence of  measures already in effect, such as “value based reimbursements” and “Accountable Care Organizations.”  ObamaCare has thus attained one of its main goals before it even begins. Quite an accomplishment, I must say, if true.

Note that Cutler rules out that the downward bending cost curve is a result of the 2008-9 world recession and the spindly recovery thereafter. As he writes:

“Even as coverage efforts are sputtering, success on the cost front is becoming more noticeable. Since 2010, the average rate of health-care cost increases has been less than half the average in the prior 40 years. The first wave of the cost slowdown emerged just after the recession and was attributed to the economic hangover. [Wrong. The slowdown began during the recession]. Three years later, the economy is growing, and costs [No. He means the growth rate of costs] show no sign of rising. Something deeper is at work.”

Sounds too good to be true. With some minor jiggling, Obama’s central planners have somehow slowed the rise in health care costs for the first time in forty years. Per Cutler: “The Affordable Care Act is a key to the underlying change.”

Cutler fails to mention the world-wide phenomenon of slowing healthcare costs caused by the world recession and the weak recovery in its aftermath. The U.S. medical cost slowdown has nothing to do with the ObamaCare tweaks that Cutler praises. Cutler would have us believe that the somnambulant world economy explains the deceleration of medical costs in all countries except the United States, where ObamaCare must be credited. Try selling that one on the streets.

gp to forbes.com 

To Achieve ObamaCare's Insurance Goals, We Must Abolish ObamaCare

ObamaCare was sold to the American people as an “effort to help 40 to 50 million Americans with low income or people with preexisting conditions.” (Democratic Rep. Earl Blumenauer,  http://thomas.loc.gov).  ObamaCare’s original promises (now long forgotten) were that we can help those 40 to 50 million unfortunates who can’t get insurance, keep our doctor and plan, lower premiums by $2,500, and it will  cost less than a trillion dollars over a ten year period. Sounds almost too good to be true, and it was!

If your car is acting up, you want the mechanic to fix the problem. Only if the car’s problems are catastrophic would you consider junking it. However, Obama is ready to junk our health care system because of problems with the uninsured poor and pre-existing conditions that affect only three percent of the population. He did not ask, like in the case of  the auto mechanic, what it costs to insure the poor and those with pre-existing conditions, while keeping the rest of the system that is working just fine (such as our current plan and doctor) for the 97 percent of us.

go to forbes.com

I, Like Ms. Fluke, Am Denied Free Access to Preventive Care

Dear  HHS Secretary  Sibelius:

After viewing Ms. Fluke’s testimony on her right to free access to contraception, I wish to bring to your attention that I am also being denied free access to vital preventive health care. Medical studies prove the reduced health-care costs of  senior citizens, who engage  in  moderate daily exercise in a proper facility under supervision of a physical therapist certified in geriatric care.

Medical research has clearly demonstrated that I – as a 71 year old male -- will have fewer hospitalizations and need fewer prescription medications as a result of daily moderate supervised aerobic and other exercise. I provide in the attached appendix actuarial calculations that demonstrate the discounted present value of health-cost savings over my projected lifespan exceeds the cost of the vital preventative medical care that I hereby petition.

I base my claim on HHS paragraph 13.1 - Medicare Policies (Rev. 71, 04-09-04), which clearly states that:

“The National Coverage Determinations (NCDs) are developed by CMS to describe the circumstances for Medicare coverage nationwide for a specific medical service procedure or device. NCDs generally outline the conditions for which a service is considered to be covered (or not covered) under §1862(a)(1) of the Act or other applicable provisions of the Act. NCDs are usually issued as a program instruction. Once published in a CMS program instruction, an NCD is binding on all Medicare carriers/DMERCS, FIs, Quality Improvement Organizations (QIOs, formerly known as Peer Review Organizations or PROs), Program Safeguard Contractors (PSCs) and beginning 10/1/01 are binding for Medicare+Choice organizations. NCDs made under §1862(a)(1) of the Act are binding on Administrative Law Judges (ALJ) during the claim appeal process. (See 42 CFR 405.732 and 42 CFR 405.860).

I am confident you will agree with my reading of HHS paragraph 13.1, rev. 71,04-09-04, that I am entitled to free access to this vital preventive medical care.

go to forbes.com 

Advice for Romney: I Have Seen State Health Care Up Close and It Does Not Work

If Mitt Romney wishes to become President of the United States, he must cease any and all defense of  Massachusetts-Care. Rick Santorum told him that in so many words in Thursday's debate, and Santorum is right.

There is no one, however, as qualified as Romney to pass judgement on Obama Care. "We tried it in Massachusetts. It was a noble experiment. I was for it. It did not work, despite Massachusett's favorable conditions. This is why we have a federal system. We can experiment at the state level with all kinds of things, and this experiment warns against trying to do the same thing for the nation as a whole."

Case closed.

If You Do Not Understand the Economics of Health Care – Read These Few Lines

The provision of health care is one of the most complicated businesses around. People do not go to their doctors or hospitals for fun. Much of the payment for medical care is through third parties, giving users the impression that it is free. Since 1965, federal and state governments have been heavily involved.

We are now in a wrenching debate about increasing state involvement in health care, full of charges, counte rcharges, truths, half truths, and lies.

Simple economic analysis, however, provides a tried-and-true guide for those who really want to understand the debate. Economics suggests the following points.

“Affordable” universal health care cannot be provided to everyone without mandatory reductions in payments to doctors, hospitals, drug companies, and nurses. Everyone, in effect, will get a “voucher” for health care to be provided at a low (or zero to the patient) price.

Lower mandated payments to health-care providers will have the following effects. Health-care providers will:

Treat only those who pay a price higher than the mandated price.

Transfer into unregulated medical activities (such as cosmetic surgery or weight loss programs).

Withdraw from medicine for related professions that reward them for their training and education.

This means that the government “vouchers” for medical services will have little value. Few medical professionals will honor them. The state health care program is therefore discredited. When this happens, the state has two choices:

Let those who least can afford medical care endure long lines, wait for life-saving treatments, and forego necessary medication. The treatment of the “rich” will be unaffected as financially-strapped medical care providers welcome them to special VIP programs. This option is a political disaster.

Use coercion to force medical care providers to accept voucher patients. The state imposes severe penalties for violations, and, in extreme cases, makes it illegal for any health care provider to charge a price higher than the state-reimbursement rate. At this point, we have a single payer system kept in place by state coercion.

The second solution will result in a loss of economic freedom, from which it will be difficult to recover.