CANADIAN PREMIER TO COME TO U.S. FOR HEART SURGERY

Today multiple sources have reported that Premier Danny Williams of Newfoundland and Labrador is heading to the United States for heart surgery that is unavailable in the province which he governs.

The Canadian Press, similar to the U.S.-based Associated Press, wrote today, “His decision to go to the U.S. for health care has triggered a heated debate online, particularly in a province that has tried to restore public confidence in its health care services after a major scandal involving botched breast cancer tests.”

Canada, a single payer system, is often held up by lawmakers as a model worth emulating (in whole or part) in the U.S. However, the system has also been plagued by claims of waiting lines, inadequate care, and poor survival rates.

In 2007, one of the problems --wait times-- had gotten so bad that the Prime Minister announced:

“During the last federal election campaign, I and my party made a clear and unequivocal commitment to Canadians. We promised to sit down with the provinces to develop Patient Wait Times Guarantees, and today, I’m proud to announce, we’re delivering.”

With the promise of delivering a solution by 2010, many Canadians remain skeptical. For more of the problems associated with Canada’s health care system see here.

NRLC has long argued that the cost of health care does not require rationing lifesaving treatment. (See here) As Congress contemplates how to move forward to pass health care reform intended to have universal coverage, it is essential that any health plan include a means of sustainable, adequate funding for it (see here), so as to lessen the real danger of rationing.

This high profile story from Canada is one among countless examples of what can go wrong in the rationed health care systems elsewhere that rely on general fund revenues.

CONGRESS NOT GIVING UP REFORM EFFORTS

“While the focus shifts to legislation on jobs, party leaders are taking advantage of a cooling-off period to strategize, seek a new compromise and improve the public's opinion of the legislation” begins a Los Angeles Times article from this past weekend.

It has been a widely articulated theory that many Democrats are facing an impossible choice of getting beat-up in the election over a “yes” vote they already cast on the initial round of reform, versus having nothing to show for it at the end of the day. Many see their only option as passing something and then attempting to exalt and defend the bill later.

While it appears that healthcare, for the time being, has taken a backseat to other policy concerns such as job creation, Democrats have nonetheless been continuing to meet in order to strategize on how best to move healthcare forward. It has been reported that there may even be hope of agreement on a procedural path forward by the end of this week.

Although Speaker Pelosi (D-Ca.) has repeatedly said that she does not have the votes for the Senate Bill as is, there is the general feeling that a modified Senate bill offers the Democrats their best shot. Rep. Connolly (D-Va.) was quoted saying "The more they think about it, the more they can appreciate that it may be a viable . . . vehicle for getting healthcare reform done."

This being said, in the current political climate, many (at least up to 8) Democratic Senators are squeamish about the idea of using reconciliation to make changes to make the effort palatable to the House. And with Speaker Pelosi having already lost some votes, is very likely to lose more if certain important elements are not resolved. These issues include abortion funding as well as the tax on “Cadillac Plans.”

While the House would surely like to drop the tax altogether, this would create a need for new revenue as well as make it tough to get the bill past the Senate’s fiscal conservatives.

Although many challenges lie ahead, Democrats and the White House have not yet abandoned the pending Senate and House bills for any sort of scaled-back or bi-partisan approach.

THE PUSH IS STILL ON

Although the situation in a state of flux, the push for health reform of some sort is still on. In an interview with Politico newspaper this afternoon, Speaker Pelosi said that, “We have to get it done. What the process is doesn’t matter. The outcome is what is important, and what it means to working families in America.”

The idea of passing a comprehensive amendment via reconciliation in order to make the Senate bill palatable to the House is still very much alive. While some House Democratic leaders predict that they may be able to garner enough votes to pass the Senate healthcare overhaul bill through the House (contingent upon changes), Speaker Pelosi herself last night told reporters that "At this time, in this form, there aren't the votes in the House, not anywhere near, to pass the Senate bill.”

Meanwhile, the 80-member National Coalition on Health Care announced this afternoon that they are launching a campaign to promote this approach. The coalition’s CEO Ralph Neas said that President Obama and Congress should immediately resume negotiations, and then the Senate should use reconciliation to pass "corrections" - therefore only needing a simple majority.

Be it “corrections” to the Senate bill, or stand alone measures, an increasing number of Senate Democrats have voiced strong reservations about using the reconciliation process. (They include seven Democrats and one independent, Sen. Joe Lieberman)

Although the President is not expected to focus on health care in tonight’s State of the Union Address, we can expect that this issue will remain a top priority for both the White House and the Congress.

LEADERSHIP PUSHING AHEAD WITH SENATE RATIONING BILL

With this Wednesday's State of the Union address drawing near, Democrats have been tight-lipped on what strategy they may use to make a final push for health care reform. The White House and top Democratic congressional leaders, despite losing the seat previously held by Senator Ted Kennedy (D-Mass.) to Republican Scott Brown, are nonetheless determined to push ahead with broad health care legislation.

Although no formal strategy has been announced, multiple sources, including AP, have reported that House Speaker Nancy Pelosi (D-Ca.) will attempt to gather the votes needed to pass the Senate bill by addressing House concerns in a single comprehensive amendment. The Senate would then use a procedural maneuver known as reconciliation (which would only require 51 votes in the Senate) to adopt these House changes.

This modified Senate version will certainly contain dangerous and numerous mechanisms that would lead to rationing. Some of these include - premium price controls, a powerful Medicare cost-cutting board, and numerous grants of "quality" and "efficiency" discretion given to the Secretary of Health and Human Services. A full analysis of the rationing concerns present in the pending Senate bill is available here.

A SCALED-BACK APPROACH?

In a town hall meeting in Elyria, Ohio this afternoon, President Obama again expressed his commitment to passing some sort of reform, saying, "I am not going to walk away just because it's hard."

The form that health reform may take is evolving daily, but the idea of a scaled-back package – one that could attract Republican support - may be gaining steam. Several House Democrats, like Rep. Paul Grijalva (D-Ariz.), are pushing for the use of Reconciliation for some of the controversial portions, and a series of small measures which might attract Republican support.

This morning, Howard Dean (former Democratic Party Chairman) was also advocating passage of a series of scaled-back healthcare measures instead of one comprehensive bill, adding, "I would go back and do that though and run it through the reconciliation program."

Democratic leaders have said they will not hold votes on healthcare reform until Brown is seated. Further, Sen. Chris Dodd has called for lawmakers to "take a breather for a month, six weeks."
Although the timetable, as well as the direction of health reform is unclear, Obama and congressional Democrats are far from abandoning reform this session.

MORE INDICATIONS HEALTH BILL WILL BE PUSHED THROUGH RECONCILIATION PROCESS

Adding to information reported earlier today, Representative Paul Ryan (R-WI), the ranking Republican member on the House Budget Committee now says the majority will seek to use the reconciliation process to adopt as much as possible of the health care bill stalled by the Massachusetts victory of Senator-Elect Scott Brown.

NRLC PRESS CONFERENCE 1/21/2010 STATEMENT ON HEALTH CARE RATIONING

STATEMENT BY BURKE J. BALCH, J.D.
DIRECTOR, ROBERT POWELL CENTER FOR MEDICAL ETHICS
National Right to Life Committee Press Conference
Zenger Room, National Press Building, Washington, D.C.
January 21, 2010
　
Since its inception, the pro-life movement has been just as concerned with protecting the lives of people with disabilities and older people from euthanasia as it has been with protecting unborn children from abortion, and we have regarded government-imposed rationing of lifesaving medical treatment, food and fluids as an unacceptable form of involuntary euthanasia.

Therefore, the pro-life movement has grave concerns about rationing elements in the pending health care legislation. This morning’s Washington Post quotes Harvard health policy professor Robert Blendon as saying that what Massachusetts voters heard was now Senator-elect Scott Brown’s message that the national health care bills would require Medicare cuts. Indeed, a great deal of the backlash, not just in Massachusetts but also nationally, comes from those with insurance realizing that their health care will be endangered if the proposed legislation is enacted.

That legislation is based upon a widely held but fundamentally fallacious assumption – that it is necessary to "bend the cost curve" of health care spending because America cannot afford to continue to increase health care spending in the future as it has in the past.

As it happens, foremost among the economists who have debunked this fallacy is the Obama Administration’s nominee for Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, Columbia University health care economist Sherry Glied, in her 1997 book "Chronic Condition: Why Health Reform Fails." The first two of these charts are based on data from that book, updated.

The percent of the average family budget devoted to health care (including what employers pay for employees’ health insurance) has steadily grown from 3% in 1940 to 17% in 2006. This trend, and fear that it will continue unless "the cost curve is bent," lies behind the increasingly widespread view that rationing, however unpalatable, is essential. But as Glied’s book demonstrates, the trend must be seen in context.

During that same period, the percent of the average family budget devoted to food declined from almost 30% to under 15%, because of ever-increasing improvements in agricultural productivity. We can look further at the three essentials of food, clothing, and shelter combined. From 1940 to 2006, the percent of the average family budget devoted to these necessities fell from about 53% to about 33%. Consequently, the percent for health care plus food, clothing, and shelter actually dropped from 56% in 1940 to 50% in 2006. Productivity improvements in such areas as agriculture, transportation, and the assembly of clothing freed up resources enabling Americans, on average, to put significantly more resources into obtaining better health care.
While we are presently coping with severe economic downturn, research by health care economists across the ideological spectrum, from David Cutler[1] to Robert Hall and Charles Jones, shows that there is no reason, so long as productivity growth continues, why we cannot indefinitely continue to increase the proportion of our incomes that is spent to keep us alive and healthy.

The pending health legislation contains numerous mechanisms to hold down the amount of their funds Americans are allowed to use to save their own lives. As documented on our website, both the House and Senate bills would not just limit government health care spending; they would empower bureaucrats to limit what private citizens can spend to get unrationed health insurance. Senior citizens, faced with massive Medicare cuts, could be prevented by the federal Centers for Medicare and Medicaid Services from exercising the choice current law allows them to add their own money on top of the diminishing government Medicare contribution in order to get Medicare Advantage private fee-for-service plans less likely to deny treatments and diagnostic tests. Those participating in the health insurance exchanges could see their insurance choices limited to those plans most likely to deny care if government bureaucrats exclude plans less likely to ration care on the claim that they cost too much.

Under the Senate bill, an almost omnipotent commission would be directed not only to hold Medicare increases below the rate of medical inflation, but also to recommend to the HHS Secretary measures to keep increases private health care spending below medical inflation as well. The HHS Secretary would be empowered to impose so-called "quality" and "efficiency" standards on ALL health care providers governing the health care they provide not only under government programs but also under private insurance.

We don’t need this U.K.-style rationing, and the National Right to Life Committee will be working to prevent or repeal it. Last night, in an interview with George Stephanopoulos, the President suggested the possibility of a stripped-down bill, but one of the three items he mentioned as being in such a bill was "cost-containment." We will be carefully watching any such stripped-down measure to determine whether it includes provisions that, like the pending bills, would ration health care, and will be quick to publicize and oppose them.

[1] David M Cutler, Your Money or Your Life: Strong Medicine for America's Healthcare System (Oxford: Oxford University Press, 2004).