September 30. An amendment proposed by Senator Jon Kyl (R-AZ) to get rid of a 5% penalty for Medicare doctors who order treatments and tests for their patients that wind up in the 10% most expensive per patient over a year was defeated 13-10 in the Senate Finance Committee this evening, with all committee Republicans voting to end the penalty and all committee Democrats voting to keep it.
Before the vote, however, Senator Kent Conrad (D-ND), said, "We’d be well advised ... to drop the penalty. I want to commit to working with Senator Kyl to find [another] offset before we go to the floor." This was in line with Conrad’s remarks on September 29 when Senator Kyl first brought up the amendment and temporarily withdrew it in order try to work out an alternative way of paying for the elimination of the penalty, which is scored by the Congressional Budget Office as cutting Medicare payments by $1 billion over ten years. The senators and their staffs were unable to agree on such an alternative during the intervening 24 hours, but, as Senator Conrad’s remarks indicate, will continue to try to agree on one so as to be able to support a jointly acceptable amendment by the time the measure goes before the full Senate for a vote.
Of course, even if Senators Conrad and Kyl agree, that is no guarantee that an amendment they both support will in fact be adopted when offered on the Senate floor. "Those concerned with the grave danger that Medicare doctors will be induced to ration more and more each year by this ‘musical chair’ penalty need to redouble their efforts to convince their Senators in the short weeks before the Senate votes on health care restructuring," said Burke J. Balch, director of National Right to Life’s Powell Center for Medical Ethics.
Wednesday, September 30, 2009
Tuesday, September 29, 2009
“DEATH SPIRAL” IN TROUBLE? NEGOTIATIONS BEHIND THE SCENES CONTEMPLATED
September 29. This evening in the Senate Finance Committee, Senator Jon Kyl (R-AZ) offered his amendment to strike from the health care restructuring bill a provision imposing a 5 % penalty on one in ten Medicare physicians yearly, those whose costs per senior citizen wind up in the top 10%. However, he agreed temporarily to withdraw it at the request of Senator Kent Conrad (D - ND), who spoke out strongly against the penalty provision but sought modifications in the offset originally proposed by Senator Kyl. The temporary withdrawal raises the prospect that an agreed method might be worked out to strike the penalty provision.
The National Right to Life Committee strongly supports the Kyl Amendment and opposes the penalty provision. Senator Kyl quoted Executive Director David N. O'Steen, Ph.D., "This provision creates a cruel death spiral. By financially penalizing Medicare providers, the Baucus bill sets up the cruelest and most effective way to ensure that doctors are forced to ration care for their senior citizen patients. Instead of bureaucrats directly specifying the treatment denials that will mean death and poorer health care for older people, it compels individual doctors to do the dirty work."
Under the bill as it stands, any physician treating Medicare patients who ordered treatments and tests whose cost turned out to be in the highest ten percent per capita would have to pay back to the federal government five percent of all the Medicare reimbursements the physician had received for that year. Senator Kyl warned this would force a "race to the bottom." He said, "If we’re focused on evidence-based criteria, how can we in good conscience simply take an arbitrary number? Ten percent will take a hit regardless of results." He warned that it would create a "conflict of interest" for doctors who would be deterred from ordering what is in the best interests of their patients for fear that they might end up among the 10% of doctors who would face a hefty financial penalty each year. Kyl noted that the Alliance of Specialty Medicine, a coalition of 11 medical organizations representing 200,000 doctors, has endorsed his amendment.
Senator Conrad remarked, "As I try to think about putting … my feet in the shoes, of a doctor who might be treating Medicare patients facing this construct, it is one thing to have the feedback, I think we should absolutely… I think we should do that. But I think this putting in a penalty, that really leaves me cold. I don’t know how you separate out overutilization that is really overutilization from those doctors who may have a group of patients who require more treatment than another group of patients and when you’re put in the position of, there is no way of knowing as you go through the year what is going to happen at the end of the year. And so what do any doctor who wants to avoid being in this penalty box have to do? …I think this is one part of this that I think we should think long and hard about. There is no way of knowing when you go through the year, what you are going to do at the end of the year. . . . I think this is something we would get down the road and we’d regret."
Committee Chairman Senator Max Baucus (D-MT), although he emphasized what he saw as the need to reduce "overutilization," said, "Maybe Senator Kyl has a point here" and offered to "see what modification we can make to address his concern."
Under the rules regulating amendments in the committee, any amendment that strikes a provision "scored" by the Congressional Budget Office (CBO) as cutting costs must include a measure that cuts the same amount in some other way. The CBO scored the penalty provision as cutting Medicare by $ 1 billion over ten years, and as proffered Senator Kyl’s amendment offset that by taking a corresponding amount from funding for the cooperative plans designed by Senator Conrad, and included in the bill proposed by Chairman Baucus, as a replacement for the much-debated "public plan."
Whether the Kyl Amendment to strike the "death spiral" provision, with a different offset, will be brought back with broad support, or whether it will face a closely divided vote, the next day or so is likely to show. Chairman Baucus has expressed his hope that the Senate Finance Committee will complete its consideration of amendments and take a final vote on approving the bill as amended by the end of the week.
The National Right to Life Committee strongly supports the Kyl Amendment and opposes the penalty provision. Senator Kyl quoted Executive Director David N. O'Steen, Ph.D., "This provision creates a cruel death spiral. By financially penalizing Medicare providers, the Baucus bill sets up the cruelest and most effective way to ensure that doctors are forced to ration care for their senior citizen patients. Instead of bureaucrats directly specifying the treatment denials that will mean death and poorer health care for older people, it compels individual doctors to do the dirty work."
Under the bill as it stands, any physician treating Medicare patients who ordered treatments and tests whose cost turned out to be in the highest ten percent per capita would have to pay back to the federal government five percent of all the Medicare reimbursements the physician had received for that year. Senator Kyl warned this would force a "race to the bottom." He said, "If we’re focused on evidence-based criteria, how can we in good conscience simply take an arbitrary number? Ten percent will take a hit regardless of results." He warned that it would create a "conflict of interest" for doctors who would be deterred from ordering what is in the best interests of their patients for fear that they might end up among the 10% of doctors who would face a hefty financial penalty each year. Kyl noted that the Alliance of Specialty Medicine, a coalition of 11 medical organizations representing 200,000 doctors, has endorsed his amendment.
Senator Conrad remarked, "As I try to think about putting … my feet in the shoes, of a doctor who might be treating Medicare patients facing this construct, it is one thing to have the feedback, I think we should absolutely… I think we should do that. But I think this putting in a penalty, that really leaves me cold. I don’t know how you separate out overutilization that is really overutilization from those doctors who may have a group of patients who require more treatment than another group of patients and when you’re put in the position of, there is no way of knowing as you go through the year what is going to happen at the end of the year. And so what do any doctor who wants to avoid being in this penalty box have to do? …I think this is one part of this that I think we should think long and hard about. There is no way of knowing when you go through the year, what you are going to do at the end of the year. . . . I think this is something we would get down the road and we’d regret."
Committee Chairman Senator Max Baucus (D-MT), although he emphasized what he saw as the need to reduce "overutilization," said, "Maybe Senator Kyl has a point here" and offered to "see what modification we can make to address his concern."
Under the rules regulating amendments in the committee, any amendment that strikes a provision "scored" by the Congressional Budget Office (CBO) as cutting costs must include a measure that cuts the same amount in some other way. The CBO scored the penalty provision as cutting Medicare by $ 1 billion over ten years, and as proffered Senator Kyl’s amendment offset that by taking a corresponding amount from funding for the cooperative plans designed by Senator Conrad, and included in the bill proposed by Chairman Baucus, as a replacement for the much-debated "public plan."
Whether the Kyl Amendment to strike the "death spiral" provision, with a different offset, will be brought back with broad support, or whether it will face a closely divided vote, the next day or so is likely to show. Chairman Baucus has expressed his hope that the Senate Finance Committee will complete its consideration of amendments and take a final vote on approving the bill as amended by the end of the week.
Monday, September 28, 2009
MARK-UP TO RESUME TOMORROW
The Senate Finance Committee hearings on healthcare restructuring will resume Tuesday due to the Monday holiday. The hearing is expected to continue over this week, with many of the most contentious amendments still awaiting consideration. Sen. Baucus hopes to complete the mark-up Thursday or Friday of this week.
It has been reported that the Senate as a whole could take up its health care reform bill as soon as the week of Columbus Day Oct. 12. It is expected that once the Senate Finance Committee mark-up is complete, that Majority Leader Harry Reid, Sen. Chris Dodd (who was at the helm of the Senate HELP mark-up), and Sen. Baucus will attempt to mesh the two Senate versions together. Sen. Reid has repeatedly suggested the Senate could take Columbus day week off for a recess, "but the health care reform debate would likely take precedence."
It has been reported that the Senate as a whole could take up its health care reform bill as soon as the week of Columbus Day Oct. 12. It is expected that once the Senate Finance Committee mark-up is complete, that Majority Leader Harry Reid, Sen. Chris Dodd (who was at the helm of the Senate HELP mark-up), and Sen. Baucus will attempt to mesh the two Senate versions together. Sen. Reid has repeatedly suggested the Senate could take Columbus day week off for a recess, "but the health care reform debate would likely take precedence."
Friday, September 25, 2009
WASHINGTON TIMES BLASTS DEATH SPIRAL PROVISION IN SENATE FINANCE BILL
September 25: An editorial in this morning's Washington Times warns of the rationing dangers in the Senate Finance Committee bill provision that would penalize 1 out of every 10 Medicare doctors each year for giving too much medical treatment to their senior citizen patients. Kyl Amendment D2 (Senate Finance Committee number 125) would eliminate this dangerous provision.
Thursday, September 24, 2009
SENATE FINANCE COMMITTEE ADOPTS ROCKEFELLER AMENDMENT MAKING MEDICARE COMMISSION’S ABILITY TO ALTER MEDICARE STILL MORE POWERFUL
September 24: By a vote of 15 to 3 , with 5 members "passing," the Senate Finance Committee reduced the ability of the representatives of the people to check the enormous authority of an unelected Medicare Commission. The original proposal from Chairman Baucus allowed Congress to pass a different set of limits on Medicare growth than recommended by the Commission by a majority vote. Under the Rockefeller Amendment, in order for Congress to overturn the Commission’s dictates would require a 2/3 vote.
The Medicare Commission is given almost unlimited powers to change Medicare in order to reduce Medicare payments to fit with the limits on growth it is designed to achieve. The only limits in the Chairman’s Mark not qualified by the term "if feasible" are that its proposals "not impact providers scheduled to receive a reduction to their inflationary payment updates in excess of a reduction due to productivity in a year in which the Commission’s proposals would take effect" and that they not "ration care, increase revenues, or otherwise change Medicare beneficiary cost-sharing, benefits, or eligibility standards." (Page 156 of Chairman’s Mark as modified).
Consequently, the Commission, without a vote by the people’s representatives in Congress, could, for example, significantly curtail the Private-Fee-for-Service alternative in Medicare Advantage. Under current law, the private fee-for-service alternative is the only one that permits senior citizens, without being subject to limits that could be imposed by the Center for Medicare and Medicaid Services, to add their own money on top of the government contribution in order to get health insurance that is less likely to limit access to medical treatment through managed care techniques or other means. With the significant cuts in Medicare funding that this legislation imposes in order to finance extending subsidies to cover the uninsured, it is particularly important to preserve this option for older Americans to allow them to protect their own life and health with their own money.
The three "no" votes came from Senators Hatch, Bunning, and Cornyn. Senators Grassley, Kyl, Crapo, Roberts, and Enzi passed. All Democratic Senators on the committee and Senators Snowe and Ensign voted in favor.
The Medicare Commission is given almost unlimited powers to change Medicare in order to reduce Medicare payments to fit with the limits on growth it is designed to achieve. The only limits in the Chairman’s Mark not qualified by the term "if feasible" are that its proposals "not impact providers scheduled to receive a reduction to their inflationary payment updates in excess of a reduction due to productivity in a year in which the Commission’s proposals would take effect" and that they not "ration care, increase revenues, or otherwise change Medicare beneficiary cost-sharing, benefits, or eligibility standards." (Page 156 of Chairman’s Mark as modified).
Consequently, the Commission, without a vote by the people’s representatives in Congress, could, for example, significantly curtail the Private-Fee-for-Service alternative in Medicare Advantage. Under current law, the private fee-for-service alternative is the only one that permits senior citizens, without being subject to limits that could be imposed by the Center for Medicare and Medicaid Services, to add their own money on top of the government contribution in order to get health insurance that is less likely to limit access to medical treatment through managed care techniques or other means. With the significant cuts in Medicare funding that this legislation imposes in order to finance extending subsidies to cover the uninsured, it is particularly important to preserve this option for older Americans to allow them to protect their own life and health with their own money.
The three "no" votes came from Senators Hatch, Bunning, and Cornyn. Senators Grassley, Kyl, Crapo, Roberts, and Enzi passed. All Democratic Senators on the committee and Senators Snowe and Ensign voted in favor.
Wednesday, September 23, 2009
ROBBING PETER TO PAY PAUL – FUNDING THE SENATE FINANCE BILL BY CUTTING HEALTH CARE FUNDING FOR OLDER AMERICANS
[Updated October 8, 2009]
The $829 billion (over ten years) bill for expanding health insurance coverage under the Senate Finance Committee bill as it now stands would be funded (roughly) 50% by cuts in Medicare and also 24% by a 40% tax on health insurance premiums over certain thresholds.
Thus, over half of the cost of covering the uninsured would come from “robbing Peter to pay Paul.” Older Americans, in particular, would be targeted, facing Medicare cuts of over $410 billion over the ten years from 2010 through 2019.
The one source of funding that would keep pace with the rising resources devoted to health care would be the 40% levy on health insurance premiums. Initially, this would apply (with some exceptions) to insurance plans that cost over $8000 annually for an individual or $21,000 annually for a family. These threshold amounts would increase each year by the average rate of inflation plus one percent. Since what is spent on health care consistently rises substantially more each year than the average inflation rate, the effect would be that, over time, larger and larger proportions of those with health insurance would begin to pay the tax on gradually rising portions of their premiums. [Compare NRLC's plan to extend healthcare without rationing here and an explanatory webinar here.]
DETAILS AND DOCUMENTATION
It is important to understand that the precise figures are in a state of flux, as the bill has not yet been converted to legislative language.[1] The objective here is solely to give a “big picture” rough analysis.
The total cost of expanding coverage (the subsidies for the uninsured, outlays for Medicaid and the Children’s Health Insurance Program and credits for small business) was estimated by the Congressional Budget Office at $829 billion.[2]
The total cuts to Medicare are over $410 billion dollars. [3]
The 40% excise tax on health care plans with annual premiums of more than $8000 for an individual or $21,000 for a family (with this threshold rising annually at the average rate of general inflation plus 1%), and with exceptions for over-55 retirees and those in certain high-risk professions is estimated to produce $201 billion over 10 years. [4]
NOTES
[1] The Senate Finance Bill as amended is available here.
[2] Based on tables entitled “Preliminary Estimate for Title I, Subtitle F Through Title V of the Chairman's Mark as Amended...” attached to Letter of Congressional Budget Office Director Douglas Elmendorf to Chairman Max Baucus of October 7, 2009, available here. The figure of $829 billion is derived from adding back in the offsets in that table for penalty payments and the excise tax on high premium insurance plans.
[3] Letter, from Doug Elmendorf and CBO to Chairman Max Baucus of October 7, 2009, available here. For a breakdown of Medicare spending see here.
[4] Joint Committee on Taxation, “Estimated Revenue Effects of the Revenue Provisions Contained in Title Vi Of Fiscal Years 2010 – 2019 as Amended Through October 2, 2009, And Under Consideration By The Committee On Finance" available here.
The $829 billion (over ten years) bill for expanding health insurance coverage under the Senate Finance Committee bill as it now stands would be funded (roughly) 50% by cuts in Medicare and also 24% by a 40% tax on health insurance premiums over certain thresholds.
Thus, over half of the cost of covering the uninsured would come from “robbing Peter to pay Paul.” Older Americans, in particular, would be targeted, facing Medicare cuts of over $410 billion over the ten years from 2010 through 2019.
The one source of funding that would keep pace with the rising resources devoted to health care would be the 40% levy on health insurance premiums. Initially, this would apply (with some exceptions) to insurance plans that cost over $8000 annually for an individual or $21,000 annually for a family. These threshold amounts would increase each year by the average rate of inflation plus one percent. Since what is spent on health care consistently rises substantially more each year than the average inflation rate, the effect would be that, over time, larger and larger proportions of those with health insurance would begin to pay the tax on gradually rising portions of their premiums. [Compare NRLC's plan to extend healthcare without rationing here and an explanatory webinar here.]
DETAILS AND DOCUMENTATION
It is important to understand that the precise figures are in a state of flux, as the bill has not yet been converted to legislative language.[1] The objective here is solely to give a “big picture” rough analysis.
The total cost of expanding coverage (the subsidies for the uninsured, outlays for Medicaid and the Children’s Health Insurance Program and credits for small business) was estimated by the Congressional Budget Office at $829 billion.[2]
The total cuts to Medicare are over $410 billion dollars. [3]
The 40% excise tax on health care plans with annual premiums of more than $8000 for an individual or $21,000 for a family (with this threshold rising annually at the average rate of general inflation plus 1%), and with exceptions for over-55 retirees and those in certain high-risk professions is estimated to produce $201 billion over 10 years. [4]
NOTES
[1] The Senate Finance Bill as amended is available here.
[2] Based on tables entitled “Preliminary Estimate for Title I, Subtitle F Through Title V of the Chairman's Mark as Amended...” attached to Letter of Congressional Budget Office Director Douglas Elmendorf to Chairman Max Baucus of October 7, 2009, available here. The figure of $829 billion is derived from adding back in the offsets in that table for penalty payments and the excise tax on high premium insurance plans.
[3] Letter, from Doug Elmendorf and CBO to Chairman Max Baucus of October 7, 2009, available here. For a breakdown of Medicare spending see here.
[4] Joint Committee on Taxation, “Estimated Revenue Effects of the Revenue Provisions Contained in Title Vi Of Fiscal Years 2010 – 2019 as Amended Through October 2, 2009, And Under Consideration By The Committee On Finance" available here.
NAT HENTOFF ON THE “DEATH SPIRAL”
Be sure to read the column by acclaimed civil libertarian Nat Hentoff, “Health bill's deadly fine print”: http://www.wnd.com/index.php?fa=PAGE.view&pageId=110710#
ANTI-RATIONING - MEDICARE COMMISION AMENDMENTS DEFEATED
This afternoon, the Senate Finance Committee defeated two amendments related to the Medicare Commission. The first amendment (offered by Sen. Cornyn (D6/165)), which would have eliminated the Medicare Commission altogether, lost 14-9.
The other defeated amendment was offered by Sen. Kyl (D7/130). This amendment, support of which was urged by NRLC, was more limited than Sen. Cornyn’s amendment. The Kyl amendment sought eliminate a particular provision that gives the Medicare Commission almost unlimited powers to change Medicare in order to reduce Medicare payments to fit with the limits on growth it is designed to achieve (see blog immediately below for more analysis, also available at http://powellcenterformedicalethics.blogspot.com/2009/09/nrlc-urges-support-of-amendments-to.html).
Although Sen. Kyl spoke in favor of the amendment and sought to highlight many of the dangers of rationing that could be present in this Commission structure, the amendment was ultimately voted down on party lines on a procedural issue. [All amendments are required to show how they will be funded using offsets in the existing bill. Sen. Kyl argued, unsuccessfully, that his amendment needed no offset. ]
One amendment related to this issue remains, Sen. Bunning's Amendment D3 (135). It is to be hoped that many of Sen. Kyl's strong arguments of the danger of such a Commission will be raised again.
NRLC SUPPORTS AMENDMENTS TO REIGN IN ALMOST UNLIMITED MEDICARE COMMISSION POWER TO CHANGE MEDICARE
With respect to the current amendment process, the National Right to Life Committee urges members of the Senate Finance Committee:
To SUPPORT Amendments 135 or 130 to require a Congressional vote in order to implement recommendations of the Medicare Commission.
Background:
The Medicare Commission is given almost unlimited powers to change Medicare in order to reduce Medicare payments to fit with the limits on growth it is designed to achieve. The only limits in the Chairman’s Mark not qualified by the term “if feasible” are that its proposals “not impact providers scheduled to receive a reduction to their inflationary payment updates in excess of a reduction due to productivity in a year in which the Commission’s proposals would take effect” and that they not “ration care, increase revenues, or otherwise change Medicare beneficiary cost-sharing, benefits, or eligibility standards.” (Page 156 of Chairman’s Mark as modified).
Consequently, the Commission, without a vote by the people’s representatives in Congress, could, for example, significantly curtail the Private-Fee-for-Service alternative in Medicare Advantage. Under current law, the private fee-for-service alternative is the only one that permits senior citizens, without being subject to limits that could be imposed by the Center for Medicare and Medicaid Services, to add their own money on top of the government contribution in order to get health insurance that is less likely to limit access to medical treatment through managed care techniques or other means. With the significant cuts in Medicare funding that this legislation imposes in order to finance extending subsidies to cover the uninsured, it is particularly important to preserve this option for older Americans to allow them to protect their own life and health with their own money.
While under the unamended Chairman’s Mark Congress could theoretically alter the Commission’s proposals so long as its legislative product resulted in the same reductions in Medicare, the burden of acting would be put on the Congress; an unelected group could eviscerate the right of senior citizens to get what they deem adequate care UNLESS majorities in the relevant committees and in both houses of Congress, with the agreement of the President, acted to preserve it. This is a risk too dangerous to take.
Therefore, the National Right to Life Committee urges support for Amendments 135 or 130, which would eliminate the automatic implementation of the Medicare Commission recommendations, requiring instead a vote by Congress to give them effect.
[The National Right to Life Committee has taken positions on other amendments – see http://powellcenterformedicalethics.blogspot.com/2009/09/position-on-certain-amendments.html and may shortly take positions on additional amendments.]
To SUPPORT Amendments 135 or 130 to require a Congressional vote in order to implement recommendations of the Medicare Commission.
Background:
The Medicare Commission is given almost unlimited powers to change Medicare in order to reduce Medicare payments to fit with the limits on growth it is designed to achieve. The only limits in the Chairman’s Mark not qualified by the term “if feasible” are that its proposals “not impact providers scheduled to receive a reduction to their inflationary payment updates in excess of a reduction due to productivity in a year in which the Commission’s proposals would take effect” and that they not “ration care, increase revenues, or otherwise change Medicare beneficiary cost-sharing, benefits, or eligibility standards.” (Page 156 of Chairman’s Mark as modified).
Consequently, the Commission, without a vote by the people’s representatives in Congress, could, for example, significantly curtail the Private-Fee-for-Service alternative in Medicare Advantage. Under current law, the private fee-for-service alternative is the only one that permits senior citizens, without being subject to limits that could be imposed by the Center for Medicare and Medicaid Services, to add their own money on top of the government contribution in order to get health insurance that is less likely to limit access to medical treatment through managed care techniques or other means. With the significant cuts in Medicare funding that this legislation imposes in order to finance extending subsidies to cover the uninsured, it is particularly important to preserve this option for older Americans to allow them to protect their own life and health with their own money.
While under the unamended Chairman’s Mark Congress could theoretically alter the Commission’s proposals so long as its legislative product resulted in the same reductions in Medicare, the burden of acting would be put on the Congress; an unelected group could eviscerate the right of senior citizens to get what they deem adequate care UNLESS majorities in the relevant committees and in both houses of Congress, with the agreement of the President, acted to preserve it. This is a risk too dangerous to take.
Therefore, the National Right to Life Committee urges support for Amendments 135 or 130, which would eliminate the automatic implementation of the Medicare Commission recommendations, requiring instead a vote by Congress to give them effect.
[The National Right to Life Committee has taken positions on other amendments – see http://powellcenterformedicalethics.blogspot.com/2009/09/position-on-certain-amendments.html and may shortly take positions on additional amendments.]
Tuesday, September 22, 2009
POSITION ON CERTAIN FINANCE COMMITTEE AMENDMENTS
With respect to the current amendment process, the National Right to Life Committee urges members of the Senate Finance Committee:
1. TO SUPPORT Amendments 125/137 to eliminate the 5% penalty for Medicare physicians in the top 10% of spending.
2. TO SUPPORT Amendment 152 to allow senior citizens to opt out of Medicare.
3. TO OPPOSE Amendments 207, 208, and 210, relating to advance care planning, in their current form.
The National Right to Life Committee expects to take positions on additional amendments.
------------------------------
A brief statement of our reasons for the positions summarized above follows:
1. TO SUPPORT Amendments 125/137 to eliminate the 5% penalty for Medicare physicians in the top 10% of spending.
The provision penalizing doctors establishes that for at least five years, Medicare physicians who authorize treatments for their patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year [see footnote 1 at bottom of release].
This means that all doctors treating older people will constantly be driven to try to order the least expensive tests and treatments for fear that they will be caught in that top 10%. It is noteworthy that this feature operates independently of any considerations of quality, efficiency, or waste - if you authorize enough treatment for your patients, however necessary and appropriate it may be, you are in danger of being one of the 1 in 10 doctors who will be penalized each year. Moreover, it creates a moving target - by definition, there will ALWAYS be a top 10%, no matter how far down the total amount of money spent on Medicare is driven.
It's like a game of musical chairs, in which there is always one chair less than the number of players – so no matter how fast the contestants run, someone will always be the loser when the music stops.
The incentive this creates is purely cost-driven, without any balancing of benefit. It will create a constant sense of uncertainty in doctors, since none can know in advance precisely what the cutoff for a given year will be - resulting in still more pressure to limit treatment and diagnostic tests to the bare minimum.
2. TO SUPPORT Amendment 152 to allow senior citizens to opt out of Medicare.
In order to pay for subsidies for insurance to the uninsured, the Chairman’s Mark includes significant reductions in payments that would otherwise be made under Medicare, including the authority for the Medicare Commission to impose limits on the rate of growth below the rate of medical inflation. This will make it increasingly difficult for senior citizens to obtain medical treatment under Medicare. They ought, at the least, to have the legal option of opting out of Medicare. Under this amendment, as with those parents who send their children to private schools, those opting out of Medicare would not be relieved of having had to pay into Medicare; they would just be able to use their own funds to obtain health insurance less constrained than that under Medicare.
3. TO OPPOSE Amendments 207, 208, and 210, relating to advance care planning, in their current form. These amendments would provide for governmental payment for advance care planning and various other ways of promoting advance directives. National Right to Life strongly encourages the execution of a pro-life advance directive, the Will to Live. However, the pro-life fear is that efforts to push patients and prospective patients to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money.
Advocates of such measures frequently cite the cost savings if, as they expect, this promotion results in more directives rejecting life-saving treatment. Efforts to push patients and older people to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money.
There have been several recent studies showing how advance directives and end of life conversations generally yield cost savings. A 2009 Archives of Internal Medicine study concluded, “Patient-physician discussions about [end of life] wishes are associated with lower rates of intensive interventions.”The mean cost of care was 35.7% less for patients who reported having end-of-life discussions compared with for patients who did not in their final week of life. “We refer to the end-of-life discussion as the multimillion-dollar conversation because it is associated with shifting costs away from expensive . . . care like being on a ventilator in an ICU, to less costly comfort care…,” noted Dana-Farber's Holly Prigerson PhD. A recent JAMA study reaches a similar conclusion that, "On the other hand, patients who reported having end-of-life discussions received less aggressive medical care and were more likely to receive hospice services for more than a week."
With this background, significant safeguards would need to be incorporated in any program for advance care planning – safeguards not fully present in the relevant amendments – in order for the promotion programs and consultation element to be truly protective of the values and intent of senior citizens, and to ensure they are not pressured into rejecting treatment against their true wishes. Therefore the National Right to Life Committee urges rejection of the amendments in their present form.
1. TO SUPPORT Amendments 125/137 to eliminate the 5% penalty for Medicare physicians in the top 10% of spending.
2. TO SUPPORT Amendment 152 to allow senior citizens to opt out of Medicare.
3. TO OPPOSE Amendments 207, 208, and 210, relating to advance care planning, in their current form.
The National Right to Life Committee expects to take positions on additional amendments.
------------------------------
A brief statement of our reasons for the positions summarized above follows:
1. TO SUPPORT Amendments 125/137 to eliminate the 5% penalty for Medicare physicians in the top 10% of spending.
The provision penalizing doctors establishes that for at least five years, Medicare physicians who authorize treatments for their patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year [see footnote 1 at bottom of release].
This means that all doctors treating older people will constantly be driven to try to order the least expensive tests and treatments for fear that they will be caught in that top 10%. It is noteworthy that this feature operates independently of any considerations of quality, efficiency, or waste - if you authorize enough treatment for your patients, however necessary and appropriate it may be, you are in danger of being one of the 1 in 10 doctors who will be penalized each year. Moreover, it creates a moving target - by definition, there will ALWAYS be a top 10%, no matter how far down the total amount of money spent on Medicare is driven.
It's like a game of musical chairs, in which there is always one chair less than the number of players – so no matter how fast the contestants run, someone will always be the loser when the music stops.
The incentive this creates is purely cost-driven, without any balancing of benefit. It will create a constant sense of uncertainty in doctors, since none can know in advance precisely what the cutoff for a given year will be - resulting in still more pressure to limit treatment and diagnostic tests to the bare minimum.
2. TO SUPPORT Amendment 152 to allow senior citizens to opt out of Medicare.
In order to pay for subsidies for insurance to the uninsured, the Chairman’s Mark includes significant reductions in payments that would otherwise be made under Medicare, including the authority for the Medicare Commission to impose limits on the rate of growth below the rate of medical inflation. This will make it increasingly difficult for senior citizens to obtain medical treatment under Medicare. They ought, at the least, to have the legal option of opting out of Medicare. Under this amendment, as with those parents who send their children to private schools, those opting out of Medicare would not be relieved of having had to pay into Medicare; they would just be able to use their own funds to obtain health insurance less constrained than that under Medicare.
3. TO OPPOSE Amendments 207, 208, and 210, relating to advance care planning, in their current form. These amendments would provide for governmental payment for advance care planning and various other ways of promoting advance directives. National Right to Life strongly encourages the execution of a pro-life advance directive, the Will to Live. However, the pro-life fear is that efforts to push patients and prospective patients to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money.
Advocates of such measures frequently cite the cost savings if, as they expect, this promotion results in more directives rejecting life-saving treatment. Efforts to push patients and older people to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money.
There have been several recent studies showing how advance directives and end of life conversations generally yield cost savings. A 2009 Archives of Internal Medicine study concluded, “Patient-physician discussions about [end of life] wishes are associated with lower rates of intensive interventions.”The mean cost of care was 35.7% less for patients who reported having end-of-life discussions compared with for patients who did not in their final week of life. “We refer to the end-of-life discussion as the multimillion-dollar conversation because it is associated with shifting costs away from expensive . . . care like being on a ventilator in an ICU, to less costly comfort care…,” noted Dana-Farber's Holly Prigerson PhD. A recent JAMA study reaches a similar conclusion that, "On the other hand, patients who reported having end-of-life discussions received less aggressive medical care and were more likely to receive hospice services for more than a week."
With this background, significant safeguards would need to be incorporated in any program for advance care planning – safeguards not fully present in the relevant amendments – in order for the promotion programs and consultation element to be truly protective of the values and intent of senior citizens, and to ensure they are not pressured into rejecting treatment against their true wishes. Therefore the National Right to Life Committee urges rejection of the amendments in their present form.
Monday, September 21, 2009
AMENDMENTS SEEK TO INTRODUCE END OF LIFE PROVISIONS
564 amendments have been released by members of the Senate Finance Committee. They are grouped by topic: financing, coverage expansion and delivery system reform. You can find them at http://www.finance.senate.gov/sitepages/legislation.htm.
As expected, Sen. Rockefeller has sought to reincorporate many of the controversial end of life provisions relating to Advance Directives 207,208,210 (Rockefeller C27, C28, C30). National Right to Life strongly encourages the execution of a pro-life advance directive, the Will to Live (See http://www.nrlc.org/MedEthics/WilltoLiveProject.html). However, the pro-life fear is that efforts to push patients and prospective patients to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money. This much is even admitted by the amendment as it is predicted to save money.
This batch of amendments is one among several of concern. Also, several key anti-rationing amendments have also been introduced. Check back in for more information before the Senate Finance Committee mark-up begins tomorrow morning.
Saturday, September 19, 2009
AMENDMENTS SET TO BE RELEASED THIS WEEKEND
Sen. Max Baucus's plan which has created deep divisions on both sides of the aisle is due to be considered in committee beginning Tuesday, September 22. At that time a slew of amendments are set to be considered. The amendments are set to be released Saturday morning. Please check back this weekend for analysis of these amendments as well as other provisions of the bill.
Thursday, September 17, 2009
“DEATH SPIRAL” RATIONING IN THE SENATE FINANCE BILL – DRIVING DOCTORS TO DENY CARE TO SENIOR CITIZENS
Senate Finance Committee Chairman Max Baucus’s “Mark,” released September 16 and due to be considered in committee beginning Tuesday, September 22, contains a provision penalizing doctors based on how much medical treatment they direct for senior citizens on Medicare. It establishes that for at least five years (2015-2020), Medicare physicians who authorize treatments for their patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year.
This means that all doctors treating older people will constantly be driven to try to order the least expensive tests and treatments for fear that they will be caught in that top 10%. Note that this feature operates independently of any considerations of quality, efficiency, or waste – if you authorize enough treatment for your patients, however necessary and appropriate it may be, you are in danger of being one of the 1 in 10 doctors who will be penalized each year.
Moreover, the penalty for Medicare doctors creates a moving target – by definition, there will ALWAYS be a top 10%, no matter how far down the total amount of money spent on Medicare is driven. Say that in 2015 the top 10% is anything over $10,000 per patient. In 2016 most doctors will scramble to hold down the treatments they authorize to avoid breaking that limit – with the result that the total amount spent will drop, so that the top 10% might then be, say, anything over $9,500. As the process repeats, the next year it might be anything over $9,000, the year after that anything over $8,000, and so on.
It's like a game of musical chairs, in which there is always 1 chair less than the number of players -- so no matter how fast the contestants run, someone will always be the loser when the music stops.
The disincentive to provide treatment for senior citizens the penalty creates is determined purely by cost, without any assessment of balancing cost with benefit. It will create a constant sense of uncertainty in doctors, since none can know in advance precisely what the cutoff for a given year will be – resulting in ever-increasing pressure to limit treatment and diagnostic tests to the bare minimum.
The provision to which this blog entry refers is as follows ( from documents available at http://finance.senate.gov/sitepages/legislation.htm ).
On pages 80-81, in the "Expansion of Physician Feedback Program" in Title III, Subtitle A, Part I; specifically, at the top of page 81: "Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician's resource use is at or above the 90th percentile of national utilization. After five years, the Secretary would have the authority to convert the 90th percentile threshold for payment reductions to a standard measure of utilization, such as deviations from the national mean."
On page 80, the Chairman's Mark states, "In preparing feedback reports, the Secretary would be required to make appropriate data adjustments to (1) account for differences in the demographic characteristics and health status of individuals so as not to penalize those physicians who tend to serve less healthy individual [sic] who may require more intensive interventions, and (2) eliminate the effect of geographic adjustments in payment rates."
While these adjustments may reduce the degree to which physicians are disproportionately penalized if they have sicker patients or work in high-cost areas, they do not change the fundamental danger of this provision, which (as explained above) is to create continual pressure on doctors to make ever-increasing reductions in the treatments and tests they order for their patients so as to avoid being in the penalized top 10%.
CBO rates this as taking $1 billion from Medicare payments over a period of 6 years. See CBO 9/16/09 letter to Chairman Baucus, Table, page 3 of 7.
This is the cruelest and most effective way to ensure that doctors are forced to ration care for their senior citizen patients. It takes the telltale fingerprints from the government: instead of bureaucrats directly specifying the treatment denials that will mean death and poorer health for older people, it compels individual doctors to do the dirty work. It is an outrageous way to "reform" health care – by taking it away from America’s senior citizens.National Right to Life Committee Executive Director David N. O’Steen, Ph.D.
Senate Finance Committee Chairman Max Baucus’s “Mark,” released September 16 and due to be considered in committee beginning Tuesday, September 22, contains a provision penalizing doctors based on how much medical treatment they direct for senior citizens on Medicare. It establishes that for at least five years (2015-2020), Medicare physicians who authorize treatments for their patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year.
This means that all doctors treating older people will constantly be driven to try to order the least expensive tests and treatments for fear that they will be caught in that top 10%. Note that this feature operates independently of any considerations of quality, efficiency, or waste – if you authorize enough treatment for your patients, however necessary and appropriate it may be, you are in danger of being one of the 1 in 10 doctors who will be penalized each year.
Moreover, the penalty for Medicare doctors creates a moving target – by definition, there will ALWAYS be a top 10%, no matter how far down the total amount of money spent on Medicare is driven. Say that in 2015 the top 10% is anything over $10,000 per patient. In 2016 most doctors will scramble to hold down the treatments they authorize to avoid breaking that limit – with the result that the total amount spent will drop, so that the top 10% might then be, say, anything over $9,500. As the process repeats, the next year it might be anything over $9,000, the year after that anything over $8,000, and so on.
It's like a game of musical chairs, in which there is always 1 chair less than the number of players -- so no matter how fast the contestants run, someone will always be the loser when the music stops.
The disincentive to provide treatment for senior citizens the penalty creates is determined purely by cost, without any assessment of balancing cost with benefit. It will create a constant sense of uncertainty in doctors, since none can know in advance precisely what the cutoff for a given year will be – resulting in ever-increasing pressure to limit treatment and diagnostic tests to the bare minimum.
The provision to which this blog entry refers is as follows ( from documents available at http://finance.senate.gov/sitepages/legislation.htm ).
On pages 80-81, in the "Expansion of Physician Feedback Program" in Title III, Subtitle A, Part I; specifically, at the top of page 81: "Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician's resource use is at or above the 90th percentile of national utilization. After five years, the Secretary would have the authority to convert the 90th percentile threshold for payment reductions to a standard measure of utilization, such as deviations from the national mean."
On page 80, the Chairman's Mark states, "In preparing feedback reports, the Secretary would be required to make appropriate data adjustments to (1) account for differences in the demographic characteristics and health status of individuals so as not to penalize those physicians who tend to serve less healthy individual [sic] who may require more intensive interventions, and (2) eliminate the effect of geographic adjustments in payment rates."
While these adjustments may reduce the degree to which physicians are disproportionately penalized if they have sicker patients or work in high-cost areas, they do not change the fundamental danger of this provision, which (as explained above) is to create continual pressure on doctors to make ever-increasing reductions in the treatments and tests they order for their patients so as to avoid being in the penalized top 10%.
CBO rates this as taking $1 billion from Medicare payments over a period of 6 years. See CBO 9/16/09 letter to Chairman Baucus, Table, page 3 of 7.
Wednesday, September 16, 2009
SENATE FINANCE DRAFT CONTAINS DANGEROUS PENALTIES THAT INCENTIVIZE LIMITING CARE FOR SENIORS
The bill unveiled today by Sen. Max Baucus (D-MT) contains important elements that would greatly impact the ability of patients to receive unrationed medical care.
With respect to rationing, the proposal contains a Medicare provision that, beginning in 2015, would severely financially penalize physicians who are in the top 10% of medical resource use. This provision does not link funding to outcomes or quality; instead, it will force a "race to the bottom" with relentless pressure on doctors to limit health care for their older patients. On top of the significant Medicare cuts in the bill, this will gravely endanger the lives of America's senior citizens.
The bill does contain language to prevent the use of comparative effectiveness analysis in a manner that would discriminatorily deny treatment because of age, disability, or terminal illness; however, this language would not affect the financial incentive to ration care as described above.
There are other places in the bill where the Secretary of Health and Human Services is given discretion to regulate the treatment that healthcare providers can give to their patients. Please check back soon for further analysis.
With respect to rationing, the proposal contains a Medicare provision that, beginning in 2015, would severely financially penalize physicians who are in the top 10% of medical resource use. This provision does not link funding to outcomes or quality; instead, it will force a "race to the bottom" with relentless pressure on doctors to limit health care for their older patients. On top of the significant Medicare cuts in the bill, this will gravely endanger the lives of America's senior citizens.
The bill does contain language to prevent the use of comparative effectiveness analysis in a manner that would discriminatorily deny treatment because of age, disability, or terminal illness; however, this language would not affect the financial incentive to ration care as described above.
There are other places in the bill where the Secretary of Health and Human Services is given discretion to regulate the treatment that healthcare providers can give to their patients. Please check back soon for further analysis.
Tuesday, September 15, 2009
THE HIGHLY ANTICIPATED SENATE FINANCE MARK EXPECTED TOMORROW
The Senate Finance Committee Chairman, Sen. Baucus (D-MT), is expected to release his highly anticipated health reform mark as early as Wednesday. It has also been reported that Sen. Rockefeller (D-WV) plans to introduce amendments containing end-of-life provisions that were originally expected to be part of the Baucus mark but were taken out over the summer after concerns.
During a briefing to reporters following a meeting of Finance Democrats on Monday, Sen. Baucus conveyed optimistically, that be believed that committee amendments would not unravel bipartisanship and that some Republicans join in – in adopting the bill - even if none sign on to the initial mark. This remark was no doubt in response to the major concerns that Republican Senators Enzi and Grassley had as reported today by the New York Times writing, “Two of the three Republicans in a small group trying to forge a bipartisan compromise on health care have requested numerous major changes in a proposal drafted by the chairman of the Senate Finance Committee, reducing the chances that he can win their support.”
It has also been reported that after the chairman's mark is released Wednesday (Sept. 16), after which the committee will meet in executive session to prepare the groundwork for amendments when markup begins next Tuesday (Sept. 22).
During a briefing to reporters following a meeting of Finance Democrats on Monday, Sen. Baucus conveyed optimistically, that be believed that committee amendments would not unravel bipartisanship and that some Republicans join in – in adopting the bill - even if none sign on to the initial mark. This remark was no doubt in response to the major concerns that Republican Senators Enzi and Grassley had as reported today by the New York Times writing, “Two of the three Republicans in a small group trying to forge a bipartisan compromise on health care have requested numerous major changes in a proposal drafted by the chairman of the Senate Finance Committee, reducing the chances that he can win their support.”
It has also been reported that after the chairman's mark is released Wednesday (Sept. 16), after which the committee will meet in executive session to prepare the groundwork for amendments when markup begins next Tuesday (Sept. 22).
Monday, September 14, 2009
OPEN ADVOCACY OF RATIONING - YET AGAIN
Over the weekend tens of thousands gathered in Washington D.C. to voice opposition to the proposed Health Care Restructuring Plans. At the same time, President Obama at a rally in Minnesota again reiterated that he is not dissuaded from moving forward -- while at the same time presenting no credible source of financing this new health care promise.
This morning, a USA Today article gives us a peak at things to come if we cannot adequately pay for the health care restructuring contemplated by existing proposals. The new extension of health benefits and new subsidies, as the House bill, the bill reported from the Senate Health, Education, Labor and Pension Committee, and the President's outline would attempt to pay for them, will leave a funding gap that would force government-imposed rationing of life-saving medical treatment. The article, available at http://www.usatoday.com/news/health/2009-09-13-kidney-doctors_N.htm?csp=24&R, describes a commentary published in the Journal of the American Society of Nephrology by Felix Knauf and Peter Aronson.
In their commentary in the prestigious journal, the pair openly notes that dialysis rationing would curb Medicare spending on chronic kidney failure in a big way. They regretfully acknowledge that to ration in this way "would almost certainly be politically unacceptable." ...But only 'politically' unacceptable....
The Yale doctors go on to write that "physicians are often willing to provide dialysis care to patients with greatly diminished quality of life.” They note disapprovingly that a survey of kidney doctors found that nearly half would be willing to continue dialysis in a patient who develops permanent severe dementia.
Here, note that they use the phrase "diminished quality of life." Under House and Senate HELP Committee proposals, if inadequate funding is combined with the emphasis on “controlling costs”, people with disabilities, those with poor “qualities of life”(whatever that will be interpreted to mean), the elderly and the terminally could be the first in line to have their treatment labeled 'ineffective' and denied. And, of course, it will not stop with dialysis.
The emphasis on reducing cost present in White House and Congress, coupled with an increasing openness in advocating rationing present in the Knauf/Aronson piece - makes for a real threat of rationing if the gap in available funding for healthcare becomes too wide.
See older posts and www.nrlc.org/healthcarerationing for positive solutions.
This morning, a USA Today article gives us a peak at things to come if we cannot adequately pay for the health care restructuring contemplated by existing proposals. The new extension of health benefits and new subsidies, as the House bill, the bill reported from the Senate Health, Education, Labor and Pension Committee, and the President's outline would attempt to pay for them, will leave a funding gap that would force government-imposed rationing of life-saving medical treatment. The article, available at http://www.usatoday.com/news/health/2009-09-13-kidney-doctors_N.htm?csp=24&R, describes a commentary published in the Journal of the American Society of Nephrology by Felix Knauf and Peter Aronson.
In their commentary in the prestigious journal, the pair openly notes that dialysis rationing would curb Medicare spending on chronic kidney failure in a big way. They regretfully acknowledge that to ration in this way "would almost certainly be politically unacceptable." ...But only 'politically' unacceptable....
The Yale doctors go on to write that "physicians are often willing to provide dialysis care to patients with greatly diminished quality of life.” They note disapprovingly that a survey of kidney doctors found that nearly half would be willing to continue dialysis in a patient who develops permanent severe dementia.
Here, note that they use the phrase "diminished quality of life." Under House and Senate HELP Committee proposals, if inadequate funding is combined with the emphasis on “controlling costs”, people with disabilities, those with poor “qualities of life”(whatever that will be interpreted to mean), the elderly and the terminally could be the first in line to have their treatment labeled 'ineffective' and denied. And, of course, it will not stop with dialysis.
The emphasis on reducing cost present in White House and Congress, coupled with an increasing openness in advocating rationing present in the Knauf/Aronson piece - makes for a real threat of rationing if the gap in available funding for healthcare becomes too wide.
See older posts and www.nrlc.org/healthcarerationing for positive solutions.
Friday, September 11, 2009
MR. PRESIDENT – WE ARE GETTING MORE FOR OUR MONEY!
In his September 9th speech before Congress, President Obama’s asserted that our extra money spent in the United States does not buy us better healthcare.
But, Mr. President, – we ARE getting more for our money!
What about wait times?
According to the Commonwealth Fund, there are alarming percentages of people who have to wait more than four months for non-emergency surgery. In the U.S., 5% wait more than 4 months. In Australia, Australia 23% wait more than 4 months. In New Zealand, 26% wait, in Canada 27% wait and in Britain, over one-third – 36% wait more than 4 months.
What About Survival Rates for major conditions and access to treatments?
According to the American Cancer Society in a recent 2009 report— the number of cancer deaths have steadily declined in the United States over the past 15 years, saving a possible 650,000 lives. The cancer death rate (the #2 cause of death) fell by 19.2 percent for men and 11.4 percent for women between 1990 and 2005.
An article published in 2007 in the British medical journal The Lancet strongly suggests that the United States is also outperforming the world when it comes to surviving diseases such as AIDS, heart disease, cancer, and pneumonia.
Forty-four percent of Americans who could benefit from statins, lipid-lowering medication that reduces cholesterol and protects against heart disease, take the drug. That number seems low until compared with the 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians who could both benefit from the drug and receive it.[i] Similarly, 60 percent of Americans taking anti-psychotic medication for the treatment of schizophrenia or other mental illnesses are taking the most recent generation of drugs, which have fewer side effects. But just 20 percent of Spanish patients and 10 percent of Germans receive the most recent drugs.[ii]
What about life expectancy?
The 2009 CDC report (relying on the latest data from 2006) says Americans are living longer than ever now, and longer every year. Americans average 77.9 years, up from 68 years in the 1950’s.
Although there is the common perception that life expectancy in the U.S. is lower than most industrialized nations, a study by Robert Ohsfeldt and John Schneider for the American Enterprise Institute found that exogenous factors to be so distorting that if you correct for homicides and accidents, the United States rises to the top of the list for life expectancy.[iii]
What about medical advancements?
In fact, Americans played a key role in 80 percent of the most important medical advances of the past 30 years.[iv]
[i] Oliver Schoffski, “Diffusion of Medicines in Europe,” paper prepared for the European Federation
of Pharmaceutical Industries and Associations,” 2002, cited in Daniel Kessler, “The Effects of Pharmaceutical Price Controls on the Cost and Quality of Medical Care: A Review of the Empirical
Literature,” submitted to the U.S. International Trade Commission.
[ii] Ibid.
[iii] Robert L. Ohsfeldt and John E. Schneider, The Business of Health: The Role of Competition, Markets,
and Regulation (Washington: American Enterprise Institute Press, 2006).
[iv] Economic Report of the President (Washington: Government Printing Office, 2004), p. 192.
But, Mr. President, – we ARE getting more for our money!
What about wait times?
According to the Commonwealth Fund, there are alarming percentages of people who have to wait more than four months for non-emergency surgery. In the U.S., 5% wait more than 4 months. In Australia, Australia 23% wait more than 4 months. In New Zealand, 26% wait, in Canada 27% wait and in Britain, over one-third – 36% wait more than 4 months.
What About Survival Rates for major conditions and access to treatments?
According to the American Cancer Society in a recent 2009 report— the number of cancer deaths have steadily declined in the United States over the past 15 years, saving a possible 650,000 lives. The cancer death rate (the #2 cause of death) fell by 19.2 percent for men and 11.4 percent for women between 1990 and 2005.
An article published in 2007 in the British medical journal The Lancet strongly suggests that the United States is also outperforming the world when it comes to surviving diseases such as AIDS, heart disease, cancer, and pneumonia.
Forty-four percent of Americans who could benefit from statins, lipid-lowering medication that reduces cholesterol and protects against heart disease, take the drug. That number seems low until compared with the 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians who could both benefit from the drug and receive it.[i] Similarly, 60 percent of Americans taking anti-psychotic medication for the treatment of schizophrenia or other mental illnesses are taking the most recent generation of drugs, which have fewer side effects. But just 20 percent of Spanish patients and 10 percent of Germans receive the most recent drugs.[ii]
What about life expectancy?
The 2009 CDC report (relying on the latest data from 2006) says Americans are living longer than ever now, and longer every year. Americans average 77.9 years, up from 68 years in the 1950’s.
Although there is the common perception that life expectancy in the U.S. is lower than most industrialized nations, a study by Robert Ohsfeldt and John Schneider for the American Enterprise Institute found that exogenous factors to be so distorting that if you correct for homicides and accidents, the United States rises to the top of the list for life expectancy.[iii]
What about medical advancements?
In fact, Americans played a key role in 80 percent of the most important medical advances of the past 30 years.[iv]
[i] Oliver Schoffski, “Diffusion of Medicines in Europe,” paper prepared for the European Federation
of Pharmaceutical Industries and Associations,” 2002, cited in Daniel Kessler, “The Effects of Pharmaceutical Price Controls on the Cost and Quality of Medical Care: A Review of the Empirical
Literature,” submitted to the U.S. International Trade Commission.
[ii] Ibid.
[iii] Robert L. Ohsfeldt and John E. Schneider, The Business of Health: The Role of Competition, Markets,
and Regulation (Washington: American Enterprise Institute Press, 2006).
[iv] Economic Report of the President (Washington: Government Printing Office, 2004), p. 192.
Thursday, September 10, 2009
FUNDAMENTAL FLAW IN OBAMA'S HEALTHCARE SPEECH
President Obama's September 9th speech to Congress advocating his health care restructuring plan suffered from a key and fatal flaw. His mistake is one that, unfortunately, is shared by many liberals, conservatives, Democrats and Republicans. He said, “[It] will slow the growth of health care cost for our families, our businesses, and our government.”
Consequently, his proposal focuses on limiting our ability to spend increasing amounts to save lives and preserve health through increasingly better healthcare as we have been doing consistently for over 75 years.
The assumption that one can reduce what is spent to save lives and preserve health -- and do so solely by attacking waste and inefficiency without rationing is simply wrong.
[See http://www.nrlc.org/medethics/AmericaCanAfford.html, http://www.nrlc.org/MedEthics/SaveNotRation.html, and our webinar at http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ ]
In simplest form, the facts are these:
1. As a nation we have been spending more each decade on healthcare BECAUSE WE CAN: production increases in our economy have continually freed up more resources that we can devote to this life-saving product.
2. Contrary to President Obama’s assertions, this extra money buys us better healthcare – reflected in higher survival rates for life-threatening illnesses in the United States.
3. The problem of the uninsured is one of distribution not incapacity --we as a society can afford better healthcare for those with low incomes who cannot cover the costs of healthcare in the way that most working class Americans can.
4. It is government, not the economy as a whole, that has trouble paying for healthcare because of a fundamental mistake in the way that existing and proposed subsidies for healthcare are funded.
5. The solution is to finance these subsidies based on what Americans are paying for healthcare rather than on general fund revenue that cannot keep up.
6. If on the contrary, as President Obama proposes, we seek to reduce the deficit by government imposed limitations on what Americans can spend to save their own lives and preserve their health, the result will be rationing, worse health, and unnecessary deaths.
Consequently, his proposal focuses on limiting our ability to spend increasing amounts to save lives and preserve health through increasingly better healthcare as we have been doing consistently for over 75 years.
The assumption that one can reduce what is spent to save lives and preserve health -- and do so solely by attacking waste and inefficiency without rationing is simply wrong.
[See http://www.nrlc.org/medethics/AmericaCanAfford.html, http://www.nrlc.org/MedEthics/SaveNotRation.html, and our webinar at http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ ]
In simplest form, the facts are these:
1. As a nation we have been spending more each decade on healthcare BECAUSE WE CAN: production increases in our economy have continually freed up more resources that we can devote to this life-saving product.
2. Contrary to President Obama’s assertions, this extra money buys us better healthcare – reflected in higher survival rates for life-threatening illnesses in the United States.
3. The problem of the uninsured is one of distribution not incapacity --we as a society can afford better healthcare for those with low incomes who cannot cover the costs of healthcare in the way that most working class Americans can.
4. It is government, not the economy as a whole, that has trouble paying for healthcare because of a fundamental mistake in the way that existing and proposed subsidies for healthcare are funded.
5. The solution is to finance these subsidies based on what Americans are paying for healthcare rather than on general fund revenue that cannot keep up.
6. If on the contrary, as President Obama proposes, we seek to reduce the deficit by government imposed limitations on what Americans can spend to save their own lives and preserve their health, the result will be rationing, worse health, and unnecessary deaths.
Wednesday, September 9, 2009
ADVANCE CARE PLANNING PROMOTION – THE GENUINE CONCERNS BEHIND THE COMPETING RHETORIC
Focusing on condemnation of some exaggerations and hyperbole in the questions raised about the promotion of “advance care planning” in H.R.3200, the House health restructuring bill, President Obama and others have ignored or swept aside legitimate concerns about the troubling nature of pushing older people to consider rejecting life-saving medical treatment in the context of what is promoted as a cost-saving measure in health carereform. Testimony recently presented by the Chairman Barbara Meara of the New York State Right to Life Committee provides a well-documented and careful analysis of the dangers in these provisions as written.
[Testimony text is available at: http://www.nrlc.org/HealthCareRationing/NYtestimony.pdf]
In addition, an article by Jim Towey detailing his fight to remove a Veteran’s Administration document that illustrates precisely the sort of unbalanced pressure to reject treatment critics fear, a fight that was successful in the previous Administration but was reversed by the Obama Administration, makes chilling reading. [Article available at: http://article.nationalreview.com/?q=ZWEzMjVlODBiMmFhNDNiNTRiZTg1ZWRmNzU1NDc4YTE=&w=Mw==]
[Testimony text is available at: http://www.nrlc.org/HealthCareRationing/NYtestimony.pdf]
In addition, an article by Jim Towey detailing his fight to remove a Veteran’s Administration document that illustrates precisely the sort of unbalanced pressure to reject treatment critics fear, a fight that was successful in the previous Administration but was reversed by the Obama Administration, makes chilling reading. [Article available at: http://article.nationalreview.com/?q=ZWEzMjVlODBiMmFhNDNiNTRiZTg1ZWRmNzU1NDc4YTE=&w=Mw==]
Tuesday, September 8, 2009
WE HAVE AN ALTERNATIVE, MR. PRESIDENT !
I’ve got a question for all these folks who say, you know, we’re going to pull the plug on Grandma . . . – you’ve heard all the lies. I’ve got a question for all those folks: What are you going to do? What’s your answer? What’s your solution?
And you know what? They don’t have one.
– President Barack Obama, Labor Day Speech 9/7/09
Since its 2007 Convention, the National Right to Life Committee has been pointing out that there is a way to provide health insurance to all Americans – without raiding Medicare, without limiting what Americans can choose to pay for health care and health insurance, and without government-imposed denial of life-saving medical treatment.
We have been pointing out that it is simply false to say that we need to “bend the cost curve” (for which read, limit spending on life- and health- saving medical treatment); that in fact, on average, Americans can afford the constantly improving health care we have been experiencing, and could afford to continue to improve it in the future [ See http://www.nrlc.org/medethics/AmericaCanAfford.html ].
We have been pointing out that the actual problems are distribution and the source of government financing for subsidies to older people and those unable to afford adequate health insurance, and – based on analysis by able health care economists – have put forth a concrete, affordable financing mechanism that would fix these problems. [See http://www.nrlc.org/MedEthics/SaveNotRation.html and our webinar at http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ ]
We’ve put it in legislative language. [See http://www.nrlc.org/MedEthics/FinancingLegDraft809.pdf ]
We’ve even made clear how we could address the problem of adequately funding Medicare and Medicaid into the future. [Again, see http://www.nrlc.org/MedEthics/SaveNotRation.html and our webinar at http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ ]
Sadly, although we’ve been assiduously lobbying to call attention to these alternatives, they’ve not been seriously taken up, and, political realities being what they are, they are now unlikely to be incorporated during consideration of health care reform this Fall.
However, amidst talk about “lies,” the real falsehood is to assert that our only alternatives are a form of health care restructuring that will ration care and deny treatment based on age and disability, on the one hand, and doing nothing to cover the uninsured, on the other.
And you know what? They don’t have one.
– President Barack Obama, Labor Day Speech 9/7/09
Since its 2007 Convention, the National Right to Life Committee has been pointing out that there is a way to provide health insurance to all Americans – without raiding Medicare, without limiting what Americans can choose to pay for health care and health insurance, and without government-imposed denial of life-saving medical treatment.
We have been pointing out that it is simply false to say that we need to “bend the cost curve” (for which read, limit spending on life- and health- saving medical treatment); that in fact, on average, Americans can afford the constantly improving health care we have been experiencing, and could afford to continue to improve it in the future [ See http://www.nrlc.org/medethics/AmericaCanAfford.html ].
We have been pointing out that the actual problems are distribution and the source of government financing for subsidies to older people and those unable to afford adequate health insurance, and – based on analysis by able health care economists – have put forth a concrete, affordable financing mechanism that would fix these problems. [See http://www.nrlc.org/MedEthics/SaveNotRation.html and our webinar at http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ ]
We’ve put it in legislative language. [See http://www.nrlc.org/MedEthics/FinancingLegDraft809.pdf ]
We’ve even made clear how we could address the problem of adequately funding Medicare and Medicaid into the future. [Again, see http://www.nrlc.org/MedEthics/SaveNotRation.html and our webinar at http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ ]
Sadly, although we’ve been assiduously lobbying to call attention to these alternatives, they’ve not been seriously taken up, and, political realities being what they are, they are now unlikely to be incorporated during consideration of health care reform this Fall.
However, amidst talk about “lies,” the real falsehood is to assert that our only alternatives are a form of health care restructuring that will ration care and deny treatment based on age and disability, on the one hand, and doing nothing to cover the uninsured, on the other.
Friday, September 4, 2009
SEN. ENZI NOTES THE MISSED CHANCE TO PREVENT RATIONING
In the GOP weekly radio/YouTube address, Sen. Enzi (R-Wyoming) was critical of the existing health restructuring proposals - particularly the one that emerged from the senate HELP committee. Specifically addressing rationing concerns, he noted the lack of adequate financing mechanisms and also pointed to comparative effectiveness research provisions.
“The bills would expand comparative effectiveness research that would be used to limit or deny care based on age or disability of patients. Republican amendments in the HELP Committee would have protected Americans by prohibiting the rationing of their health care. The Democrats showed their true intent by voting every amendment down and leaving these unacceptable provisions in the bill. This intrusion of a Washington bureaucrat in the relationship between a doctor and a patient is not the kind of reform that Americans are seeking."
To see more please click here.
“The bills would expand comparative effectiveness research that would be used to limit or deny care based on age or disability of patients. Republican amendments in the HELP Committee would have protected Americans by prohibiting the rationing of their health care. The Democrats showed their true intent by voting every amendment down and leaving these unacceptable provisions in the bill. This intrusion of a Washington bureaucrat in the relationship between a doctor and a patient is not the kind of reform that Americans are seeking."
To see more please click here.
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