In the much ballyhooed debt-reduction “framework” President Obama revealed this week in a speech at George Washington University, the President proposed a dramatically graver limit on what Americans will be allowed to spend for our own healthcare than that which will be imposed by the Obama Health Care Law if it is not repealed before 2015.
As now enacted, the Obama Health Care Law directs an unelected 18-member panel called the “Independent Payment Advisory Board” to limit what Americans are permitted to spend on health care out of their own, nongovernment, funds to less than enough to keep up with medical inflation. However, Obama is now proposing what the White House framework calls “a more ambitious target of holding . . . cost growth . . . to GDP [gross domestic product] plus 0.5 percent beginning in 2018, through strengthening the Independent Payment Advisory Board (IPAB).”
Suppose this proposal had been in effect in 2009, the most recent year for which statistics are available. In 2009, because of the recession the overall real GDP per capita, as reported by the Bureau of Labor and Statistics, actually shrank by 2.1 percent. If you use President Obama’s formula for that period of time, after adding .5% , Americans would have been forced to decrease what we would be allowed to spend to save our lives and preserve our health by 1.6 percent.
In 2009, the actual rate of medical inflation was 2.7%. Had the Obama Health Care Law (ObamaCare) been in effect, Americans would have been able to increase their medical spending, but not enough to keep up with the 2.7% medical inflation rate.
But under the Obama proposal announced this week, what Americans of all ages would be permitted to spend for health care, taking into account the increased cost of medical goods and services, would in real terms be 3.3% less than in the previous year.
While there has been increasingly widespread opposition to the Independent Medical Payment Advisory Board from physician groups, Republicans, and an increasing number of Democrats, the public focus has been on its mission to make cuts in government Medicare spending. Far too little attention has been given to the rationing it would impose through limits on the resources Americans will be allowed to devote to our own health care.
Under the Obama Health Care Law, these limits will be subject to enforcement by the federal Department of Health and Human Services, which will be empowered to impose so-called “quality” and “efficiency” measures on health care providers. Any doctor who dares to provide life-saving treatment in excess of these limits will be disqualified from contracting with any of the insurance plans which, under the individual mandate, Americans will be required to purchase.
The Obama Health Care Law must be repealed, and his still more draconian proposals defeated. If not, as is now true of Canadians who must often come to the United States to obtain life-saving health care, Americans will increasingly have to find locations abroad if we want to be able to use our own money effectively to save their own lives.
Showing posts with label Independent Payment Advisory Commission. Show all posts
Showing posts with label Independent Payment Advisory Commission. Show all posts
Saturday, April 16, 2011
Friday, March 4, 2011
PRESIDENT’S SUPPORT FOR STATE “FLEXIBILITY” IN IMPLEMENTING OBAMA HEALTH CARE LAW WON’T AVOID RATIONING
President Obama made headlines in a speech before the National Governors Association, when he endorsed a Senate bill described as allowing states to seek “waivers” of certain requirements in the Obama Healthcare Law. However, the offer comes with strings, and would do nothing to change the elements of the federal law that will impose rationing of medical treatment if it is not repealed.
There would be no “waiver” from the duty of the Independent Payment Advisory Board to recommend, or the authority of the federal Department of Health and Human Services to impose, so-called “quality” and “efficiency” standards on health care providers designed to limit what Americans will be permitted to spend on life-saving medical care for themselves and their families, forcing it below the rate of medical inflation.
Senate Bill 248, for which the President expressed support, would move from 2017 to 2014 the date when states would be allowed to seek exemptions from certain Obama Health Care Law requirements, such as state insurance exchanges, and the individual and employer mandates. Such a waiver would be granted, however, only if the Administration is convinced that the state’s alternative would 1) make insurance just as "affordable" as under Obamacare (translation: limit what resources people are allowed to devote to their own health care); 2) Cover as many people as Obamacare with health insurance which is as “comprehensive” as Obamacare; and 3) Not increase the federal budget deficit.
Most States are struggling with their health care budgets, and many expect the situation to become worse under the requirements of the Obama health care law. Politico reported, “The move comes as governors, particularly Republican state leaders, say the law is overly burdensome on the already stretched states. Much of the expansive legislation has to be implemented at the state level.”
Were the bill to be enacted, the most likely result would be that proposals threatening the most dangerous rationing would see new life in the states. For example, Vermont officials are pushing hard to secure a waiver to implement their proposed “single-payer” system – under which all Vermont citizens would be forced into a single state government health plan, subject to state budgetary limits, with no opportunity to choose other insurance less likely to ration. Said Senator Bernard Sanders (Socialist-VT), “At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, it is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all, single-payer approach.”
While it is, in theory, possible for states to craft any sort of plan they wish within the requirements, it is difficult to see how the Obama administration might approve ones that did not dramatically curtail what people are allowed to spend for their health care. It is precisely the policy of preventing people from being allowed, if they choose, to use their own funds to keep up with health care inflation that creates the gravest threat of rationing.
The Senate proposal may have a difficult time in the House, where congressional Republicans want states to have much more flexibility. Inside Health Policy wrote that the plan to bump up the waiver dates, “was met with disdain from GOP lawmakers, who said the opt-out criteria are too stringent and called the move a confession that the bill is unworkable in its current form.”
Politico reported, “Mandating many of the same requirements, this plan would treat states as agents of the very law these governors are running away from,” said Michael Steel, spokesman for Speaker John Boehner. “A better approach would be working with reform-minded governors to give states more flexibility . . . . Now that the administration has conceded that Obamacare is unworkable, we hope they will work with us to repeal the law and replace it with common-sense reforms . . . .”
There would be no “waiver” from the duty of the Independent Payment Advisory Board to recommend, or the authority of the federal Department of Health and Human Services to impose, so-called “quality” and “efficiency” standards on health care providers designed to limit what Americans will be permitted to spend on life-saving medical care for themselves and their families, forcing it below the rate of medical inflation.
Senate Bill 248, for which the President expressed support, would move from 2017 to 2014 the date when states would be allowed to seek exemptions from certain Obama Health Care Law requirements, such as state insurance exchanges, and the individual and employer mandates. Such a waiver would be granted, however, only if the Administration is convinced that the state’s alternative would 1) make insurance just as "affordable" as under Obamacare (translation: limit what resources people are allowed to devote to their own health care); 2) Cover as many people as Obamacare with health insurance which is as “comprehensive” as Obamacare; and 3) Not increase the federal budget deficit.
Most States are struggling with their health care budgets, and many expect the situation to become worse under the requirements of the Obama health care law. Politico reported, “The move comes as governors, particularly Republican state leaders, say the law is overly burdensome on the already stretched states. Much of the expansive legislation has to be implemented at the state level.”
Were the bill to be enacted, the most likely result would be that proposals threatening the most dangerous rationing would see new life in the states. For example, Vermont officials are pushing hard to secure a waiver to implement their proposed “single-payer” system – under which all Vermont citizens would be forced into a single state government health plan, subject to state budgetary limits, with no opportunity to choose other insurance less likely to ration. Said Senator Bernard Sanders (Socialist-VT), “At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, it is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all, single-payer approach.”
While it is, in theory, possible for states to craft any sort of plan they wish within the requirements, it is difficult to see how the Obama administration might approve ones that did not dramatically curtail what people are allowed to spend for their health care. It is precisely the policy of preventing people from being allowed, if they choose, to use their own funds to keep up with health care inflation that creates the gravest threat of rationing.
The Senate proposal may have a difficult time in the House, where congressional Republicans want states to have much more flexibility. Inside Health Policy wrote that the plan to bump up the waiver dates, “was met with disdain from GOP lawmakers, who said the opt-out criteria are too stringent and called the move a confession that the bill is unworkable in its current form.”
Politico reported, “Mandating many of the same requirements, this plan would treat states as agents of the very law these governors are running away from,” said Michael Steel, spokesman for Speaker John Boehner. “A better approach would be working with reform-minded governors to give states more flexibility . . . . Now that the administration has conceded that Obamacare is unworkable, we hope they will work with us to repeal the law and replace it with common-sense reforms . . . .”
Wednesday, January 26, 2011
STATE OF THE UNION: HONEYED WORDS HERALD WORSE RATIONING AHEAD
Suppose a government official announced a plan to limit the automobiles you were allowed to buy, so that only the smallest and cheapest would be available. It is likely most Americans would oppose it. Announce a plan limiting what automobile manufacturers can charge you for cars, however, and it would sound appealing to many people. Yet both proposals would amount to the same plan. When the government imposes limits on what people can choose to spend for a product or service, it means that only those items that producers can afford to provide at or below the government limit will be available. Instead of letting consumers balance cost against benefit, and decide what they can afford to and want to spend their own money on, the government takes that choice away from them.
Now consider what President Obama said in his January 25, 2011 State of the Union speech about health care. He said his health care law “prevents the health insurance industry from exploiting patients.” That certainly sounds good: no one wants patients to be “exploited.” But what does it mean? Obama considers it “exploiting” people when they are given the option of paying more to save the lives of their families, through the purchase of unrationed health insurance, than Obama thinks they should be allowed to choose to pay.
There is an old joke about a man being stopped by a thief who points a gun at him and says, “Your money or your life!” The man replies, “Take my life. I’m saving my money for my old age.”
It’s very foolish to pay less than you can afford for health insurance if that means you and your family will be stuck with a cheap “managed care” plan that will use “utilization review” and limited drug “formularies” to limit the treatment or drugs you may need to save your lives. It’s foolish to look only at the price without also considering the quality you will get for that price.
Americans balance quality and price all the time. Of course we look for the “better deal” that will save us money, but we also keep in mind that sometimes paying bottom dollar for shoddy merchandise is no bargain.
In the State of the Union speech, President Obama said of what people are allowed to spend on health care, “The health insurance law we passed last year will slow these rising costs.” And he called for “further reducing health care costs.”
What he didn’t mention was how the Obama health care law will “slow . . . rising costs.” It will do so in large part by forcing doctors and other health care providers to limit care, through “quality and efficiency” standards imposed on them that will establish one uniform national standard of care for what treatment may – and may not – be offered patients. Beginning in 2015, these “quality and efficiency” standards will be drawn from recommendations of an 18-member Independent Payment Advisory Board that is directed to come up with ways to limit what private citizens choose to pay, using their own funds and private insurance, so that they cannot keep up with the rate of medical inflation. (For details and documentation, see http://www.nrlc.org/HealthCareRationing/Index.html .)
If you’re not allowed to keep up with medical inflation, what do you think will happen to the quantity and quality of the health care you can get? It will go into a steady decline.
Yet Obama is not only pledged to veto any repeal of the health care rationing law– he is now threatening to seek unspecified (so far) measures that will limit the resources Americans are allowed to use to save their own lives still further.
Honeyed words – but words that mean one thing: worse and worse health care rationing ahead.
Now consider what President Obama said in his January 25, 2011 State of the Union speech about health care. He said his health care law “prevents the health insurance industry from exploiting patients.” That certainly sounds good: no one wants patients to be “exploited.” But what does it mean? Obama considers it “exploiting” people when they are given the option of paying more to save the lives of their families, through the purchase of unrationed health insurance, than Obama thinks they should be allowed to choose to pay.
There is an old joke about a man being stopped by a thief who points a gun at him and says, “Your money or your life!” The man replies, “Take my life. I’m saving my money for my old age.”
It’s very foolish to pay less than you can afford for health insurance if that means you and your family will be stuck with a cheap “managed care” plan that will use “utilization review” and limited drug “formularies” to limit the treatment or drugs you may need to save your lives. It’s foolish to look only at the price without also considering the quality you will get for that price.
Americans balance quality and price all the time. Of course we look for the “better deal” that will save us money, but we also keep in mind that sometimes paying bottom dollar for shoddy merchandise is no bargain.
In the State of the Union speech, President Obama said of what people are allowed to spend on health care, “The health insurance law we passed last year will slow these rising costs.” And he called for “further reducing health care costs.”
What he didn’t mention was how the Obama health care law will “slow . . . rising costs.” It will do so in large part by forcing doctors and other health care providers to limit care, through “quality and efficiency” standards imposed on them that will establish one uniform national standard of care for what treatment may – and may not – be offered patients. Beginning in 2015, these “quality and efficiency” standards will be drawn from recommendations of an 18-member Independent Payment Advisory Board that is directed to come up with ways to limit what private citizens choose to pay, using their own funds and private insurance, so that they cannot keep up with the rate of medical inflation. (For details and documentation, see http://www.nrlc.org/HealthCareRationing/Index.html .)
If you’re not allowed to keep up with medical inflation, what do you think will happen to the quantity and quality of the health care you can get? It will go into a steady decline.
Yet Obama is not only pledged to veto any repeal of the health care rationing law– he is now threatening to seek unspecified (so far) measures that will limit the resources Americans are allowed to use to save their own lives still further.
Honeyed words – but words that mean one thing: worse and worse health care rationing ahead.
Sunday, March 21, 2010
REPEALING OBAMA’S DEATH CARE LAW
The health care restructuring bill approved 219 to 212 by the House of Representatives on Sunday, March 21, 2010 and sent for President Obama’s signature (having been adopted by the Senate in December 2009) will, if not repealed before its most dangerous provisions come into effect, result in the rationing denial of lifesaving medical treatment, and consequent premature and involuntary death, of an unknown but immense number of Americans.
Americans will effectively be limited in spending their own money to save their own lives, unless they are able to travel abroad for life-preserving measures which will be denied them in this country.
These effects will occur regardless of whether the separate "reconciliation" bill also approved by the House is passed by the Senate, since its contents will in no way diminish, although they may exacerbate, the rationing in the bill about to be signed.
The Obama Health Care Rationing Law: The Commission That Will Develop Standards the Administration Will Impose to Limit Private Sector Medical Care
An 18-member "Independent Payment Advisory Board" [Sec. 10320(b)] is given the duty, on January 15, 2015 and every two years thereafter, with regard to private health care, to make "recommendations to slow the growth in national health expenditures . . . that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively" [Section 10320(a)(5)(o)(1)(A)]. In turn, the Secretary of Health and Human Services is empowered to impose "quality" AND "efficiency" measures [Section 10304] on health care providers (including hospices, ambulatory surgical centers, rehabilitation facilities, home health agencies, physicians and hospitals) [Section 3014(a) adding Social Security Act Section 1890(b)(7)(B)(I)] which must report on their compliance.
In complex gobbledegook, what this amounts to is that doctors, hospitals, and other health care providers will be told by Washington just what diagnostic tests and medical care is considered to meet "quality" and "efficiency" standards – not only for federally funded health care programs like Medicare, but also for health care paid for by private citizens and their nongovernmental health insurance. And these will be "quality and efficiency" standards specifically designed to limit what ordinary Americans spend on health care. Treatment that a doctor and patient in consultation deem needed or advisable to save that patient’s life or preserve or improve the patient’s health but which the government decides is too costly – even if the patient is willing and able to pay for it – will run afoul of the imposed standards. In effect, there will be one uniform national standard of care, established by Washington bureaucrats and set with a view to limiting what private citizens are allowed to spend on saving their own lives.
Detailed analysis of other provisions that will impose rationing.
The Prospect of Repeal
The silver lining to this very dark cloud is that the most onerous rationing elements of the Obama health care law will not go into effect until 2015– well after the next Presidential election. For repeal to be a realistic prospect, three things are essential:
–The President who takes office in 2013 would have to be someone who would sign a repeal. (Theoretically, a two-thirds majority of both Houses committed to repeal could accomplish it even over a presidential veto, but achieving such numbers would be extremely difficult.)
– As a result of the 2010 and 2012 Congressional elections, a majority of those in the 2013 House of Representatives must support repeal.
– Also as a result of the 2010 and 2012 Congressional elections, the 2013 Senate must have an adequate majority committed to repeal. Full confidence of repeal would come from 60 of the 100 Senators supporting repeal – enough to impose cloture so as to overcome a filibuster. However, it is possible that, if the elections were clearly seen to have been greatly influenced by popular rejection of the Obama Health Care Rationing Law, then even if there were 41 or more Senators who had supported its adoption, some of them might prefer not to obstruct repeal, especially those soon up for re-election. It is also conceivable that the "reconciliation" process used to secure enactment of the health care law could be used by pro-repeal Senators to gut it with 51 votes.
While most observers expect gains by opponents of Obamacare in the election of Senators in 2010, a shift to a majority in support of repeal may not be achieved. However, in 2012, only 10 or 11 opponents of the law will beup for re-election, compared to either 23 or 24 Senators who voted for it standing for re-election. (This number depends on who wins the 2010 special election to fill Secretary of State Hillary Clinton’s New York Senate seat – its winner will have to face the voters again in 2012.) With these odds, the chance for pro-repeal Senators to emerge in control of the Senate in 2013 is a decent one.
In short, horrific as the enactment of the Obama Health Care Rationing Law is, now is not the time to despair. Rather, the pro-life movement must devote itself over these critical years – 2010 through 2012– to ensuring that the American people are given the facts needed to counter the placating misinformation the Obama Administration and its apologists in Congress and the press are already spreading, confident that with a spoon full of sugar we will swallow their deadly recipe. We must maintain and expand the current majority that, according to most public opinion polls, rejects the Obama Health Care Rationing Law.
Americans will effectively be limited in spending their own money to save their own lives, unless they are able to travel abroad for life-preserving measures which will be denied them in this country.
These effects will occur regardless of whether the separate "reconciliation" bill also approved by the House is passed by the Senate, since its contents will in no way diminish, although they may exacerbate, the rationing in the bill about to be signed.
The Obama Health Care Rationing Law: The Commission That Will Develop Standards the Administration Will Impose to Limit Private Sector Medical Care
An 18-member "Independent Payment Advisory Board" [Sec. 10320(b)] is given the duty, on January 15, 2015 and every two years thereafter, with regard to private health care, to make "recommendations to slow the growth in national health expenditures . . . that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively" [Section 10320(a)(5)(o)(1)(A)]. In turn, the Secretary of Health and Human Services is empowered to impose "quality" AND "efficiency" measures [Section 10304] on health care providers (including hospices, ambulatory surgical centers, rehabilitation facilities, home health agencies, physicians and hospitals) [Section 3014(a) adding Social Security Act Section 1890(b)(7)(B)(I)] which must report on their compliance.
In complex gobbledegook, what this amounts to is that doctors, hospitals, and other health care providers will be told by Washington just what diagnostic tests and medical care is considered to meet "quality" and "efficiency" standards – not only for federally funded health care programs like Medicare, but also for health care paid for by private citizens and their nongovernmental health insurance. And these will be "quality and efficiency" standards specifically designed to limit what ordinary Americans spend on health care. Treatment that a doctor and patient in consultation deem needed or advisable to save that patient’s life or preserve or improve the patient’s health but which the government decides is too costly – even if the patient is willing and able to pay for it – will run afoul of the imposed standards. In effect, there will be one uniform national standard of care, established by Washington bureaucrats and set with a view to limiting what private citizens are allowed to spend on saving their own lives.
Detailed analysis of other provisions that will impose rationing.
The Prospect of Repeal
The silver lining to this very dark cloud is that the most onerous rationing elements of the Obama health care law will not go into effect until 2015– well after the next Presidential election. For repeal to be a realistic prospect, three things are essential:
–The President who takes office in 2013 would have to be someone who would sign a repeal. (Theoretically, a two-thirds majority of both Houses committed to repeal could accomplish it even over a presidential veto, but achieving such numbers would be extremely difficult.)
– As a result of the 2010 and 2012 Congressional elections, a majority of those in the 2013 House of Representatives must support repeal.
– Also as a result of the 2010 and 2012 Congressional elections, the 2013 Senate must have an adequate majority committed to repeal. Full confidence of repeal would come from 60 of the 100 Senators supporting repeal – enough to impose cloture so as to overcome a filibuster. However, it is possible that, if the elections were clearly seen to have been greatly influenced by popular rejection of the Obama Health Care Rationing Law, then even if there were 41 or more Senators who had supported its adoption, some of them might prefer not to obstruct repeal, especially those soon up for re-election. It is also conceivable that the "reconciliation" process used to secure enactment of the health care law could be used by pro-repeal Senators to gut it with 51 votes.
While most observers expect gains by opponents of Obamacare in the election of Senators in 2010, a shift to a majority in support of repeal may not be achieved. However, in 2012, only 10 or 11 opponents of the law will beup for re-election, compared to either 23 or 24 Senators who voted for it standing for re-election. (This number depends on who wins the 2010 special election to fill Secretary of State Hillary Clinton’s New York Senate seat – its winner will have to face the voters again in 2012.) With these odds, the chance for pro-repeal Senators to emerge in control of the Senate in 2013 is a decent one.
In short, horrific as the enactment of the Obama Health Care Rationing Law is, now is not the time to despair. Rather, the pro-life movement must devote itself over these critical years – 2010 through 2012– to ensuring that the American people are given the facts needed to counter the placating misinformation the Obama Administration and its apologists in Congress and the press are already spreading, confident that with a spoon full of sugar we will swallow their deadly recipe. We must maintain and expand the current majority that, according to most public opinion polls, rejects the Obama Health Care Rationing Law.
Thursday, January 21, 2010
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).
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).
Wednesday, December 23, 2009
NRLC WRITES SENATORS LISTING ABORTION, RATIONING ELEMENTS OF SENATE HEALTH BILL
The National Right to Life Committee has sent a letter to Senators setting forth the abortion and summarizing the rationing elements in the Senate health care restructuring bill, avaliable here.
Saturday, December 19, 2009
MANAGER’S AMENDMENT INTENSIFIES RATIONING
The Manager’s Amendment to the Senate health care restructuring bill offered by Majority Leader Harry Reid (D-NV) on December 19 contains two provisions that intensify the rationing already present in the Reid Substitute.
– Taking a significant step closer to the powerful Federal-Reserve-Board-like Federal Health Board envisioned by former Senator Tom Daschle, Obama’s original nominee for health czar, the Manager’s Amendment renames and expands the authority of what the Reid Substitute called the "Independent Medicare Advisory Board." Its new title is the "Independent Payment Advisory Board" [Section 10320(b), p. 189] and it is directed to make recommendations to "slow the growth" in PRIVATE (non-federal) "health expenditures . . . that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively." Section 10320(a)(5), adding Section 1899A (o)(1)(A) of the Social Security Act, p. 188. To the extent these are effective, they will limit the ability of private citizens to spend their own money to protect their own lives, by obtaining health care or health insurance that is not rationed.
– Section 10304 (p. 152) empowers the Secretary of Health and Human Services to impose "efficiency measures," in addition to the "quality measures" already provided for under the Reid Substitute, on health care providers. Much of the professional literature advocates the use of "quality of life" standards that devalue the lives of older people and people with disabilities in such measures. While there are limits on the use of comparative effectiveness research to justify denial of treatment based on quality of life criteria under Section 6301( c) of the Reid Substitute, the quality and efficiency measures are not made subject to these critically important anti-discrimination protections.
A more detailed analysis of these rationing-promoting elements of the Manager’s Amendment follows:
INDEPENDENT PAYMENT ADVISORY BOARD AUTHORITY TO RECOMMEND, AND HHS SECRETARY TO LIMIT, RIGHT TO USE ONE’S OWN MONEY TO SAVE ONE’S OWN LIFE
Under the Reid Substitute’s Section 3403 (pp. 1000- 1053) as modified by the Manager’s Amendment Section 10320 (pp. 180-90), the "Independent Payment Advisory Board" will have sweeping powers.
As originally set forth in the Reid Substitute, the Board was called the "Medicare" Advisory Board, and its mission was focused on cutting Medicare reimbursement rates (see below) – a duty it retains. However, the Manager’s Amendment dramatically expands its authority, so as to work to limit nonfederal health care spending, as well. Starting in 2014, "and at least once every two years thereafter," the Board is to make recommendations "to slow the growth in national health expenditures" other than Federal health care programs – recommendations "that the Secretary or other Federal agencies can implement administratively," as well as recommendations for legislative action. To the extent these are effective, they will limit the ability of private citizens to spend their own money to protect their own lives, by obtaining health care, or health insurance, that is not rationed.
For 2015, unless Medicare spending is projected NOT to keep up with the rate of medical inflation (specifically, unless it is projected to come in at or below a "target" set at the midway point between medical inflation and the average inflation rate for all goods and services , the "Consumer Price Index-Urban"), the Board is to specify how to cut Medicare payments by either the difference from the target or half a percent, whichever is less.
For 2016, the Board is to specify how to cut Medicare by the lesser of the difference from the target for that year or 1 percent, and for 2017 by the lesser of the difference from the target for that year or 1.25 percent.
For 2018 and subsequent years, the target shifts to the growth in Gross Domestic Product (GDP) per capita, and the Board must specify how to cut Medicare payments by the lesser of the difference from that target and 1.5 percent.
Each year, the Secretary of Health and Human Services must implement the Board’s directives unless Congress, within a given deadline, legislates an alternative set of restrictions to accomplish the same result. However, Congress could not reduce the net of the targeted cuts unless three-fifths of both chambers voted to do so. The bill goes so far as to forbid a future Congress from repealing these provisions, except for a one-time opportunity in 2017! Section 3403, adding Social Security Act Section 1899A(d)(3)( C), p. 1020.
How is the Board to bring about these Medicare reductions? On its face the bill instructs the Board not "to ration health care, raise revenues or Medicare beneficiary premiums . . . , increase Medicare beneficiary cost-sharing . . . , or otherwise restrict benefits or modify eligibility criteria." Section 3403, creating Social Security Act Section 1899A(c)(2)(A)(ii) , p. 1004. Predominately, the reductions will have to come in reimbursement rates for health care providers.
This is likely to have either – or, more likely, both– of two rationing effects. First, an increasing number of Medicare providers, being paid further and further below their costs of providing care, would stop accepting new Medicare patients. Second, the Board could change the way reimbursement rates are structured, away from a fee-for-service model toward a "capitated" model, for example, under which practitioners are paid a set annual amount per patient, or toward an "episode" model somewhat similar to the DRG payment system for hospitals, under which a set amount is paid per illness or injury. In either of these cases, the physician or other health care provider would have a strong financial incentive to limit treatment, especially if it is costly. So, in compliance with the statute, the Board itself would not be "rationing" treatment – instead, it would be compelling health care providers to do so.
"EFFICIENCY" MEASURES THAT MAY LEAD TO DISCRIMINATORY DENIAL OF TREATMENT BASED ON DISABILITY, AGE, AND OTHER QUALITY OF LIFE CRITERIA
Section 10304 (p. 152) empowers the Secretary of Health and Human Services to impose "efficiency measures," in addition to the "quality measures" provided for under the Reid Substitute, on health care providers. These measures are to be incorporated "in workforce programs, training curricula, and any other means of dissemination determined appropriate by the Secretary." Section 3014(b) adding Social Security Act Section 1890A(b)(1)(A) (p. 709). They are to be used in the calculation of value-based purchasing from hospitals, and renal dialysis services must abide by them or be penalized. Health care providers, including hospices, ambulatory surgical centers, rehabilitation facilities, home health agencies, physicians and hospitals must provide reports, generally made publicly available, based on these measures. Consequently, they exercise considerable influence on how health care providers practice medicine, and consequently on what treatment patients do – and do not – receive.
In the medical and bioethical literature, quality and efficiency measures are often based on "quality of life" standards that discriminate on the basis of age and disability.
Accordingly, during the period when the group of six Senators were negotiating in an attempt to achieve a bipartisan health care bill, agreement was reached to make anti-discrimination language applicable to the results of comparative effectiveness research. See note 1. This language remains in the Reid Substitute, Section 6301( c), adding Social Security Act Section 1182 ( c), (d) and (e) , pp. 1685-87. However, the quality and efficiency measures are NOT made subject to the same limits on employment of quality of life criteria that are applied to the use of comparative effectiveness research under Section 6301( c) of the Reid Substitute. Consequently, the Secretary is free to formulate such measures in a way that has the effect of rationing treatment on the basis of disability, age, or other "quality of life" criteria, as advocated by many mainstream bioethicists.
– Taking a significant step closer to the powerful Federal-Reserve-Board-like Federal Health Board envisioned by former Senator Tom Daschle, Obama’s original nominee for health czar, the Manager’s Amendment renames and expands the authority of what the Reid Substitute called the "Independent Medicare Advisory Board." Its new title is the "Independent Payment Advisory Board" [Section 10320(b), p. 189] and it is directed to make recommendations to "slow the growth" in PRIVATE (non-federal) "health expenditures . . . that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively." Section 10320(a)(5), adding Section 1899A (o)(1)(A) of the Social Security Act, p. 188. To the extent these are effective, they will limit the ability of private citizens to spend their own money to protect their own lives, by obtaining health care or health insurance that is not rationed.
– Section 10304 (p. 152) empowers the Secretary of Health and Human Services to impose "efficiency measures," in addition to the "quality measures" already provided for under the Reid Substitute, on health care providers. Much of the professional literature advocates the use of "quality of life" standards that devalue the lives of older people and people with disabilities in such measures. While there are limits on the use of comparative effectiveness research to justify denial of treatment based on quality of life criteria under Section 6301( c) of the Reid Substitute, the quality and efficiency measures are not made subject to these critically important anti-discrimination protections.
A more detailed analysis of these rationing-promoting elements of the Manager’s Amendment follows:
INDEPENDENT PAYMENT ADVISORY BOARD AUTHORITY TO RECOMMEND, AND HHS SECRETARY TO LIMIT, RIGHT TO USE ONE’S OWN MONEY TO SAVE ONE’S OWN LIFE
Under the Reid Substitute’s Section 3403 (pp. 1000- 1053) as modified by the Manager’s Amendment Section 10320 (pp. 180-90), the "Independent Payment Advisory Board" will have sweeping powers.
As originally set forth in the Reid Substitute, the Board was called the "Medicare" Advisory Board, and its mission was focused on cutting Medicare reimbursement rates (see below) – a duty it retains. However, the Manager’s Amendment dramatically expands its authority, so as to work to limit nonfederal health care spending, as well. Starting in 2014, "and at least once every two years thereafter," the Board is to make recommendations "to slow the growth in national health expenditures" other than Federal health care programs – recommendations "that the Secretary or other Federal agencies can implement administratively," as well as recommendations for legislative action. To the extent these are effective, they will limit the ability of private citizens to spend their own money to protect their own lives, by obtaining health care, or health insurance, that is not rationed.
For 2015, unless Medicare spending is projected NOT to keep up with the rate of medical inflation (specifically, unless it is projected to come in at or below a "target" set at the midway point between medical inflation and the average inflation rate for all goods and services , the "Consumer Price Index-Urban"), the Board is to specify how to cut Medicare payments by either the difference from the target or half a percent, whichever is less.
For 2016, the Board is to specify how to cut Medicare by the lesser of the difference from the target for that year or 1 percent, and for 2017 by the lesser of the difference from the target for that year or 1.25 percent.
For 2018 and subsequent years, the target shifts to the growth in Gross Domestic Product (GDP) per capita, and the Board must specify how to cut Medicare payments by the lesser of the difference from that target and 1.5 percent.
Each year, the Secretary of Health and Human Services must implement the Board’s directives unless Congress, within a given deadline, legislates an alternative set of restrictions to accomplish the same result. However, Congress could not reduce the net of the targeted cuts unless three-fifths of both chambers voted to do so. The bill goes so far as to forbid a future Congress from repealing these provisions, except for a one-time opportunity in 2017! Section 3403, adding Social Security Act Section 1899A(d)(3)( C), p. 1020.
How is the Board to bring about these Medicare reductions? On its face the bill instructs the Board not "to ration health care, raise revenues or Medicare beneficiary premiums . . . , increase Medicare beneficiary cost-sharing . . . , or otherwise restrict benefits or modify eligibility criteria." Section 3403, creating Social Security Act Section 1899A(c)(2)(A)(ii) , p. 1004. Predominately, the reductions will have to come in reimbursement rates for health care providers.
This is likely to have either – or, more likely, both– of two rationing effects. First, an increasing number of Medicare providers, being paid further and further below their costs of providing care, would stop accepting new Medicare patients. Second, the Board could change the way reimbursement rates are structured, away from a fee-for-service model toward a "capitated" model, for example, under which practitioners are paid a set annual amount per patient, or toward an "episode" model somewhat similar to the DRG payment system for hospitals, under which a set amount is paid per illness or injury. In either of these cases, the physician or other health care provider would have a strong financial incentive to limit treatment, especially if it is costly. So, in compliance with the statute, the Board itself would not be "rationing" treatment – instead, it would be compelling health care providers to do so.
"EFFICIENCY" MEASURES THAT MAY LEAD TO DISCRIMINATORY DENIAL OF TREATMENT BASED ON DISABILITY, AGE, AND OTHER QUALITY OF LIFE CRITERIA
Section 10304 (p. 152) empowers the Secretary of Health and Human Services to impose "efficiency measures," in addition to the "quality measures" provided for under the Reid Substitute, on health care providers. These measures are to be incorporated "in workforce programs, training curricula, and any other means of dissemination determined appropriate by the Secretary." Section 3014(b) adding Social Security Act Section 1890A(b)(1)(A) (p. 709). They are to be used in the calculation of value-based purchasing from hospitals, and renal dialysis services must abide by them or be penalized. Health care providers, including hospices, ambulatory surgical centers, rehabilitation facilities, home health agencies, physicians and hospitals must provide reports, generally made publicly available, based on these measures. Consequently, they exercise considerable influence on how health care providers practice medicine, and consequently on what treatment patients do – and do not – receive.
In the medical and bioethical literature, quality and efficiency measures are often based on "quality of life" standards that discriminate on the basis of age and disability.
Accordingly, during the period when the group of six Senators were negotiating in an attempt to achieve a bipartisan health care bill, agreement was reached to make anti-discrimination language applicable to the results of comparative effectiveness research. See note 1. This language remains in the Reid Substitute, Section 6301( c), adding Social Security Act Section 1182 ( c), (d) and (e) , pp. 1685-87. However, the quality and efficiency measures are NOT made subject to the same limits on employment of quality of life criteria that are applied to the use of comparative effectiveness research under Section 6301( c) of the Reid Substitute. Consequently, the Secretary is free to formulate such measures in a way that has the effect of rationing treatment on the basis of disability, age, or other "quality of life" criteria, as advocated by many mainstream bioethicists.
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