SENATE VOTE EXPECTED THIS WEEK

This week, the Senate is scheduled to vote on H. Con. Res. 35, which would remove funding for the entire Obama health care law that was enacted in 2010. The Obama health care law contains multiple provisions that will, if fully implemented, result in government-imposed rationing of lifesaving medical care.

Among the most dangerous provisions: The Department of Health and Human Services (HHS) will be empowered to impose so-called “quality” and “efficiency” measures on health care providers, based on recommendations by the Independent Payment Advisory Board, which is directed to force private health care spending below the rate of medical inflation. In many cases treatment that a doctor and patient deem needed or advisable to save that patient’s life or preserve or improve the patient’s health but which runs afoul of the imposed standards will be denied, even if the patient wants to pay for it.

Information regarding NRLC’s position on rationing in the Patient Protection and Affordable Care Act may be obtained by visiting here.
The action alert is available here.

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would do nothing to change the elements of the federal law that will impose rationing of medical treatment if it is not repealed.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 . . . .”

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.

HOUSE TO VOTE ON OBAMA HEALTHCARE LAW REPEAL NEXT WEEK

Last night, H.R. 2, to repeal the Obama Healthcare Law, was introduced in the House of Representatives. The bill is scheduled to come up for a vote on Wednesday, January 12th. Repeal would protect Americans from the rationing that would deny or limit life-saving health care. Unless the Obama Healthcare Law is repealed or dramatically altered, the following will occur:

1. Bureaucrats in Washington (the Department of Health and Human Services, based on recommendations by the Independent Payment Advisory Board) will be able to dictate what treatment your doctor or hospital can – and can’t – give you through so-called “quality and efficiency measures.”

2. As Medicare is slashed by billions of dollars, federal bureaucrats will be empowered to deny or limit older Americans' choice of adding their own money, if they wish, to get unrationed insurance.

3. Consumers will be denied the choice of plans offered by insurers who allow their customers to spend what state bureaucrats deem an “excessive or unjustified” amount for their health insurance.

Full documentation of these and other rationing elements can be found here.

NEW & UPDATED RATIONING RESOURCES

With most of the midterm election results in , voters have sent a strong message in favor of repealing the Obama Health care law. Rasmussen Reports telephone exit polling found that 59% of those who voted on Election Day favor repeal of that law. This came along side another poll which showed that 83% of Likely U.S. Voters think it is at least somewhat likely that Republicans will vote to repeal the health care measure passed by Democrats in March.

With the new wave of pro-repeal House members, the health law is again placed in the center of political debate. The Powell Center has UPDATED its resources that demonstate how the Obama Health Law can ration your care. Please visit our site devoted to the rationing elements in the Obama Health Care law: www.nrlc.org/HealthCareRationing

NEJM ARTICLE CALLS FOR MORE LEGISLATION TO GUARANTEE THE USE OF “QUALITY OF LIFE” CRITERIA

A revealing new article titled, “Legislating against Use of Cost-Effectiveness Information” was published last week in the New England Journal of Medicine. In the piece, the authors, Peter J. Neumann and Milton C. Weinstein, attempt to make the case that the Obama Health Care law is flawed in that it did not go far enough in rationing care.

Why? Because it bans the use of the controversial “Quality Adjusted Life Year” or QALY. For the article see here.

From the pro-life perspective this is practically the only dangerous element that ObamaCare doesn’t contain. This fundamental restructuring of the American health system includes a powerful rationing commission. As a result, basically, doctors, hospitals and other health care providers will be told by Washington just what diagnostic tests and medical care are considered to meet “quality and efficiency” standards—not only for federally-funded programs such as Medicare, but also for health care paid for by private citizens and their nongovernmental health insurance. [See here].

At least for now, ObamaCare does not explicitly include the use of QALY or any such equivalent which is a tool often used to discriminate on the basis of disability, age, and “quality of life.” But there are a slew of proponents saying it ought to be included and Obama chose as a key implementer of ObamaCare a man who is a fan of the British health care system which does employs QALY.

But, as noted above, Neumann and Weinstein lament that the QALY is not included.

What is QALY?
In general, a QALY assumes that a year of life lived in perfect health is worth one QALY, and that a year of life lived in a state of less than perfect health is worth less than one QALY. In a system that faces budget shortfalls, this calculation can be used to set an upper limit on the treatment that will be authorized.

This type of assessment is so dangerous, not only because it is being used to ration care abroad, such as by the National Institute for Health and Clinical Excellence in the United Kingdom, but also because we see many influential American academics and health providers advocating the use of QALY.

For one ominous example, we need look no further than Donald Berwick, who Obama appointed to head the Center for Medicare and Medicaid Services which runs the nation's massive Medicare and Medicaid programs. He gave an interview to Biotechnology Health Care in 2009 in which he praised the British system which famously uses QALY’s.

He told Katherine Adams that The National Institute for Health and Clinical Excellence [NICE] has “developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.” [See here]

A September 13, 2009, USA Today article titled “Kidney Doctors Question Dialysis Guidelines” describes a commentary published in the Journal of the American Society of Nephrology written by Felix Knauf and Peter Aronson. In the prestigious journal, the pair openly says that dialysis rationing would curb Medicare spending on chronic kidney failure in a big way. They lament that “physicians are often willing to provide dialysis care to patients with greatly diminished quality of life.”

In a featured piece in the July 19, 2009, New York Times Magazine, Princeton bioethicist Peter Singer openly advocated government rationing of health care, using QALYs. He made it clear that society should be more willing to withhold treatment from those who are old and those with disabilities.

And now, another example among many, we see an article October 14 in the prestigious New England Journal of Medicine.

The authors of last week’s NEJM piece write that “QALYs provide a convenient yardstick for measuring and comparing health effects of varied interventions across diverse diseases and conditions.” This “yardstick” would mean practicing discrimination against countless patients.

What Neumann and Weinstein ignore is that the assumptions built into the use of quality-adjusted life years are often inaccurate. As Hayden Bosworth of the Duke University Medical Center documents, “Patients who have not experienced a stroke ... or individuals at risk for future stroke ... respond with low [quality of life] estimates for physical impairments. Yet it is clear that patients who actually experience a high level of impairment as a result of a stroke provide high estimates of their quality of life.”

Predictably, the authors write that ban on the use of QALYs in the Obama health law
“…represents another example of our country's avoidance of unpleasant truths about our resource constraints. Although opportunities undoubtedly exist to eliminate health care waste, the best way to improve health and save money at the same time is often to redirect patient care resources from interventions with a high cost per QALY to those with a lower cost per QALY.”

What unfortunately was lost in the mad push for health care legislation was real dialogue about the fact that Americans can afford the kind of health care we want and deserve.

OBAMA HEALTH CARE LAW AND MEDICARE – MORE “MEANINGFUL CHOICE” OR DENIAL OF CHOICE TO AVOID RATIONING?

With the rollout of a few of the early provisions of President Obama’s new health law, public opinion against the health law remains high. The Administration continues to attempt to sell key elements to a skeptical public, chief among them are the massive changes to the Medicare program for seniors.

Administration officials had been continually making the dubious claim that the new health law would not harm Medicare, despite nearly half a billion dollars in cuts and other changes. However, according to published reports, they’ve had to do some backpeddling, particularly as it relates to the very popular “Medicare Advantage” plans.

Today Politico reported that,

“The Department of Health and Human Services quietly changed the web version of a speech in which HHS Secretary Kathleen Sebelius described how the health care overhaul is going to affect Medicare Advantage plans, a controversial section of the law, after aides to Sen. Charles E. Grassley (R-Iowa) challenged its accuracy.

“Sebelius had told an AARP conference in Orlando last week that next year ‘there will be more Medicare Advantage plans to choose from,’ according to prepared remarks e-mailed to reporters and posted on HHS’s website on Monday. Grassley’s staff asked HHS to back up the statement, an aide to the senator, who has long been skeptical of Democrats’ claims about the health law’s impact, told POLITICO.

“As Grassley’s office was drafting a formal letter to Sebelius questioning the claim, the speech text was altered on the HHS web site without noting the change. The statement about more Medicare Advantage plans was deleted and now reads, ‘there will be more meaningful choices.’"

Sebelius effectively concedes the number of Medicare Advantage plans will diminish under the law; however, the new administration line is that “seniors will have now have more meaningful choices."

"More meaningful choices" is a clever attempt to disguise the fact that seniors will be "protected" from having the choice to spend their own money to save their own life. Millions of Americans have chosen the Medicare Advantage plan known as “private fee-for service plans.” This option allows senior citizens the choice of health insurance whose value is not limited by what the government may pay toward it. These plans had been able to set premiums and reimbursement rates for providers without upward limits imposed by government regulation. This means that such plans would not have been forced to ration treatment, as long as senior citizens chose to pay more for them.

Now, the Obama Health Care Rationing Law allows bureaucrats at CMS (Center for Medicare/Medicaid Services) to refuse to permit senior citizens to choose private-fee-for-service plans that charge what the bureaucrats regard as premiums that are too high. Literally, the new law allows CMS to reject any private-fee-for-service plan (or any other Medicare Advantage plan) , for any reason or no reason.

What the Administration calls "more meaningful choices" will ultimately mean that seniors will be prevented from having the effective choice to spend their own money to save their own lives.


Note: revised 10.11.2010