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
Thursday, November 4, 2010
Thursday, October 21, 2010
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.
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.
Friday, October 8, 2010
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,
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
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
Thursday, August 19, 2010
NEW HHS ANNOUNCEMENT RAISES MORE RATIONING CONCERNS
While some of the most dangerous rationing elements of Obamacare are not slated to occur until 2014, other provision are coming on line sooner – ones that may lead to the denial of treatment.
Earlier this week, the Department of Health and Human Services (HHS) announced that 45 states had applied for money set aside in the new health care law which they can use to set up or, in some cases strengthen existing laws surrounding “premium review.” Why should we be concerned?
One of the provisions of Obamacare that took effect immediately requires health insurance companies to file proposed premium increases and to justify (any yet to be defined) “unreasonable” increases to the government. The states are meant to be the first line of enforcement, with HHS acting as a fallback enforcer.
But how the term “unreasonable” is used may prove to be a dangerous thing. HHS Secretary Kathleen Sebelius told reporters in a conference call that officials are still crafting a definition of the term “unreasonable” with the assistance of industry and consumer advocates and other stakeholders.
That means that this fall, when nearly everyone enrols for next year’s benefits, any rate increases an insurer might need to make, must now be justified and be what HHS considers reasonable.
This ramped up review authority, (purported to be aimed at shielding the insured from being gouged by their insurers) is merely one of many tools built into Obamacare aimed at limiting what people can spend to save their own lives.
When the government limits by law what can be charged for health insurance, it limits what people are allowed to pay for medical treatment. While everyone would prefer to pay less – or nothing – for health care (as for anything else), government price controls in fact prevent access to lifesaving medical treatment that costs more to supply than the price set by the government.
Many states already review insurance increases. But now many states will receive money to beef up that effort, or to create new regulations to give them more power to reject premium increases. In other words the funding these 45 states will receive is merely the first round.
Most importantly, in 2014, under ObamaCare the states will actually become empowered to block insurers from participating in the state based “exchanges if they are judged to show a pattern of excessive or unjustified increases.”
Under this new authority, exchanges will be able, in effect, to limit the value of the insurance policies that Americans using the exchanges may purchase. Here’s how.
Not only will the exchanges be allowed to exclude policies when government authorities do not agree with the size of the premiums, they will also be able to look at any proposed increases plans charge that are outside the exchange . The states and ultimately HHS have the power to say that “particular health insurance issuers should be excluded from participation in the Exchange based on a pattern or practice of excessive or unjustified premium increases” [42 USCS § 300gg-94]
This will create a “chilling effect,” deterring insurers who hope to be able to compete within the exchange. Moreover, this innocuous little provision also says that “we will look at what insurers do in all their plans, not just ones in the Exchange.” This means that all insurers can be prevented from offering adequately funded plans to their regular customers if they have even one plan in that exchange. And the less money available for plans, the less care they will be able to provide.
As health insurance companies are squeezed more and more tightly each year by the declining “real” (that is, adjusted for health care inflation ) value of the premiums they take in, they will ration lifesaving medical treatment. Under a scheme of premium price controls, these day-to-day rationing decisions will have the most direct and visible impact on the lives – and deaths – of people with a poor “quality of life.”
This dangerous provision is one among many that we will continue to highlight as the rationing elements of Obamacare come online.
Earlier this week, the Department of Health and Human Services (HHS) announced that 45 states had applied for money set aside in the new health care law which they can use to set up or, in some cases strengthen existing laws surrounding “premium review.” Why should we be concerned?
One of the provisions of Obamacare that took effect immediately requires health insurance companies to file proposed premium increases and to justify (any yet to be defined) “unreasonable” increases to the government. The states are meant to be the first line of enforcement, with HHS acting as a fallback enforcer.
But how the term “unreasonable” is used may prove to be a dangerous thing. HHS Secretary Kathleen Sebelius told reporters in a conference call that officials are still crafting a definition of the term “unreasonable” with the assistance of industry and consumer advocates and other stakeholders.
That means that this fall, when nearly everyone enrols for next year’s benefits, any rate increases an insurer might need to make, must now be justified and be what HHS considers reasonable.
This ramped up review authority, (purported to be aimed at shielding the insured from being gouged by their insurers) is merely one of many tools built into Obamacare aimed at limiting what people can spend to save their own lives.
When the government limits by law what can be charged for health insurance, it limits what people are allowed to pay for medical treatment. While everyone would prefer to pay less – or nothing – for health care (as for anything else), government price controls in fact prevent access to lifesaving medical treatment that costs more to supply than the price set by the government.
Many states already review insurance increases. But now many states will receive money to beef up that effort, or to create new regulations to give them more power to reject premium increases. In other words the funding these 45 states will receive is merely the first round.
Most importantly, in 2014, under ObamaCare the states will actually become empowered to block insurers from participating in the state based “exchanges if they are judged to show a pattern of excessive or unjustified increases.”
Under this new authority, exchanges will be able, in effect, to limit the value of the insurance policies that Americans using the exchanges may purchase. Here’s how.
Not only will the exchanges be allowed to exclude policies when government authorities do not agree with the size of the premiums, they will also be able to look at any proposed increases plans charge that are outside the exchange . The states and ultimately HHS have the power to say that “particular health insurance issuers should be excluded from participation in the Exchange based on a pattern or practice of excessive or unjustified premium increases” [42 USCS § 300gg-94]
This will create a “chilling effect,” deterring insurers who hope to be able to compete within the exchange. Moreover, this innocuous little provision also says that “we will look at what insurers do in all their plans, not just ones in the Exchange.” This means that all insurers can be prevented from offering adequately funded plans to their regular customers if they have even one plan in that exchange. And the less money available for plans, the less care they will be able to provide.
As health insurance companies are squeezed more and more tightly each year by the declining “real” (that is, adjusted for health care inflation ) value of the premiums they take in, they will ration lifesaving medical treatment. Under a scheme of premium price controls, these day-to-day rationing decisions will have the most direct and visible impact on the lives – and deaths – of people with a poor “quality of life.”
This dangerous provision is one among many that we will continue to highlight as the rationing elements of Obamacare come online.
Thursday, August 12, 2010
NEW MEDICARE REPORT SIGNALS TROUBLE
Running ads featuring the beloved Andy Griffith, Obamacare advocates used Medicare’s recent 45th birthday to attempt to continue to sell the unbelievable claim that the massive cuts planned for Medicare will not hurt the program. In the ad, the veteran television star attempts to assure seniors they won’t lose benefits. But with the hundreds of billions of dollars in cuts facing the program, this assertion is almost laughable.
As it happened the Medicare Trustees report came out at the same time that the Obama administration is engaged in this major campaign to sell its health care “reform.” While the reports offers the assurance that Obamacare will add an additional 12 years of life onto the Medicare program, there is some very ominous information contained in “2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds.”
By law, the Board of Trustees of Medicare is required to issue annual reports on the financial status of the Medicare Trust Funds. Those reports are required to contain a statement of actuarial opinion by the Chief Actuary. The Chief Actuary of CMS is responsible for providing accounting information and cost-projections to the Medicare Board of Trustees in order to assist them in assessing the financial health of the program.
While the report says that Medicare will save money and add years, there are major flaws – ones so major that in the first time in 45 years, we have what amounts to a dissenting opinion in the report. For the FIRST time in report history, Richard Foster, Medicare’s Chief Actuary, felt it necessary to release a detailed statement appended to the Trustees’ Report calling the assumptions “implausible” and “unreasonable.” [1]
The report makes assumptions that simply do not hold up under scrutiny. Pushing aside the notion that hundreds of billions on cuts have no effect on services under the Medicare program, the trustees make more predictions for the future.
For example, the trustees' report assumes Medicare physician fees will be cut by 30 percent over the next three years. We have seen this fiction play out year after year, something Foster calls "impossible."
Since the mid-1990’s, Medicare physicians were supposed to face serious yearly cuts to keep Medicare solvent. However, faced with political reality and the importance of paying doctors enough to participate in the Medicare program, Congress cobbled together expensive bills to find the money.
Basically, the big cuts never happen, which means that Medicare is quickly approaching insolvency. But now we are supposed to believe that under Obamacare, Congress will allow the devastating cuts to occur, driving countless physicians out of Medicare.
For another example, the trustees' report assumes that productivity in medical services will match productivity in the rest of the economy. However, in the very same breath we see the admission that “Most categories of health care providers have not been able to improve their productivity to the same extent as the economy at large.” [1]
For well over a decade, the National Right to Life Committee has argued this very point – but from a different perspective. NRLC points out that continually rising productivity in other sectors of the economy, such as agriculture, frees up resources that can be and are used to extend our lives and improve our health. So as the cost of goods falls, resources are freed up for healthcare, whose price is dropping in inflation-adjusted amount, but just not as rapidly as the price of goods. This does not mean there aren’t real cost problems associated with health care.
The first problem is that while the benefits of rising productivity are seen in rising real incomes for Americans, those income increases are not distributed equally. Those whose incomes have not increased--when adjusted for inflation--may truly face difficulties because of the rising nominal (meaning the current value of money) cost of health insurance. When health costs rise, and incomes do not rise as fast, this led to many of the uninsured.
Second, while the American economy as a whole can continually afford more and better health care (because of rising productivity in other sectors that frees up more and more resources for health care), the same is not true of government’s share of health care costs. For further description of this, see http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar. This ‘webinar’ will not only describe how the economy as a whole can afford health care, but how the cost of what people can afford could be used to address the government healthcare entitlements.
With this notion that somehow Medicare can increase in productivity (when there is no proof that health care can do this to the extent Obamacare assumes) along side the totally unrealistic conclusion that hundreds of billions in cuts somehow make Medicare stronger, the program is in real trouble.
[1] See Centers for Medicare and Medicaid Services, “2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds,” August 5, 2010, at https://www.cms.gov/ReportsTrustFunds/downloads/tr2010.pdf (August 10, 2010).
As it happened the Medicare Trustees report came out at the same time that the Obama administration is engaged in this major campaign to sell its health care “reform.” While the reports offers the assurance that Obamacare will add an additional 12 years of life onto the Medicare program, there is some very ominous information contained in “2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds.”
By law, the Board of Trustees of Medicare is required to issue annual reports on the financial status of the Medicare Trust Funds. Those reports are required to contain a statement of actuarial opinion by the Chief Actuary. The Chief Actuary of CMS is responsible for providing accounting information and cost-projections to the Medicare Board of Trustees in order to assist them in assessing the financial health of the program.
While the report says that Medicare will save money and add years, there are major flaws – ones so major that in the first time in 45 years, we have what amounts to a dissenting opinion in the report. For the FIRST time in report history, Richard Foster, Medicare’s Chief Actuary, felt it necessary to release a detailed statement appended to the Trustees’ Report calling the assumptions “implausible” and “unreasonable.” [1]
The report makes assumptions that simply do not hold up under scrutiny. Pushing aside the notion that hundreds of billions on cuts have no effect on services under the Medicare program, the trustees make more predictions for the future.
For example, the trustees' report assumes Medicare physician fees will be cut by 30 percent over the next three years. We have seen this fiction play out year after year, something Foster calls "impossible."
Since the mid-1990’s, Medicare physicians were supposed to face serious yearly cuts to keep Medicare solvent. However, faced with political reality and the importance of paying doctors enough to participate in the Medicare program, Congress cobbled together expensive bills to find the money.
Basically, the big cuts never happen, which means that Medicare is quickly approaching insolvency. But now we are supposed to believe that under Obamacare, Congress will allow the devastating cuts to occur, driving countless physicians out of Medicare.
For another example, the trustees' report assumes that productivity in medical services will match productivity in the rest of the economy. However, in the very same breath we see the admission that “Most categories of health care providers have not been able to improve their productivity to the same extent as the economy at large.” [1]
For well over a decade, the National Right to Life Committee has argued this very point – but from a different perspective. NRLC points out that continually rising productivity in other sectors of the economy, such as agriculture, frees up resources that can be and are used to extend our lives and improve our health. So as the cost of goods falls, resources are freed up for healthcare, whose price is dropping in inflation-adjusted amount, but just not as rapidly as the price of goods. This does not mean there aren’t real cost problems associated with health care.
The first problem is that while the benefits of rising productivity are seen in rising real incomes for Americans, those income increases are not distributed equally. Those whose incomes have not increased--when adjusted for inflation--may truly face difficulties because of the rising nominal (meaning the current value of money) cost of health insurance. When health costs rise, and incomes do not rise as fast, this led to many of the uninsured.
Second, while the American economy as a whole can continually afford more and better health care (because of rising productivity in other sectors that frees up more and more resources for health care), the same is not true of government’s share of health care costs. For further description of this, see http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar. This ‘webinar’ will not only describe how the economy as a whole can afford health care, but how the cost of what people can afford could be used to address the government healthcare entitlements.
With this notion that somehow Medicare can increase in productivity (when there is no proof that health care can do this to the extent Obamacare assumes) along side the totally unrealistic conclusion that hundreds of billions in cuts somehow make Medicare stronger, the program is in real trouble.
[1] See Centers for Medicare and Medicaid Services, “2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds,” August 5, 2010, at https://www.cms.gov/ReportsTrustFunds/downloads/tr2010.pdf (August 10, 2010).
Friday, July 2, 2010
2010 General Session: 2,000 Pages of Really Bad Stuff
Listen to Master of Ceremonies and National Right to Life Executive Director David N. O’Steen give background on how the health care system worked before and will work after Obamacare. Then, Federal Legislative Director Douglas Johnson discusses abortion coverage in the new law. Finally, Burke Balch, J.D. who directs the Powell Center for Medical Ethics discusses rationing components of the law. To download the PowerPoint presentation accompanying the discussion of rationing, click on "Rationing in the Obama Health Care Law, June 26, 2010." To see as well as hear the presentation, view the C-SPAN coverage.
Monday, June 14, 2010
MAIN PILLAR OF OBAMACARE UNDER FIRE
An article from last week’s New York Times titled, “Study Cited for Health-Cost Cuts Overstated Its Upside, Critics Say,” has stirred up criticism surrounding one of the main pillars Obamacare.
The Obama administration, in its mad push to enact health care reform, made the unbelievable argument that they would pay for reform by simply cutting billions in wasteful health care spending, and that there would be no outcome on the quality of care people receive.
Throughout the course of congressional health care hearings leading up to the health reform passage, as well as in open floor debates, Obamacare advocates would over and over cite to a Dartmouth Atlas College research project, often inviting its authors to testify. Advocates touted the research as if it was definitive proof of their claim – when it was far from it. The compiled research focuses on the spending levels of Medicare patients with a chronic illness who were in their last six months or two years of life.
The Dartmouth research makes the wild claim that it could cuts billions of what it characterized as “wasteful” spending and actually make people healthier. The NYT quotes Dr. Elliott Fisher, a physician who is one of the principal authors of the Dartmouth work writing, “We show where the waste is in medicine. If everyone could operate like Oregon, Seattle or the Upper Midwest, there’s huge savings.”
The NYT points to a key criticism of the compiled research writing,
There is reason to remain concerned over this highly criticized Dartmouth research. The NYT writes,
This distorted view of the Dartmouth Atlas research could dangerously be institutionalized and used to financially punish hospitals that have high survival rates and improve people’s lives – all in the name of cost.
NRLC has long argued that the cost of health care does not require rationing life-saving treatment (see here). Obamacare advocates wanted to sell the idea that by simply cutting wasteful spending, the expansion could pay for itself. This faulty and gratuitously cited Dartmouth Atlas compiled research gave them cover for that argument – cover that is quickly evaporating. However, when increased health care spending does in fact save lives and increase quality, the administration and new health care law sadly offered no other real long-term way to pay for the kind of quality care Americans deserve.
The Obama administration, in its mad push to enact health care reform, made the unbelievable argument that they would pay for reform by simply cutting billions in wasteful health care spending, and that there would be no outcome on the quality of care people receive.
Throughout the course of congressional health care hearings leading up to the health reform passage, as well as in open floor debates, Obamacare advocates would over and over cite to a Dartmouth Atlas College research project, often inviting its authors to testify. Advocates touted the research as if it was definitive proof of their claim – when it was far from it. The compiled research focuses on the spending levels of Medicare patients with a chronic illness who were in their last six months or two years of life.
The Dartmouth research makes the wild claim that it could cuts billions of what it characterized as “wasteful” spending and actually make people healthier. The NYT quotes Dr. Elliott Fisher, a physician who is one of the principal authors of the Dartmouth work writing, “We show where the waste is in medicine. If everyone could operate like Oregon, Seattle or the Upper Midwest, there’s huge savings.”
The NYT points to a key criticism of the compiled research writing,
“But the atlas’s hospital rankings do not take into account care that prolongs or improves lives. If one hospital spends a lot on five patients and manages to keep four of them alive, while another spends less on each but all five die, the hospital that saved patients could rank lower because Dartmouth compares only costs before death. 'It may be that some places that are spending more are actually getting better results,' said Dr. Harlan M. Krumholz, a professor of medicine and health policy expert at Yale. Failing to receive credit for better care enrages some hospital administrators.”The systematic New York Times review of varying criticisms is well worth reading. But the short summary is that there is very little evidence to support the Dartmouth conclusion that the nation’s best hospitals are typically the least expensive. In other words, the idea that Americans are in fact getting more for their money remains a valid argument – one that was almost totally ignored throughout the health care debate.
There is reason to remain concerned over this highly criticized Dartmouth research. The NYT writes,
“Dr. Donald Berwick, nominated by President Obama to run Medicare, called it the most important research of its kind in the last quarter-century. In March, in response to the Congressional Democrats who would have otherwise withheld their support for the health legislation, the administration made a promise. It said it would ask the Institute of Medicine, a nongovernment advisory group, to consider ways of putting the Dartmouth findings into action by setting payment rates that would punish inefficient hospitals and reward efficient ones.”
This distorted view of the Dartmouth Atlas research could dangerously be institutionalized and used to financially punish hospitals that have high survival rates and improve people’s lives – all in the name of cost.
NRLC has long argued that the cost of health care does not require rationing life-saving treatment (see here). Obamacare advocates wanted to sell the idea that by simply cutting wasteful spending, the expansion could pay for itself. This faulty and gratuitously cited Dartmouth Atlas compiled research gave them cover for that argument – cover that is quickly evaporating. However, when increased health care spending does in fact save lives and increase quality, the administration and new health care law sadly offered no other real long-term way to pay for the kind of quality care Americans deserve.
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