Health care

Rationing of health care, now and on the horizon

by Bob Weeks on December 31, 2010

A Wall Street Journal article explains that — contrary to the promises of President Barack Obama and supporters of his health care plan — rationing of health care is happening and will become more pervasive.

Citing the story of Avastin (see below), the authors write “The Avastin story is emblematic of the government’s broader agenda to ration care based on cost and politics. Once ObamaCare comes into full force, such rationing will be pervasive. When the government sees insufficient benefit, all but the wealthiest and most politically connected will have to go without.”

The article explains the doctrine of “comparative effectiveness,” used in England to ration health care, and how the 2009 stimulus bill allocated $1.1 billion to study this.

Additionally, end-of-life counseling has been revived through regulation, not legislation. This, the authors write, “might coax the elderly away from life-sustaining but expensive treatments.”

Where I might disagree with the authors is in this passage:

There’s an enormous difference between government-imposed rationing and treatment decisions in the private sector. When insurance companies deny coverage — for example, on grounds that treatment is “experimental” or not “medically necessary” — they do so based on contract language agreed to in advance by subscribers. If you don’t like what a particular insurer offers, you’re free to shop around.

The idea that people can shop around for health insurance is not a reality for most people. For those who receive insurance from their employers, they get what the boss offers, maybe with a few choices. Contrast this with the lightly-regulated automobile insurance market, where policies are available with many options, and insurance companies actively compete for customers. Those on Medicare get what the government provides, although many seniors shop around for a supplemental policy that meets their needs.

If the health insurance market were less regulated, particularly eliminating the perverse practice of insurance being tied to employment, a market would likely develop where customers would be able to shop for or specify policies that meet their needs. If someone wanted a policy that would pay for experimental, cutting-edge treatments, they could pay an additional amount for such a policy. I have no idea how much extra this option would cost, but I imagine we would be surprised at how little it would be.

Or, if someone has signed an advance directive indicating that they do not want extraordinary and expensive care at the end of their life, shouldn’t they be allowed to buy policies that specify this as part of the contract between the insurance company and the insured? That could save a lot of money.

The rationing of health care has implications for economic development in Wichita. The State of Kansas and Wichita are making a large investment in Center of Innovation for Biomaterials in Orthopaedic Research. This center seeks to make advancements in medical devices, including artificial hips and knees. These types of operations, however, are the type of medical care that we can easily foresee will be restricted as the federal government seeks to control spending on health care.

‘Death Panels’ Come Back to Life

The FDA’s restrictions on the drug Avastin are the beginning of a long slide toward health-care rationing.

By David B. Rivkin Jr. and Elizabeth Price Foley

Earlier this month, the Food and Drug Administration banned doctors from prescribing Avastin, a potent but costly drug, to patients with advanced-stage breast cancer. According to the FDA, the drug doesn’t offer “a sufficient benefit in slowing disease progression to outweigh the significant risk to patients.” Yet in some clinical trials Avastin has halted the spread of patients’ cancer for months, providing respite to women and their families wracked by physical and psychological pain.

Ponder the FDA’s justification—there wasn’t “sufficient” benefit in relation to Avastin’s risks. Sufficient according to whom? For your wife, mother or daughter with terminal breast cancer, how much is an additional month of good-quality life worth? And what costs should be weighed? Like all drugs, Avastin has side effects including bleeding and high blood pressure. But isn’t the real cost to these women a swifter, less dignified death? The FDA made a crude cost calculation; as everyone in Washington knows, it wouldn’t have banned Avastin if the drug cost only $1,000 a year, instead of $90,000.

Continue reading at The Wall Street Journal or at Rivkin’s site.

Tagged as: Barack Obama, Health care, Regulation

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Obama health care rejected in Missouri election

by Bob Weeks on August 4, 2010

What are we to think when President Obama’s signature legislative achievement is highly unpopular with Americans?

Scott Rasmussen has written: “One of the more amazing aspects of the health-care debate is how steady public opinion has remained. Despite repeated and intense sales efforts by the president and his allies in Congress, most Americans consistently oppose the plan that has become the centerpiece of this legislative season.”

Now we have election results that show that Americans — Missourians, anyway — don’t like what they see in the Obama health care plan. The Wall Street Journal’s James Taranto reports on the Missouri election.

Mo. to O.: ‘No’

They said voters would learn to stop worrying and love ObamaCare. They were wrong.
By James Taranto

They told us that Americans would learn to stop worrying and love ObamaCare. To judge by yesterday’s election in Missouri, they were wrong.

Official election returns show that citizens of the Show Me State voted overwhelmingly–71% to 29% in favor of Proposition C, a ballot measure described in a pre-election report from Time magazine:

The specific issue boils down to this: Can the government require that citizens buy health insurance? Mandatory insurance is a key element of the health care reforms passed by congressional Democrats and signed by Obama this year. Adding healthy people to the insurance pool spreads the cost of policies for people with health problems. Missouri’s referendum rejects that mandate by asking voters whether state laws should be amended to forbid penalties for failing to have health insurance.

Time describes the vote as “largely symbolic.” Other states have already passed such opt-out laws via legislative action rather than voter initiative, and the real test will come in the courts. But symbolism matters. If the constitutional question is a difficult one, it’s possible that judges will resolve it on the side of public opinion. And of course the public’s reaction to ObamaCare is likely to influence the politicians who have control over its implementation and possible repeal.

Continue reading at the Wall Street Journal

Tagged as: Barack Obama, Government health care, Health care

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Dr. Milton Wolf at AFP Kansas summit

by Bob Weeks on April 28, 2010

At the Kansas Defending the American Dream Summit 2010, produced by Americans for Prosperity-Kansas, Dr. Milton Wolf addressed the crowd on health care issues. Wolf is a physician and second cousin to President Barack Obama.

“Three months ago I had never been to a political rally,” he told the audience. He started a website — The Wolf Files — and became involved.

He told the audience of some of the personal attacks he’s received.

“Freedom isn’t free, and liberty cannot be a spectator sport.” The government takeover of health care is really a cover for an assault on our freedom, he told the audience. Deep in the thousands of pages of the bill is health care rationing, which its supporters claim is not the purpose of the bill.

Wolf said that by coming between citizens and their doctors, there is no other part of life that regulators can’t touch.

Donald Berwick, the head of Medicare, says that there will be rationing. He compliments the British health care system, but doesn’t talk about the results. Wolf said that the results for cancer survivability in Great Britain are much worse than in the United States.

He said that Health and Human Services Secretary Kathleen Sebelius received a report from her own agency that said health costs will rise after government reform, but that she withheld release of the report until after Congress voted.

There are free market solutions for health care. First, get the government out of the patient exam room. Government should not be regulating who get mammograms.

Second, make health care insurance companies answerable to consumers, not their employers. Where free markets are allowed to work in medicine, such as laser eye surgery, the costs have come down tremendously.

Third, eliminate junk lawsuits. From $100 billion to $200 billion is spent each year on defensive medicine, he said. He mentioned a novel concept: health care dollars get spent on health care, not lawyers.

Tagged as: Americans For Prosperity, Government health care, Health care

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Bigger danger of healthcare bill: the arrogance of Congress

by Bob Weeks on March 28, 2010

By Eric O’Keefe.

We may never fully know the damage that will be done by the massive health care bill Congress passed on Sunday, but one thing is certain: It will lead to lower-quality care at higher costs.

Dozens of new health boards will come on line in the next few years, as bureaucrats gradually take control of our health care system. Who knows how many bright college students will decide to avoid medical careers because they don’t want to follow orders from these bureaucrats?

As alarming as some of the bill’s provisions are, what’s more dangerous is the arrogance this Congress demonstrated.

The House of Representatives used to represent; now it rules.

This health care reform was widely debated for a year, and it became less popular by the month. A weekend poll by Rasmussen Reports showed the depth of that unpopularity, with only 26 percent strongly supporting the reform and 45 percent strongly opposing it.

How can elected representatives defy the considered will of the people?

Because defiance becomes an easy habit when you know that there is almost no chance you will lose your next election. The loss of accountability enables public servants to indulge their own lust for power. As Lord Acton wrote, “Power tends to corrupt, and absolute power corrupts absolutely.”

If we do not address the problem of a permanent class of rulers in Congress, we will watch Congress bankrupt the country and destroy the republic.

Most members of the House represent specially drawn districts where one party dominates. As a result, these members face no primary election challengers and only nominal competition in the general election.

Congressional entrenchment is not a product of popularity; Congress has routinely been unpopular the past 30 years. A February survey by Rasmussen Reports showed approval of Congress at a historic low, with only 10 percent rating their performance as good or excellent. Rasmussen also found 63 percent favor replacing the entire Congress.

Unfortunately, that will not happen. Even during this year’s extreme political turmoil, you can be confident that over 80 percent of House incumbents will win yet again in November. In most modern US elections, more than 95 percent of House incumbents are reelected.

The reason is a century of entrenchment by incumbents looking out for themselves. They have large staffs and budgets to run a permanent campaign; they have pork and patronage to distribute at taxpayer expense; and they enacted campaign restrictions to hobble challengers.

With mostly one-party districts, incumbents own their seats unless they face serious primary challenges. But party organizations controlled by incumbents work to discourage primary challenges, regardless of the performance of the incumbent. In fact, only eight incumbents have lost their primary races in the past three elections combined – that’s a renomination rate of over 99 percent.

To regain congressional accountability, we must work outside the political parties to set the standard of acceptable behavior, and to enforce it in primary elections.

In 2006 and 2008, Democrats won the close House races and took control of Congress because voters were tired of big-spending Republicans. In 2010 voters will defeat Democrats in close elections, and the House is likely to return to Republican control. But what will those Republicans do? Should we trust them to behave this time?

I would say no. Congress will not behave on its own because the political parties now exist to serve the politicians, not the taxpayers.

That’s why the development of the tea party movement has been so forceful and swift. Tea party leaders stepped up because both parties had failed us. Yet they understand that you don’t solve the problem of two unaccountable parties by creating a third. What we really need is a way to hold politicians of any party accountable, and that begins with independent organizations demanding accountability, and backing primary challengers to representatives of both political parties who fail to live up to their job title: Representative.

In 2010, tossing out some big-spending Democrats may be all that voters can accomplish. But if we don’t solve the bigger problem of creating the organizations to systematically hold politicians accountable, we will only get another round of broken promises on the road to ruin. The fate of the republic depends on building an independent system to hold Congress accountable to the taxpayers.

Eric O’Keefe is chairman of Sam Adams Alliance, a Chicago-based nonprofit focused on communicating free-market principles.

Tagged as: Elections, Government health care, Health care, Politics, Sam Adams Alliance, United States Congress

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After U.S. health care reform, where will Canadians go?

by Bob Weeks on March 22, 2010

Now that the Democrats’ health care reform package has passed Congress and is sure to be signed into law, wealthy Canadians will need to start looking for somewhere else to travel for surgery.

Earlier this year Danny Williams, the premier of the Canadian province of Newfoundland traveled to Miami for heart valve surgery. As Sally C. Pipes explains in a San Francisco Chronicle article: “With his trip, Williams joined a long list of Canadians who have decided that they prefer American medicine to their own country’s government-run health system when their lives are on the line.”

In an interview defending his decision, Williams said “This is my heart. It’s my health and it’s my choice.” Williams, a millionaire, has the resources to make a choice that most Canadians don’t have.

Pipes writes that 40,000 Canadians travel to the United States each year for medical reasons. But as big-government health care reform starts to drag down American health care to that of the level of Canada, we can expect to see that number decline.

Medical tourism is a benefit to Wichita’s economy. Galichia Heart Hospital in Wichita offers a wide variety of surgical procedures — not just heart surgery — to people willing to travel to Wichita. The hospital has a website — Galichia Medical Tourism — complete with prices for some procedures. A promotional video on the site specifically mentions categories of surgery that Canadians are finding difficult to obtain in their own country.

Will Galichia be able to maintain this business after the full effect of Obama-style health care reform is realized? Will we have a health care system that Canadians will want to use? It will take some time to know the answer.

Tagged as: Government health care, Health care

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Health care about to get worse

by Bob Weeks on March 22, 2010

A good summary of the problems with American health care, and of what the future holds is from Competitive Enterprise Institute‘s Gregory Conko. In his piece Health Care Crisis About to Get a Whole Lot Worse he writes:

Most of the problems in America’s health care system — high and rising prices, lack of consistent and reliable access for millions, rampant cost shifting, and an inability to distinguish between effective and ineffective services or between high and low quality, to name just a few — stem not from some supposed market failure, but primarily from existing government interventions in the market for health care and health insurance.

One of the government interventions that leads to market dysfunction is the reliance on employers to provide health insurance for so many Americans. This happened because of government policy, not by accident. As a result, workers have little choice in their coverage, and some feel tied to their present jobs just for the insurance.

Americans — some anyway — complain that health insurers will collect premiums for years, and then not pay when the covered become sick. There’s also not a vigorous market for health insurance for individuals, partly because the employer market swamps out efforts to sell to individuals or families.

Contrast this situation with the market for automobile insurance. This is a product that is regulated, to be sure, but much more lightly than health insurance. It’s something that no employers purchase for their workers and their private cars. Instead, drivers have to seek out and purchase their own policies.

And what is the result? There’s a thriving and competitive market for auto insurance. The pitchmen for two large companies — the quirky lizard and the exuberant Flo — are well known to television viewers. Auto insurance companies innovate to see who can produce products that meet the needs of consumers.

Do auto insurance companies fail to pay claims, as it is alleged health insurance companies do? If an auto insurance company developed a reputation for not paying, customers would quickly and easily leave that company for others. That is a credible threat, as there is a competitive market for auto insurance. Those who feel they have been wronged by a health insurance company often have no alternative to turn to — there is no credible threat of taking one’s business to another company.

One of the things that President Obama’s health care reform is designed to do is to create a marketplace for health insurance. But we don’t need more government regulation to accomplish that. Such government-sponsored effort is likely to fail. Less government intervention and less regulation, like in the market for auto insurance, would produce a result better for consumers.

Tagged as: Barack Obama, Free markets, Government health care, Health care, Regulation

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To some, Democrats not bold enough, despite Massachusetts results

by Bob Weeks on January 21, 2010

A coalition of liberal political action groups has released a poll that contradicts the conventional wisdom stemming from Tuesday’s election.

The poll, conducted after Republican Scott Brown’s victory in the United States Senate election in Massachusetts, was sponsored by Progressive Change Campaign Committee, Democracy for America, and MoveOn.org.

According to a communique from Democracy for America, Democrats in Washington should “Be bold, fight for more change — not less, and pass healthcare with a public option.”

The message speaks of “Stay-at-Home Voters and Obama-Voting Independents” as a new set of swing voters. These voters, DFA claims, were responsible for Brown’s victory.

The poll results, delivered under the sub-heading “Even Scott Brown voters want the public option, want Democrats to be bolder” is interpreted by Charles Chamberlain, political director of Democracy for America this way: “In an election between Scott Brown and the public option, the public option would have won.”

Further, according to DFA, “Both sets of swing voters don’t think the current Senate bill goes far enough and over 80% of them want a public option. … If a public option was in the Senate bill then these swing voters would have delivered victory to the Democrats.”

Tagged as: Government health care, Health care, Politics, United States Congress

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Wall Street Journal on government health care

by Bob Weeks on November 12, 2009

The Wall Street Journal has compiled its editorials and op-eds into a collection titled The WSJ Guide to ObamaCare. It’s an invaluable collection of reporting and analysis.

For example: The German model, promoted by American liberals as a model to follow? “Alas, the German system is starting to come apart at the financial seams.” (The Stressed German Model: It took the Germans 125 years to figure out that their health-care system doesn’t work)

On learning from the states: “Like participants in a national science fair, state governments have tested variants on most of the major components of the health-care reform plans currently being considered in Congress. The results have been dramatically increased premiums in the individual market, spiraling public health-care costs, and reduced access to care. In other words: The reforms have failed.” (The Lesson of State Health-Care Reforms)

On the purported right to health care: “The question of health care is not one of rights but of how best in practice to organize it. America is certainly not a perfect model in this regard. But neither is Britain, where a universal right to health care has been recognized longest in the Western world. Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.” (Is There a ‘Right’ to Health Care? In Britain, its recognition has led to substandard care.)

On Obama’s tall tales: “To highlight abusive practices, Mr. Obama referred to an Illinois man who ‘lost his coverage in the middle of chemotherapy because his insurer found he hadn’t reported gallstones that he didn’t even know about.’ The president continued: ‘They delayed his treatment, and he died because of it.’ Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce.” (Fact-Checking the President on Health Insurance: His tales of abuse don’t stand scrutiny.)

Tagged as: Barack Obama, Government health care, Health care

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Failure of one program doesn’t justify forming another

by Bob Weeks on November 12, 2009

The blogger at the KRA got it just right in the post Liberal-socialists ignore government failure in insuring children.

It seems that at a recent rally in Johnson County, a sign said there were 58,000 uninsured children in Kansas.

The blogger points out “But doesn’t the state of Kansas already have a program in place that is supposed to insure children when their family can’t afford to do so? Of course, it’s called Kansas Healthwave!”

At the national level a similar problem exists: people are eligible for government programs, but they don’t sign up. As I wrote in Uninsured count needs explanation:

There’s also the issue that many people are eligible for some sort of government assistance with health insurance, but they don’t take advantage of it. Yet, these people are counted as uninsured. As explained in The Top Ten Myths of American Health Care: A Citizen’s Guide by Sally Pipes of the Pacific Research Institute: “As many as 14 million of the 45.7 million uninsured — poor and low-income Americans — are fully eligible for generous government assistance programs like Medicare, Medicaid, and SCHIP. The problem is, they’re just not enrolling in these programs.”

Tagged as: Government health care, Kansas state government

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In Winfield, citizens don’t agree with their opinion leaders

October 30, 2009

On Wednesday the Winfield Daily Courier printed an editorial titled ‘Tea party’ bunch is going to extreme.

While criticizing a move made by some Kansas legislators, it uses loaded language like “in full Glenn Beck mode,” “they look silly,” “appealing to prejudice rather than reason,” and “should just laugh at the ‘tea party’ jesters.”

Tagged as: Government health care, Health care, Kansas news media

Health care

‘Death Panels’ Come Back to Life

Mo. to O.: ‘No’

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