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Is Stimulus a Trojan Horse for Health Care Reform?

Are radical reforms of the private health care system buried in the stimulus bill? Betsy McCaughey, whose 1994 cover story in The New Republic helped sink the Clinton Administration's health care reforms, thinks so. In an opinion piece for Bloomberg, she writes:

The bill's health rules will affect "every individual in the United States." Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and "guide" your doctor's decisions. These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, Critical: What We Can Do About the Health-Care Crisis. According to Daschle, doctors have to give up autonomy and "learn to operate less like solo practitioners." . . .

Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration's health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. "If that means attaching a health-care plan to the federal budget, so be it," he said. "The issue is too important to be stalled by Senate protocol."

I recognize McCaughey's 1994 analysis is disputed, and it is entirely possible she is mis-reading the language of the stimulus bill too. At the same time, it would not surprise me were all sorts of mischief buried deep within the massive bill. Hence my question: Is she correct in her assessment of the health care provisions of the stimulus? I would be particularly interested in the views of my co-blogger David Hyman (who's probably forgotten more about health care policy than I'll ever know) and others who follow this issue more closely than I do.

Steve:
Sure sounds like the same old scare tactics to me. "Government will tell your doctor what he can and can't do, blah blah blah." Thank goodness private insurance companies never do that.
2.9.2009 9:10pm
therut (mail):
Well the difference is if your insurance does not pay you can still get the treatment and pay yourself or say you will. Will the .gov system allow you to privately pay for the care you feel you need. You can not do so in Canada. Or will that be unfair that some can pay and other can't? Will it still be a free country. I personally am extrememly angry that I spent all the time and worked hard to become a physician and now I am going to be nothing but a slave to the State. Only good thing is I only have to put up with it for the next 10 years. Unfortunately, I will be treated by a very bad system in my old age. I am not looking forward to being ill. It will be terrifying for those of us who know the bad things that will happen. Hope I get dementia so I do not know.
2.9.2009 9:22pm
Fûz (mail) (www):
My church warned us a week ago that this spendulus bill is also a trojan horse for expanding abortions.

Not that I care intensely, but the Catholics indeed do, and attaching FOCA to economic recovery legislation appears to be underhanded.

The stimulus bill has already been equated with the PATRIOT Act---a preexisting wish list of legislative items that wouldn't solve the problem, pushed through with plenty of hurry (and hyperbole) and not enough debate.
2.9.2009 9:25pm
Steve:
Yes, therut, you're right to be concerned. Through some obscure provision buried deep in the stimulus bill, the Obama Administration will set up an evil bureaucracy to PREVENT doctors from providing treatment even if the patient is happy to pay for it themselves. Hard-working doctors may be fined or thrown in jail because the patient didn't really need that X-ray. This is all very, very plausible, and you are in no way overreacting to a post on a blog.
2.9.2009 9:34pm
Guest12345:
"Government will tell your doctor what he can and can't do, blah blah blah." Thank goodness private insurance companies never do that.


Oh boy, what a difference a simple little 's' makes.
2.9.2009 9:35pm
Ari (mail) (www):
"My church warned us a week ago that this spendulus bill is also a trojan horse for expanding abortions."

You would think that <a rel="nofollow" href="http://www.trojancondoms.com/">Trojans</a> would do the reverse...
2.9.2009 9:38pm
John Moore (www):
There is another hidden health system change (unless it has been removed - the text is unavailable): the extension of Cobra for those over 55 until they reach Medicare eligibility.

This may sound reasonable, but it will drive up insurance costs for employers, incentivizing them to either drop coverage or find some other way to shed these costly (150% of average) insureds.

Unless businesses can find ways around this (and they already use outrageous tactics to force people off their COBRA rolls), this will further push businesses towards outsourcing health insurance to the government.
2.9.2009 9:41pm
Soronel Haetir (mail):
I don't know what particular items are being pushed here, but there is one medical reform I would like to see.

Doing away with paper prescription forms. While I have not yet had a pharmacy give me the wrong medication due to misreading the doctor's handwriting I know people who have. I've also had personal instances where getting a prescription filled took longer because they had to call and make sure what they thought it said was correct.

Moving to electronic filing would also allow tracking of people doctor shopping for meds, so we'd finally know whether it is actually a problem or not.

I note however that this is an administrivia item, rather than actually mandating any particular medical action from the physician.
2.9.2009 9:42pm
PC:
Sure sounds like the same old scare tactics to me.

The provision is buried right next to the item that replaces state election boards with ACORN.
2.9.2009 9:43pm
ONCHIT:
Uhh, the National Coordinator has been around for several years now. Check it out!

http://www.hhs.gov/healthit/onc/mission/
2.9.2009 9:47pm
Steve:
Oh boy, what a difference a simple little 's' makes.

Right, because when my employer-provided health care plan refuses to pay for a procedure, all I have to do is march right into my boss's office and tell him to switch to a different insurance company that will cover that procedure!

Of course, we need not get bogged down in an argument over how feasible it is to shop around for a new insurer every time a claim is denied, because the stimulus bill does not abolish the private health insurance market in the United States, any more than it secretly enacts the Freedom of Choice Act. Maybe the bill is better than I thought, if people feel compelled to tell such outlandish stories in an effort to derail it.
2.9.2009 9:49pm
Vermando (mail) (www):
I have done some healthcare consulting and have now read through the bill, though I've never read Daschle's book, which she also relies on a lot. I do not think that she is portraying the act correctly; indeed, she seems to be deliberately misconstruing the provision to make it seem much more controversial than it is.

Specifically, she launches off the word "guide," saying, "[t]he goal is to reduce costs and 'guide' your doctor's decisions." She mentions specifically, "penalties" if "your doctor [goes] beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment." She also uses Daschle's book to argue that this means that doctors need to "give up autonomy," and, contra thereto, that "[k]eeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far."

That, though misrepresents the bill. The portion she quotes that the bill's purpose is to "guide" your doctor's decisions actually says that the nations system's purpose is to "provide[] appropriate information to help guide medical decisions." So, the system only provides centralized information, which, one would hope, your doctor would use to guide your care. There is nothing at all in the bill about centralized protocols or providing any other guidance about how your doctor should make his decision. This is crucial, because the controversial part of her claim is the allegation that government would be intruding on our medical care - while she may oppose the centralization and provision of information, that alone, traditionally, has not attracted nearly the same ire, and indeed, is supported by many as an easy way that care can be improved (I don't want to debate the entire merits of that here - there are pros and cons - only to point out that it's a different - and less controversial - argument).

She likewise misportrays the "incentives" provision, which she discusses briefly under a section entitled "new penalties," in which she speculates about the "penalties" that doctors might face for not following protocol.

This is odd since, first, as mentioned above, the bill does not prescribe any protocols, and second, it also does not contain any "penalties" in this area. Instead, it contains only "incentives" in the form of payments made to medical professionals who participate in the system. There is no penalty at all to anyone who does not participate - if you or your doctor wants to continue without providing or accessing this information, there are no negative consequences, not even, as far as I can tell, in the form of withheld government reimbursement payments from medicaid or medicare. The act does contain some penalties, specifically strengthening the penalties for those who violate existing laws protecting patient privacy.

In all, therefore, the act establishes a centralized information system in which medical professionals can voluntary participate. It does not establish what she describes, a system for the government regulation and provision of healthcare in which professionals are compelled to participate. If one may speculate, the reason she misconstrues this act would seem clear - the first, and real, proposal is much less benign and less controversial than the second.

In all of this, I do not speculate on what might occur later. Such a centralized system would obviously be helpful to any regulator - from an insurance company, HMO, or the government - who wanted to rationalize healthcare, so it could be that this is a first step in greater government control - I certainly acknowledge that the more information we provide to any regulatory source, the more of our liberty we potentially sacrifice. Likewise, the Ms. McCaughey seems inspired by Mr. Daschle's book to read these provisions as the first step in a process. I have not read this book nor talked with anyone in the administration about it, so I cannot comment if she is indeed interpreting it correctly, and if so, if the administration does indeed have such a plan. In any case, I can say that the next steps she suggests do not at all have to follow from what is done in this bill - the centralization of healthcare information can be an end in itself or the first step down an alternate path, and it can serve many useful, non-nefarious purposes.
2.9.2009 9:50pm
Cornellian (mail):
2.9.2009 9:53pm
Cornellian (mail):
2.9.2009 9:53pm
therut (mail):
Electronic Prescriptions are already in the works to be mandated later. Now it is bribe time. In 2009 if you send 50% of your Medicare patients RX's using EMR's you get a bribe of 2% of your total Medicare payments. This is going to go on for a few years then if you do not do so it will cost you a 5% cut. See how the heavy hand of government works. We have spent 500,000 over 5 years for an EMR system(4 physician group) and it is just not going to be cheap. We will have to hire another employee at least to put the data in. It takes tooooo much time. You say WHAT!! It takes at least 4-5 minutes to get the data into the records (this is just for the patients medications). Multiply that by 40-50 patients a day and see how much time that would take each physician. Not gonna happen without MONEY. I think it would be cheaper to not do this and take the cut. And mistakes can and are made with EMR's also. Human error and all that. One little typo and well it just may not be right.
2.9.2009 9:56pm
therut (mail):
As for tracking controlled substances forget it. You have to hand write those prescriptions.
2.9.2009 9:56pm
Cornellian (mail):
Well the difference is if your insurance does not pay you can still get the treatment and pay yourself or say you will. Will the .gov system allow you to privately pay for the care you feel you need. You can not do so in Canada.

That's hardly realistic. Few people are rich enough to pay for any major medical procedure if their insurer refuses to pay.

And you may be able to get that procedure privately in Canada, depending on the province and certainly anyone who can afford a major medical procedure on their own dime can afford to travel to another province or to the United States.
2.9.2009 9:57pm
Guest12345:
Right, because when my employer-provided health care plan refuses to pay for a procedure, all I have to do is march right into my boss's office and tell him to switch to a different insurance company that will cover that procedure!


No, while you cannot easily switch providers, I was thinking more along the lines of the fact that there is competition in the market. This leads to competition which acts as a control on how far insurance companies will push things. You won't have the same check on the behavior of the government plans without the self-interest element.
2.9.2009 10:00pm
Lior:
Vernando: I'm sure that your anaylsis is correct in that the scary claims are overblown. Nevertheless, please note that money does not grow on trees.

... the bill does not prescribe any protocols, and second, it also does not contain any "penalties" in this area. Instead, it contains only "incentives" in the form of payments made to medical professionals who participate in the system."


Where does the money for these so-called "incentives" come from? In other words, what is the opportunity cost of offering the incentives? Compared with the "no action" defaults such as lowering everyone's taxes uniformly or giving all doctors the same incentive regardless of participation, this measure will penalize those who don't participate.

On a more fundamental level, if the putative recommendations are indeed "cost-effective" then no incentives should be necessary: doctors will follow them anyway. The government sponsoring research into the comparative effectiveness of medical treatments is salutary. The government paying doctors to choose one treatment over anther should be highly suspicious.
2.9.2009 10:14pm
Randy R. (mail):
Vermando, thanks for the info.
2.9.2009 10:36pm
BRM:
Considering the funny "pork" attacks on the stimulus bill (honeybee bailout! for example), I would assume that Republicans in Congress would have seized on actually meaningful and controversial liberal policies buried in the stimulus bill if any were there. That is, assuming congressional Republicans care about anything other than snappy sound bites and demagoguery.
2.9.2009 10:39pm
Real American (mail):
if you think arguing with an insurance company is a chore, wait until you're have to argue with some government bureaucrat that's trying to get out by 3:30.

of course, ask the Canadians waiting 6 months for an MRI how they like their "free" health care.
2.9.2009 10:39pm
Lib (mail):
Guest12345:
You won't have the same check on the behavior of the government plans without the self-interest element.
But the government plan will be overseen and subject to checks and balances by independent, impartial agents of the government who will always have your best interest in mind and who will, themselves, be overseen by democratically elected public servants. What could possibly go wrong?
2.9.2009 10:43pm
therut (mail):
Real Americian--- The one time I actually decided to call the Medicare representive for health care providers was a learning experience. I actually called the number over and over for one hour and 45 minutes. I finally got an answer and was told "Sorry from 4:30 to 5:00 was for pharmacists only". I have never and will never call them again.
2.9.2009 10:55pm
Cornellian (mail):

of course, ask the Canadians waiting 6 months for an MRI how they like their "free" health care.


Every health care system has its pros and cons, but Canadians overwhelmingly prefer their health care system to the American one. That's not an arbitrary decision. You wait longer for routine tests, but you also don't die because you happened to get sick or injured while you didn't have insurance coverage, or because you've hit the limits of your policy.
2.9.2009 10:57pm
therut (mail):
People in this country do not die because of lack of insurance. I and other physician treat them all the time without any pay. I have NEVER seen a really sick or injured patient turned away. Never. Even in Dade County Miami a hell hole of a place. I would say the Canadians do not know better. If we get socialized medicine it will have to take effect over at least 20-40 years or people will revolt. Those born into the system will not realize the poor care they receive. Even in my small town of 5,000 an MRI is available 24/7. People will not wait one year or a year and a half for their knee replacement when they are used to getting one in a week or less. Next day mammograms for a lump, CT scans in 30 minutes for a headache etc. Do we over do it in this country. Definately. Do you think Ted Kennedy would wait a month or 3 or even 24 hours for a CT or MRI? Not gonna happen anytime soon. How about a helicopter ride for 25 minutes and a angiogram within 1 hour for suspicious chest pain? Think that happens in Canada? Are they set up where a C-section can be done in 10 minutes anytime of the day? No of coarse not. Are we--Yes. Even in rural small hospitals.
2.9.2009 11:08pm
Steve:
I needed an MRI last year and when I called the place they were able to fit me in that very afternoon. I was like "hmm, maybe all those people who go on and on about waiting periods in Canada have a point!"

Then I got the results and started calling knee specialists to find out what the results meant. Couldn't get a single one of them to see me in the next two months. It was then I started to appreciate the pointlessness of anecdotal evidence.

Of course, what I'm sharing here is an anecdote in itself, but from my perspective it's something that actually happened to me! So whatever. There is still no secret provision in the stimulus bill that abolishes private insurance.
2.9.2009 11:17pm
Cornellian (mail):
There's an interesting article in the current edition of Newsweek. It's mostly about how Canada's banking sector hasn't has the subprime mortgage meltdown that ours has. Canada hasn't had a single bank failure. The Toronto-Dominion bank, 15th largest in North America a year ago is now the 5th largest because of a bunch of U.S. bank failures in the (formerly) top 15.

However, there's also a paragraph about health care:

Canada has been remarkably responsible over the past decade or so. It has had 12 years of budget surpluses, and can now spend money to fuel a recovery from a strong position. The government has restructured the national pension system, placing it on a firm fiscal footing, unlike our own insolvent Social Security. Its health-care system is cheaper than America's by far (accounting for 9.7 percent of GDP, versus 15.2 percent here), and yet does better on all major indexes. Life expectancy in Canada is 81 years, versus 78 in the United States; "healthy life expectancy" is 72 years, versus 69. American car companies have moved so many jobs to Canada to take advantage of lower health-care costs that since 2004, Ontario and not Michigan has been North America's largest car-producing region.

Here's the link to the full article:

http://www.newsweek.com/id/183670
2.9.2009 11:24pm
jukeboxgrad (mail):
lib:

the government plan will be overseen and subject to checks and balances … What could possibly go wrong?


Here's something that could go wrong: we could put the government back in the hands of people who are generally opposed to the idea of government (they're called "Republicans"). When we do that, government runs especially poorly. Big surprise.

therut:

I actually called the number over and over for one hour and 45 minutes.


Usually when something is broken, it's a good idea to fix it. When government doesn't work well, the proper response is to fix it, not destroy it. When government is in the hands of people who are opposed to the idea of government, their main priority is the latter, not the former.

Republicans are good at making government work badly. This builds political support for destroying government even more. This cycle feeds on itself for a while, and then we wake up with a hangover, and realize that destroying our own government is an act of self-destruction. That's the phase we're in now: hangover.

People in this country do not die because of lack of insurance.


I guess they just die when their insurance company denies them the treatment needed to save their life.
2.9.2009 11:32pm
Daryl Herbert (www):
With one swift stroke, every good thing Bill Clinton built up has been wiped away.
2.9.2009 11:34pm
Vermando (mail) (www):
Lior,

Agreed. There is an extent to which incentives can be penalties if they become so large that recipients feel compelled to take them, as is the case with, say, the federal government's use of highway funds as an incentive for states to raise their legal drinking ages.

Here, how those incentives would function is unclear to me - there is a provision for a cap, and there is no possibility of losing other, current sources of funding, but there could be some flexibility in there that I have overlooked. I will also admit that I read that portion of the bill less thoroughly than the portion on the bill's purpose once I deduced that, contrary to Ms. McCaughey's claim, it contained no formal penalty provisions and nothing - neither incentives or penalties - to influence the doctor's choice of treatment.
2.9.2009 11:52pm
Steve J. (www):
it is entirely possible she is mis-reading the language of the stimulus bill too.

She gave it a paranoid reading. It is simply a way to avoid unnecessary paperwork and improve health care.
2.9.2009 11:56pm
A.:

Well the difference is if your insurance does not pay you can still get the treatment and pay yourself or say you will. Will the .gov system allow you to privately pay for the care you feel you need. You can not do so in Canada.

That's hardly realistic. Few people are rich enough to pay for any major medical procedure if their insurer refuses to pay.

And you may be able to get that procedure privately in Canada, depending on the province and certainly anyone who can afford a major medical procedure on their own dime can afford to travel to another province or to the United States.


How about psychotherapy and psychoanalysis? Every shrink I know is worried that a single-payer system will essentially put them out of business (or at least into a totally different business from the one that they have chosen). Canadians certainly deserve (and need!) mental health services as much as we do, and they shouldn't have to cross the border up to four times a week to get them.
2.10.2009 12:01am
davod (mail):
The moment I saw what was in the stimulus package it was apparent that it included not eight years but at least twenty years of unfulfilled socialist agenda.

Additionally, do not for one minute think Obama does not want all that Pelosi wants in the bill.

"There is another hidden health system change (unless it has been removed - the text is unavailable): the extension of Cobra for those over 55 until they reach Medicare eligibility"

I also read that the government will pay 60% percent of the cost.

Don't forget the SC... bill which was signed the other day to ensure all children have medical care. The bill covers children up to age 30? I do no know whether this is still in the bill but the previous edition also allowed the states to use the money to provide medical care for other than children.
2.10.2009 12:12am
Rascalfair (mail):
These comments are amazing. You're having a discussion on features of a bill to revolutionize health care in America. Good. Such a discussion should be held, and publicly, and over an extended period of time.

However, the actual issue here is NOT the merits of specific features of a health care bill. What is being done here is that health care is being changed WITHOUT any of the public discussion over time etc. at all. It's sneaked into a bill on saving the country's economy. This is an economic stimulus bill, and considered so vital that its not passing will lead to a catastrophe. The purpose of the legislation as sold to us mere citizens of the Republic has nothing to do with health at all.

The issue is stealth, not health. This is NO way to run a Republic. Or even a Democracy.

The politicos know what they're doing. They know better than "the people," and are sneaking in their pet idea before the rest of us peons even awaken to what they've done.

That, gentleman, lawyers, law professors....is an issue. How about some comments on what's really the point here?
2.10.2009 12:22am
Lib (mail):
jukeboxgrad:
I guess they just die when their insurance company denies them the treatment needed to save their life.
Nataline Sarkisyan's case seems to be a case of differing medical opinions where one set of doctors think the transplant was an appropriate medical procedure given her condition while other doctors didn't. Unfortunately, Geragos and the family, last I heard, were refusing to release Nataline's health records so independent doctors could look at them - thereby preventing Nataline's case from being very useful for informed public policy debate.

Wikipedia (that irrefutable source of information) has some interesting information about this which is suggestive that some transplant centers might not even have accepted Nataline for transplant. Nataline's doctors at UCLA gave her a 65% chance of six month survival while the head of UCSF's transplant center indicated that they wouldn't accept a patient for transplant unless they had a 50% or better five year survival odds. So, if Nataline had a 15% chance of dying between six months and five years after the transplant, UCSF wouldn't have been willing to do the transplant.

If one accepts Wikipedia's information, the cost of a liver transplant and one year of followup care is $450,000 (two years earlier so, if the popular claims about medical care cost inflation are true, the cost would have been over $500,000 by Dec 2007). Obviously a public health care system would have to take that cost into consideration and weigh it against the risk adjusted benefit - just as Cigna did... An interesting question is, what are the odds that a government run health care system would have "changed it's mind" just to avoid continued biased press coverage (as Cigna did)? And, who would Geregos be suing if the family didn't like the government health care policy - the family would have no realistic chance of recovery in that case.
2.10.2009 12:24am
Guest12345:
I guess they just die when their insurance company denies them the treatment needed to save their life.


More of that misrepresenting again? Just because someone files a case doesn't make it true. Their attorney also said:

The insurer "maliciously killed" Nataline because it did not want to bear the expense of her transplant and aftercare, said family attorney Mark Geragos.


How about this quote re. patients with her condition:

Transplantation is not an option for leukemia patients because the immunosuppressant drugs "tend to increase the risk and growth of any tumors," said Dr. Stuart Knechtle, who heads the liver transplant program at the University of Wisconsin at Madison and was not commenting specifically on Nataline's case.

The procedure "would be futile," he said.


Perhaps you could consider that she had a terminal condition and that is what lead to her death? Or perhaps her family deciding to take her off life support even though Cigna did reverse their decision and agreed to pay?
2.10.2009 12:28am
JB:
So according to Vermando's reading, this provision is...

an electronic medical records database? Which would replace the haphazard paper records currently in place and allow, for instance, a hospital I'm brought to to look me up and know that I'm allergic to sulfa drugs and guide them toward other courses of treatment in case I show up horribly injured?

Sounds like a great idea.
2.10.2009 12:31am
anotherpsychdoc (mail):
I really like electronic prescribing. Actually it is government regulation that is the biggest impediment to its use and, even more, its usefulness. Most people fill their prescriptions at a pharmacy accessible to the x hub. To get an idea of the implications of this consider that I made a prescription for Geodon once and got an alert that there was a potential interaction with a drug I didn't know the patient was on. Absent the interaction I wouldn't have been informed of his taking it. In the typical problematic case, such as somebody getting multiple benzodiazepine scripts and narcotics, there would be no notice because the patient record is protected, even after a person picks up your prescription. It is kept private by HIPAA regulation. Other problems include the fact that, by regulation, some common prescriptions can not be sent electronically but must be faxed; pharmacies more often overlook these. And those following a more restrictive interpretation of the law, such a WalMart, won't accept faxed prescriptions generated by the prescribing system.
2.10.2009 12:33am
ReaderY:
Too important to leave to democracy? Too important to discuss or debate or let anyone opposed have a say?

Sounds like another job for the federal courts!
2.10.2009 12:35am
Rascalfair (mail):
There's nothing quite so entertaining as hearing a bunch of lawyers bitch about medical care and offer their thought-to-be novel suggestions on topics as electronic medical records.

But there is an issue of governance, of law, of the meaning of self government here....that IS the province of lawyers...officers of the court, as I understand you to be.

Nobody is worried about an end run around the electorate in determining Federal Health Care policy? Why don't we talk about sex, or whiskey, or cigars....stuff that counts...if matters of governance are too painful for y'all?

Didja hear the joke about the "dogfood diet?" Maybe that'll start a real entertainment.
2.10.2009 1:23am
Steve:
Nobody is worried about an end run around the electorate in determining Federal Health Care policy?

Likewise, nobody is worried about the stimulus bill establishing Islam as the national religion, among the various other things that arouse no concern because they're not actually in the bill.
2.10.2009 1:51am
theobromophile (www):
One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and "guide" your doctor's decisions.

So instead of just fighting with your insurance company (which at least has an incentive to a) reduce costs later on, and b) not get sued), you get to fight with your insurance company and the federal government?

I've had a few situations in which I was pretty certain that the doctor was screwing up, and decided to seek a second opinion. Oddly enough, my instincts are right on, and that second opinion has spared me untold amounts of harm. I've also had some semi-unconventional medical tests before, but my doctors have always explained it in logical terms. (For example, most 18-year-old females in otherwise good health do not need EKGs and chest X-rays. Nevertheless, when your doctor is worried about chest pain and would prefer to quickly and safely rule out anything bad or scary, it makes a ton of sense.)

On that note, my lone contribution to the debate about socialised health care: people in the US treat it like a human rights violation if they have to wait a week for a MRI or an ultrasound. If we were to go from that to waiting months for basic diagnostic care, people would rebel. There are a lot of things about our health care system that we take for granted; those who advocate for totally overhauling it ought to at least acknowledge the good parts, and come up with a plan for retaining them in any other system they propose.
2.10.2009 1:54am
Splunge:
Right, because when my employer-provided health care plan refuses to pay for a procedure, all I have to do is march right into my boss's office and tell him to switch to a different insurance company that will cover that procedure!

This seems a little clueless. If you work for IBM and you're trying to get them to switch health plans that cover 150,000 employees, you may have a point, but I believe most people work for fairly small employers. I, for example, work for a company that has about 50 employees and a few $million in sales. I know the top brass very well, and they value my work very highly.

Consequently, last year when I had some minor trouble with our medical insurance plan, I let the CEO and HR head know. They were not happy. They gave a call to the plan office: say, we have an important employee who is not happy with your service...and by coincidence, the date on which we decide whether to renew your contract or not is right around the corner. The problem was fixed pronto.

Obviously, the larger the corporation you work for, and the lower on the totem pole you are -- which roughly means the younger you are -- the less influence you have. That's life. What else would you expect? If you want to have more influence, work hard and well, rise in the ranks, and you will reap the influence you earn.

What is especially bizarre about this argument, however, is the 180 degree turn it takes when it comes to how to solve the problem of insufficient competition in the private insurance market, and insufficient choice in employer-provided insurance plans. Rather than reform the tax advantage given to employer-based plans, so that they become employee-based plans you buy yourself, directly, and rather than changing the rules of insurance so that small plans can operate as profitably as the big guys, creating more choices, these logic-challenged oddballs propose to erect the largest possible giant monopolist insurer -- the Federal government -- and force everyone to buy from it, reducing your influence, such as it presently is, to as close to zero as makes no difference. (Unless anyone here realistically thinks that if the Federal government refuses to pay for your procedure, all you have to do is march into your Senator's local office and tell him to tell Congress and the President to rewrite the law, or else...um...I guess or else you might vote against his re-election in four or five years' time.)

So, to recap, because the present insurance system is dominated by big plans that hardly care about your lone small voice, the solution is to replace them all with an even bigger plan that cares far less about your lone small voice. Er...what? Which circuit has to blow in your brain to think that actually makes sense, I wonder?
2.10.2009 3:56am
Cornellian (mail):

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.


So I clicked on the link to the story, and through that linked to the bill. I can't say I'm too surprised that the accusation is a major distortion of the language of the bill. The NCoHIT doesn't monitor anyone's medical treatment.
2.10.2009 4:05am
Arkady:
@therut


People in this country do not die because of lack of insurance. I and other physician treat them all the time without any pay. I have NEVER seen a really sick or injured patient turned away. Never


But there has to be some cost for this, right? How paid?
2.10.2009 6:26am
jukeboxgrad (mail):
lib:

some transplant centers might not even have accepted Nataline for transplant


The ethics of the case are complicated, but I think most people would have expected her transplant to be approved by CIGNA. Here's some evidence for that: CIGNA relented under pressure. If approving her transplant wasn't the right thing to do, why did it suddenly become the right thing to do because the company was publicly humiliated? In my opinion, this in itself is proof that the system isn't working properly. I also think this kind of failure is inevitable when the purpose of the system, and the fundamental motivation, is to maximize profits for shareholders.

a public health care system would have to take that cost into consideration and weigh it against the risk adjusted benefit - just as Cigna did


A public health care system would be considering the cost in the context of a much larger pool. This means spreading the cost over a much larger base of subscribers, and it also means making the decision in the context of a much larger number of comparisons (i.e., other cases comparable to hers).

The whole concept of insurance is spreading risk over a large base. Making the base larger, and as large as possible, is an opportunity to make the whole system more effective. And even if that system led to the same decision, the decision would be more defensible and rational (if the system is well-designed, which is attainable and something on which we should insist). And also more subject to public review.

====================
guest:

Just because someone files a case doesn't make it true


Funny how you say that, and in your next breath say this:

Transplantation is not an option for leukemia patients


You're quoting one doctor who admittedly "was not commenting specifically on Nataline's case." Guess what: "just because" one doctor (who hasn't examined the patient) expresses an opinion "doesn't make it true" with regard to this specific patient.

Or perhaps her family deciding to take her off life support even though Cigna did reverse their decision and agreed to pay?


What was that about "misrepresenting?" You're implying that the family decided "to take her off life support" even though they knew "Cigna did reverse their decision." But they didn't. CIGNA issued a fax approving the transplant only 36 minutes before life support was removed. News of the approval didn't reach the family in time.
2.10.2009 7:59am
another anonVCfan:
Surely Naomi Klein will cover this in her sequel to "The Shock Doctrine," where she will decry political opportunism by the left. Surely.
2.10.2009 8:42am
Lily (mail):
Sure sounds like the same old scare tactics to me. "Government will tell your doctor what he can and can't do, blah blah blah." Thank goodness private insurance companies never do that.

The difference here is that with a private insurance company - I can switch if I feel I am not getting what I pay for. . However, with government - you are stuck, you have to take what they give you - no redress.

Difference: Choice vs no choice. I want to be free to choose.
2.10.2009 8:56am
Sarcastro (www):
Lily has a point. I know I constantly chafe under the monopoly the government has over the Post Office.
2.10.2009 9:01am
therut (mail):
Well you do get your mail at their price and at the time and where they want to have it. Plus certain things they will not allow you to have by their mail carriers. Cost keeps going up and up.
2.10.2009 9:27am
Sarcastro (www):
Not to mention the lack of private competition! There real tragedy is the lack of choices provided by the Mail Tyrants.
2.10.2009 9:30am
Lighten up Kansas:
A single payer system makes more sense in the US, as we already have all of the private insurance companies managing the majority of hospital and doctor providers. That would remove a large burden from the employers - the ones paying into the huge pool for their employees every year, and the ones who are most affected by health care funding changes.

Oh, and electronic records? Of course they can be abused, but the gains are much greater. It's 2009 for chrissakes, time to modernize!
2.10.2009 10:01am
CJColucci:
No one has heard from Betsy McCaughey in years. No one seems to have missed her. If we needed reminding, we now know why.
2.10.2009 10:03am
Bored Lawyer:

I know I constantly chafe under the monopoly the government has over the Post Office.


Yes, why with FEDEX, UPS, DHL, fax machines and email, I am sure that monopoly must really chafe.
2.10.2009 10:16am
jukeboxgrad (mail):
with FEDEX, UPS, DHL, fax machines and email, I am sure that monopoly must really chafe


Didn't you read the bill? All those things will be outlawed.
2.10.2009 10:22am
Guest12345:
You're quoting one doctor who admittedly "was not commenting specifically on Nataline's case." Guess what: "just because" one doctor (who hasn't examined the patient) expresses an opinion "doesn't make it true" with regard to this specific patient.


When wondering about the efficacy of a treatment I'll take the word of a medically knowledgeable doctor over the word of an attorney associated with the patient's family. Particularly an attorney prone to hyperbole as this one has shown himself to be.

Unless you know something about this girl's cancer that would indicate that the immunosuppressives wouldn't counteract the cancer treatment? No? Didn't think you did.
2.10.2009 10:31am
Adam B. (www):
The National Coordinator of Health Information Technology already exists. This is silly.
2.10.2009 10:57am
Dan Weber (www):
According to Daschle, doctors have to give up autonomy and "learn to operate less like solo practitioners."

This is very good news. The solo doctor and especially the solo specialist tend not to give good care.

Most care should be provided by hospitals that pay attention to the patient's entire health with thorough electronic records, evidence-based medicine, and lots of (relatively) cheaper nurses ready to answer your phone calls 24/7. Look at the Mayo Clinic and the VHA as two examples that follow this model. (And one is private and the other is public.)

There can be lots of roles for government in this -- someone should choose between being a member of the county-run hospital or of the privately-run hospital.

Now, is the stimulus bill going to do a good job of this? I haven't the slightest.
2.10.2009 11:24am
PC:
On April 27, 2004, the President issued an Executive Order creating the Office of the National Coordinator for Health Information Technology.

The socialist fiend!
2.10.2009 11:24am
George Smith:
The next smart investment wil be modern, fee-for-service hospitals in the Carribean, staffed by expatriate American ancd Canadian doctors and nurses. There will be regular shuttle flights from Miami, Tampa, New Orleans and Houston, and, of course, connecting flights from all major Canadian cities, since the Canadians won't be coming to the US for care any longer. There will be hotels for the patients. Off shore medical insurance copmpanies will sell policies covering catastrophic illness and injury, without the overused frills for regular care. Your MRI or hip replacenment will be a plane trip away. At least as long as that type of travel is legal.
2.10.2009 11:27am
Elliot123 (mail):
"No one has heard from Betsy McCaughey in years. No one seems to have missed her. If we needed reminding, we now know why."

One of the most interestings things to come from the McCaughey 1994 TNR article on Hillary-Care was the admission from so many supporters that they didn't now what was in the bill. But they supported it anyway, and attacked McCaughy for reading it and providing a detailed decsription of certain portions. They would argue that she was wrong, and at the same time admit they hadn't read the entire 1,300 page bill as she had.

Let's hope this article prompts a bit of speed reading of at least the medical sections of the bill. Maybe it will also boost sales of Daschle's book. The part about intentionally slowing the development of new medications and technologies seems especially interesting for someone nominated as HHS Secretary.

Looks like Drudge has decided this needs attention.
2.10.2009 11:34am
jukeboxgrad (mail):
guest:

When wondering about the efficacy of a treatment I'll take the word of a medically knowledgeable doctor over the word of an attorney associated with the patient's family.


It's not that you're taking "the word of a medically knowledgeable doctor over the word of an attorney associated with the patient's family." It's that you're taking the word of a doctor who never examined the patient, over the word of multiple doctors who did. Maybe you were also a fan of Frist's famous diagnosis via video.

Unless you know something about this girl's cancer that would indicate that the immunosuppressives wouldn't counteract the cancer treatment? No? Didn't think you did.


I'm not claiming I examined the patient and evaluated her condition. But unlike you I'm paying attention to the doctors who did.

=================
elliot:

Looks like Drudge has decided this needs attention.


If both you and Drudge are promoting the idea that something needs attention, that's a pretty reliable indicator that the thing doesn't need attention.
2.10.2009 11:59am
Kazinski:
Who knows what's in it? That's why we need to slow down and go over the bill provision by provision to make sure that there isn't a trojan herd in the bill.

According to one Democratic Congressman there is $300,000,000.00 in the bill for golf carts.
2.10.2009 1:24pm
JoeSixpack (mail):
This is all scaremongering by the radical right wing. Next thing they will be claiming is that with government health care they won't pay for your cancer treatment but they will offer you a free assisted suicide. Oh wait, that already happened. Bad example.

http://www.foxnews.com/story/0,2933,392962,00.html

I have personal experience with family members living in socialized medicine countries who have to bring a cash "tip" with them to the doctor's office if they want to get decent service. But for some reason there are people out there who think that doctors should basically be treated like postal workers. Therut said it best above. I too am not looking forward to being ill.
2.10.2009 1:32pm
loki13 (mail):
There are several issues that are intertwined here that seem worth mentioning:

1. The analysis of the original article appears to be way off. While the author originally made her name in her TNR piece about the Clinton healthcare proposal, in her desire see that lightning strike twice, she has completely misread the current bill. Sometimes a cigar is just a cigar, and not a socialist plan for the overhaul of our nation's healthcare system and/or world domination. There is excellent analysis of this above, but to say that her reading of this bill is uncharitable gives a bad name to charities.

2. There are certain situations that everyone knows are untenable, and have to be addressed, yet, for reasons of entrenched interests, cannot get past the status quo. Cf. the Israeli-Palestinian conflict. Then look at our health care system. We spend more on health care than any industrialized country, and receive worse results. We attempt to define health care in terms of market incentives, while remaining blind to the fact that it doesn't usually operate like other markets (what is the demand for not dying; what is the information asymmetry between providers and consumers; how much competition is there in services between insurance companies and their true consumers; how do you price compare in a medical emergency etc.). This is complicated by the fact that while we avoid the term rationing, that is the exact situation we have now- the number of doctors per specialty is rationed by the AMA (as is the total number of doctors), the types of treatments approved is rationed by the insurance companies (and, to improve their yields, many insurance companies either have a set number of auto-denies regardless of merit or pay bonuses to employees who deny more than a set number of claims). this is complicated by the increase in information, which allows insurance companies to further discriminate- until, at some point, all those who have insurance won't need it, and all those who need it won't have it (think of the Venn diagram). The only place they meet is in employee health plans that have large numbers (aggregate pricing) which keep having an increase in fees, causing our companies to remain at a competitive disadvantage with other companies. I could go on, but you get the idea.

But from this, we get two intractable positions- those who want the government to solve all problems now and will not compromise, and those who want the "free market" to keep working its magic. No solution.
2.10.2009 1:38pm
Elliot123 (mail):
"We spend more on health care than any industrialized country, and receive worse results."

Why is spending on health care a problem? Is spending on cars, pork rinds, lettuce, vaccuum cleaners, vacations, and toothpaste a problem? How do those segments compare to other industrialized countries? Do we care? Should we discourage spending on health care while encouraging spending on real estate?

Who judges results, the patients or someone else? What are the results of our spending on automobiles and toaster ovens? Better or worse than other industrialized countries?
2.10.2009 1:47pm
Kazinski:
The idea that health care quality will suffer if it is socialized is not some fantasy. In Scotland up to 10% of people diagnosed with cancer have to wait longer than two months to see a specialist and get treatment. And that is for "urgent referrals".
2.10.2009 1:57pm
loki13 (mail):
Elliot123,

Well, if you look at both percentage of GDP and growth of spending in health care (while realizing that newer therapies are getting even more expensive) you quickly realize that there is a problem. You may also note that our spending % (compared to other industrialized countries) is with a *younger* population than those countries. I mean- sure, it's not a problem (I guess), except that from other measures (the bang for the buck measures) we're not getting that much out of it.

Those are the statistical measures. Like life expectancy. Infant mortality. Survival rates for various diseases. Early detection rates for diseases. Happiness with level of care. you know- numbers and stuff that let us compare things.

So let me put this together for you:
1. We have the highest cost. (over 7k per person in 2006).
2. We have, on average, some of the worst results.
3. Our costs are increasing at an amazing rate, despite the various cost controls we have been trying.

Lots of money spent, bad results, costs increasing at amazing rate; I'm not a rocket scientist but that's usually a bad thing.
2.10.2009 1:58pm
loki13 (mail):
Kazinski,

The problem with your anecdotal evidence is just that- it is an anecdote. Both sides can amass tons of anecdotes (horror stories about socialized medicine, horror stories about insurance companies) to show how *evil* the other side is. But we have a problem, and it needs a solution. The fact is we spend more. The fact is (on the aggregate) we receive worse care. The fact is, under current regulations, insurance companies have incentives to not cover those who are most likely to need coverage, leaving their care to emergency rooms (aka the taxpayers) at a higher cost because they never received preventive care. What we need are solutions- maybe a mixed private/public like Switzerland, maybe something else. But what we currently have doesn't work.
2.10.2009 2:02pm
Dan Weber (www):
Why is spending on health care a problem?

Maybe if we got better results for it it would be okay.

But our health care system blows. I have coverage now, but I'm one accident away from becoming unable to purchase private insurance for my family.

Note that I don't want the Federal Government managing my health care. That would suck. But so does our current situation.
2.10.2009 2:03pm
JoeSixpack (mail):
Loki13's analysis also ignores the benefits from innovation that come from a free market and that the socialized systems basically free ride on. Drugs are cheaper in Canada because their creation is subsidized by the US paying more for them, thus giving the drug companies incentive to create them, and Canada free rides on this innovation. Innovation is expensive. Socialized systems have declared that they will not pay for it but will take the innovations we have paid for if they can get them on the cheap.

And his reference to people who "want the 'free market' to keep working its magic" is disingenius because the market is decidedly not free. The government dictates to the insurance companies what they have to cover and sets up all kinds of roadblocks to deter competition, particularly across state lines. The government also allows businesses to deduct insurance they pay on behalf of employees but does not allow individuals to deduct private insurance (and of course when McCain campaigned to end this market distortion Obama used scare tactics to say he wants to "increase" taxes).

The fact is that we have never seen true free market competition in the health insurance industry. It doesn't make sense that I can use the internet to quickly find the best deals for car insurance or almost any other kind of insurance, but not health insurance. We need a GEICO for health insurance.
2.10.2009 2:08pm
Elliot123 (mail):
"So let me put this together for you:
1. We have the highest cost. (over 7k per person in 2006).
2. We have, on average, some of the worst results.
3. Our costs are increasing at an amazing rate, despite the various cost controls we have been trying."


I think your position rests on #2 above. Why do you say we have some of the worst results? Results for exactly what? Knee replacements? Heart attack survival? Diabetes treatment? Life expectancy? Liposuction? Hearing loss? Cateracts? Insomnia?

Are there areas where we have some of the best results?

I'd suggest we can expect costs for health care to continue to increase as a function of new medicine, treatment, and technology. Nobody got an MRI forty years ago. They didn't get kidney transplants, either. Both innovations provided new benefits and new costs. If a new diabetes treatment, or artificial limbs controlled by computer chips are developed, they will also provide new benefits and new costs.

Is it a problem if I buy a new knee rather than a new Escalade? Is it better for me to have a new Escalade? Who determines that? Is it better for society if I have a new knee rather than a new Escalade?
2.10.2009 2:13pm
loki13 (mail):
JoeSixPack,

To thoroughly go over your points would be both tedious (because it requires a thorough grasp of details) and useless (given your history of posts on this board, nothing would convince you), so I will make the following two points to those interested:

1. WRT to the lack of free markets; the insurance companies have some of the best lobbyists you can buy. They delicately balance what they can get away with in terms of legislation with public outrage,and they do so skillfully. The little legislation that exists is their attempts to keep access to insurance for most people; without it, insurance companies would only be competing for the healthy and young (and for broad based-aggregate insurance plans). As for your other complaint- clearly, you hate federalism and long for more national regulation, yes?

2. WRT to the pharmaceutical industry; this is a multi-tiered issue. There are a number of issues tied into your simplistic analysis; other governments are not simple free-riders; they also fund basic and applied research, and some drug companies are based in those other countries. In addition, the pharmaceutical companies are able to make a profit (although not as big) in these other countries. While there are some issues involved in the FDA process (cf. fast-track, user fees, safe &effective, GRAS backlog ad infinitum) these are not germane- the majority of expenditures for these companies in the American market is not for R&D but for marketing; both direct to consumer as well as to doctors. There are also incentives for lifestyle or management drugs as opposed to single-shot or 'curative' drugs.
2.10.2009 2:21pm
Ben Franklin (mail):
Anyone who thinks we receive worse results from our healthcare industry than other countries has disqualified themselves from being taken seriously. My buddy who lives in France recently had a friend of his break his collar bone. The doctor set him up an appointment to have it set three months from now. By then the bones will have knitted improperly and they will have to be broken again. He lived in England before that and their system is even worse. It is very common there for certain treatments to be denied to the elderly regardless of their ability to pay. Europeans accept this because they have no history of freedom and because their constitutions give them very little hope for ever having any.

And didn't the government here just make a big todo about passing HIPAA or some such nonsense to make sure everyone's health information was kept secret? The last entity on earth I would want in possession of such information would be the government.

I will give you just one example. The government will be able to jail doctors for providing treatments they don't approve of. They are already doing this with doctors whom they think provide too many pain killers or who prescribe medical marijuana and even this will become easier with a database they can sift through so easily. Abortion is legal now but if that changes I imagine they could look for certain clues in the database that allow them draw up a list of suspects even if the procedure is never listed explicitly. So even if you think Obama is the only virgin in the whorehouse that is Chicago politics you have to take into account that every president who comes after him will have access to the same information. Hillary herself has already proven she isn't above going through the FBI records of her enemies.

And in the end, like the other poster said, we will all have to bribe our way into getting decent care or to have certain types of information excluded from the database. The market doesn't go away. It just goes underground and patients and their caregivers are made criminals for participating in it.

That people even contemplate allowing the government to have this much power and to implement policies which have been such clear and unequivocal failures in other countries is frightening.

But in the end I am sure everything will work out in having the government insure healthcare payments for those who can't afford them. After all, we have just had such a good experience having them insure mortgage payments for those who can't afford them. What could possibly go wrong?
2.10.2009 2:51pm
jukeboxgrad (mail):
kaz:

According to one Democratic Congressman there is $300,000,000.00 in the bill for golf carts.


What a nice example of bullshit in action. The relevant text is here:

ENERGY-EFFICIENT FEDERAL MOTOR VEHICLE FLEET PROCUREMENT For capital expenditures and necessary expenses of acquiring motor vehicles with higher fuel economy, including: hybrid vehicles; neighborhood electric vehicles; electric vehicles; and commercially-available, plug-in hybrid vehicles, $300,000,000


Your claim about "golf carts" is based on the words "neighborhood electric vehicles." So the first thing that's false about your claim is that the text does not call for $300 million for NEV. It lists 4 vehicle categories, and NEV is just one of them.

More importantly, NEVs are not "golf carts." Calling them golf carts implies that they will be used for golf. But that's not what NEVs are for. NEV is a DOT "classification for speed limited battery electric vehicles." They have many practical uses, which is why the military, under Bush, decided to lease thousands of them (link, link):

The 4,000 non-tactical electric vehicles will be used on Army bases for passenger transport, security patrol, and maintenance and delivery services.


I bet you didn't know that the Bush Pentagon decided to lease thousands of "golf carts." Porkulus!

By the way, golf carts typically have a top speed under 15 mph. NEVs can have a top speed of 25-35 mph. A golf cart looks like this. A US government NEV looks like this.

But since lots of people are ignorant, Malkin gets to run this headline:

The golf cart stimulus


With a picture of Obama standing next to a golf cart. Even though NEVs are not golf carts, and are not going to be used for golf.
2.10.2009 2:51pm
Thorley Winston (mail) (www):
Those are the statistical measures. Like life expectancy. Infant mortality. Survival rates for various diseases. Early detection rates for diseases. Happiness with level of care. you know- numbers and stuff that let us compare things.


Taking them in order (and most of this was covered in a previous post by Jonathan Alder):

Beyond a basic minimum of care (e.g. vaccinations against communicable diseases, proper sanitation) life expectancy has little to do with the quality of the health care system and the (relatively minor) differences between the United States and other industrialized nations is driven more by things like teenagers being killed in automobile accidents, death by violence, lifestyle choices (diet, exercise, etc.) and ethnicity.

As far as infant mortality rates, just as with life expectancy, beyond a certain minimum level of health care, the difference is largely a result of lifestyle choices and ethnicity. Also there are differences between how infant mortality is reported between countries and how the data is collected. Moreover even discounting the above, the actual difference between the infant mortality rate reported in the United States and the country reporting the lowest infant mortality rate is literally a fraction of a percent (IIRC about one-fourth of one percent) which is barely a rounding error.

Survival rates and early detection for diseases are the only things you list that are actually related to the quality of the health care system and the United States generally does better.
2.10.2009 3:20pm
Andy Freeman (mail):
> The whole concept of insurance is spreading risk over a large base. Making the base larger, and as large as possible, is an opportunity to make the whole system more effective.

Actually, it's an opportunity for cost shifting.

Properly priced, insurance is just a mechanism for reducing variance, for letting people pay their "expected" cost (plus a little vigorish). However, getting the pricing right, avoiding subsidies, is tricky.

One way to avoid subsidies is to have multiple insurance companies. If several of them over-price a given risk segment, they'll lose market-share in that segment to others.

With only one insurance company....

Now that I'm no longer in my 20-30s, I'm all in favor of average cost without regard to age and risk.
2.10.2009 5:22pm
Andy Freeman (mail):
> 1. We have the highest cost. (over 7k per person in 2006).
> 2. We have, on average, some of the worst results.
> 3. Our costs are increasing at an amazing rate, despite the various cost controls we have been trying.

That's the problem. However, the existence of a problem does not imply that a given proposal actually solves said problem.

If US Govt healthcare is going to be such a success, why isn't US Govt healthcare a success now?

I ask because about half of the "covered" population in the US is already covered by US govt healthcare. US Govts spend about the same to cover their "half" as the private sector does to cover its half. In other words, it's not cheaper per person.

If you're going to argue that US Govt healthcare will be cheaper, why not start by making US Govt healthcare cheaper? Then open it up at cost. If it actually is cheaper/better, companies will flee the private system.

However, until US Govt healthcare actually is cheaper/better, it's somewhat absurd to insist that it will be.
2.10.2009 5:40pm
loki13 (mail):
Last comment, then I will no longer check the thread-

1. It is interesting, after my post about anecdotes, that Ben Franklin (how are those older women, anyway?) chimes in about his buddy and his horrible experiences. Of course, this is because Europe hasn;t had much experience with freedom (I'm sure Braveheart would concur with you; the rest of the British populace might have a different take); anyway, the plural of anecdote is not data, and for every "buddy" that has had a bad experience with healthcare abroad, there is another buddy that has had a horrible experience with healthcare right here in the United States.

2. Thorley Winston comes closer to the problem by seeing there are variances within the populations. However, he employs the standard caveat (beyond a basic minimum of care...). Isn't that really what thi gets to? The argument is that the United States suffers in these categories because there are portions of the population that do not have a "basic minimum of care", especially when it comes to preventive medicine. ERs should be treatment centers for emergencies- not standard care for the indigent. And while there are some factors that cause the US to perform worse in the statistics (vehicular deaths, non-homogenous population) others should cause us to perform much, much better (younger population). Most regression analysis comes close to the idea that, on the aggregate, when comparing industrialized countries, these issues come close to a wash (excluding severe outliers such as Japan).

Unfortunately, we cannot get past anecdote- and ideology- driven arguments to come to a solution. And the current problem hurts the United States in both the health of our citizens and the competitiveness of our country (it's hard to give up a "safe" job with health care to be an entrepeneur or build your knowledge base without health care, not to mention the dire effects it has on our companies that is increasing). That's why I liken it to the Israeli-Palestinian problem. Everyone knows there is a problem. Everyone knows the current situation is untenable in the long term. No one wants to do anything about it- just keep on keepin' on.
2.10.2009 5:52pm
Guest12345:
It's not that you're taking "the word of a medically knowledgeable doctor over the word of an attorney associated with the patient's family." It's that you're taking the word of a doctor who never examined the patient, over the word of multiple doctors who did.


To be more specific I'm taking the word of a doctor knowledgeable in the field over a chicken-little attorney and four doctors who want to perform an experimental procedure. Can you provide any documentation that organ transplantation is suitable for leukemia patients? And I'm talking life saving, not "there is a chance you'll make it a year."
2.10.2009 6:03pm
thigg:
All of this talk about Health Care is interesting but Health Care reform shouldn't be included in a "Stimulus Bill". It can and should be debated at another time.
This bill is garbage and needs to be trashed.
2.10.2009 8:47pm
PQuincy1:
Noted on the blog of someone who actually knows about this stuff:

Established by President George W. Bush in 2004, the Office "provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation" of "health information technology."

Well, it's good to see another face of the Bush administration's evil, revealed by Ms. McCaughey!
2.10.2009 9:22pm
pmorem (mail):
I have just one word for all this:

Sandman
2.10.2009 10:03pm
jukeboxgrad (mail):
andy:

With only one insurance company....


For some strange reason a bunch of supposedly rational people have adopted the wacky idea that Obama is going to abolish private health insurance.

Is this before or after he imposes sharia law and forces everyone to have a gay abortion?

===================
guest:

I'm taking the word of a doctor knowledgeable in the field over a chicken-little attorney and four doctors who want to perform an experimental procedure.


Except that those "four doctors" have examined the patient, and the "doctor knowledgeable in the field" has not. And let us know if you have any basis for claiming that the "four doctors" are not "knowledgeable in the field," because that's the implication of what you said.

Can you provide any documentation that organ transplantation is suitable for leukemia patients?


What I have is documentation that you prefer the opinion of one doctor who hasn't examined the patient, over the opinions of four doctors who have. I think that tells us what we need to know about your objectivity.

And we also learned something about your integrity, when you falsely implied that the family removed life support even though they knew the transplant had finally been approved. That's not what happened.

===================
pquincy:

Established by President George W. Bush in 2004, the Office "provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation" of "health information technology."


There's helpful information in that article. Thanks for mentioning it. Here's the link.
2.11.2009 8:27am
David M. Nieporent (www):
The problem with your anecdotal evidence is just that- it is an anecdote. Both sides can amass tons of anecdotes (horror stories about socialized medicine, horror stories about insurance companies) to show how *evil* the other side is. But we have a problem, and it needs a solution. The fact is we spend more. The fact is (on the aggregate) we receive worse care.
There is no "aggregate." People receive individual care, not aggregate care. That's the problem with your analysis, because as it happens, both of the metrics you (and other socialized-medicine proponents) advocate -- life expectancy and infant mortality -- are measures of individual outcomes (affected by many things other than health care), not the care received.

You have the same problem with your discussion of spending; you say that "we" spend more. But who's "we"? "We" don't pay for health care; I do, and you do. Of course, there is a "we" involved -- the government. But if the government spends more for health care than those in other countries do -- and it does -- then why do people think that concentrating even more control over the federal government will magically make costs go down?
2.11.2009 1:08pm
pmorem (mail):
David M. Neiropent wrote:
then why do people think that concentrating even more control over the federal government will magically make costs go down?

It will make them go down:

* Experimental treatment isn't cost-effective.
* The elderly (non-producers) have little residual economic value, so very little can actually be cost-effective.
* Hospice is the second most cost-effective treatment for most terminal illnesses.
* Assisted suicide is the most cost-effective treatment for most terminal illnesses.

Under this law, doctors and hospitals who offer treatments not deemed cost-effective will face penalties and fines. The only people who will be able to afford such treatment are those who can pay for both the treatment and the fines.

This is the Sandman Solution.

This is turning Boxer into glue.

I mean that with all disrespect for the people who support this.
2.11.2009 1:54pm
pmorem (mail):
On the bright side, it will probably save enough on Social Security and Medicaid to cover the entire porkulus.
2.11.2009 2:00pm
jukeboxgrad (mail):
Under this law, doctors and hospitals who offer treatments not deemed cost-effective will face penalties and fines.


Under what law?
2.11.2009 2:10pm
pmorem (mail):

Hospitals and doctors that are not "meaningful users" of the new system will face penalties. "Meaningful user" isn't defined in the bill. That will be left to the HHS secretary, who will be empowered to impose "more stringent measures of meaningful use over time" (511, 518, 540-541)
2.11.2009 2:23pm
jukeboxgrad (mail):
Hospitals and doctors that are not "meaningful users" of the new system will face penalties


I realize that McCaughey said that. Where does the bill say that? Exact text, please. And it would also be nice if you provide a link to the version you're talking about. McCaughey says she is using a "pdf version," but then offers a link to a page that does not provide a pdf version.

That will be left to the HHS secretary, who will be empowered to impose "more stringent measures of meaningful use over time"


Those "stringent measures" are with regard to judging if hospitals are using EHR (electronic health records), for the purpose of giving them incentives to do so. Let's recall what you said:

Under this law, doctors and hospitals who offer treatments not deemed cost-effective will face penalties and fines.


What is the connection between what the bill says (giving hospitals incentives to use EHR) and the claim you made? Where does the bill say that "doctors and hospitals who offer treatments not deemed cost-effective will face penalties and fines?"

Why are you and McCaughey making shit up?
2.11.2009 3:13pm
Dan Weber (www):
* Hospice is the second most cost-effective treatment for most terminal illnesses.

You said this as a joke. But people in hospice tend to outlive people doing aggressive treatment of the same disease. And at a much higher standard of living.
2.11.2009 3:43pm
David Warner:
"But there has to be some cost for this, right? How paid?"

It's embedded in the cost for the haves, which makes inequality look worse than it is, as well as the performance of the current health system, which does a great deal right, especially considering the millions of immigrant workers covered under this "plan".

From each according to his abilities, to each according to his needs. Socialized medicine might be less Marxist than what we already have.
2.11.2009 8:44pm
jukeboxgrad (mail):
pmorem, I guess you're not going to tell us why you made those wacky statements. But here's what it looks like: along with Rush, Drudge, Fox and WSJ, you were spreading "A Conservative Lie."
2.11.2009 9:18pm
Michael H Schneider (mail):
"Is she correct in her assessment of the health care provisions of the stimulus?"

No, not by my reading.

A link to the pdf version of the whole bill is found about halfway down this page:
http://mediamatters.org/items/200902100001
It's long, the relevant part starts around page 440

A press relase from Sen. Baucus of the Finance Committee describing what he thinks is in the bill is the second pdf linked on this page:
http://finance.senate.gov/sitepages/baucus.htm
2.12.2009 1:01am
jukeboxgrad (mail):
A press relase from Sen. Baucus of the Finance Committee describing what he thinks is in the bill is the second pdf linked on this page


Thanks for pointing to that pdf. A direct link to it is here. It's an excellent summary, in plain English, of what the bill says about health care.

You also referenced a Media Matters article that does a good job of summarizing the issue. The link for that article (in directly clickable form) is here.

McCaughey et al have been spreading pure baloney. It would be hard to find a clearer example of the right-wing noise machine manipulating ignorant voters by promoting misinformation and hysteria.
2.12.2009 8:51am
Just an old FP doc (mail):
McCaughey notes in her article: One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.

From the background statement of ONCHIT (the Office of NCHIT) at http://www.hhs.gov/healthit/onc/background/ :

In 2004, the President issued an Executive Order establishing the position of the National Coordinator for Health Information Technology within the Office of the Secretary of HHS. The primary purpose of this position is to aid the Secretary of HHS in achieving the President's Goal for most Americans to have access to an interoperable electronic medical record by 2014.

Ms. McCaughey's statement is quite a leap. Perhaps eventually the government might get to where she is predicting, but with the rapid frequency of folks in this country changing health care providers (through changing jobs and/or health care plans, for example), it sure would be helpful for physicians to have available as much information about the patients they treat. That information is often now scattered among several electronic health records that are not interoperable. Having a National "Coordinator" to work with academia, the private health care industry and governmet to develop standards for what data should be exchangeable between systems should make sense to everyone, I would hope.
2.13.2009 7:07pm

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