Skip to comments.Understanding the Death Panel
Posted on 11/16/2009 6:48:41 AM PST by FromLori
This WSJ editorial tells it like it is: As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserveand one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.
Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every yearand then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."
On that last score, he's right. Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."
As envisioned by the Senate Finance Committee, the commissionall 15 members appointed by the Presidentwould have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point...
To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.
So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?
But a decade from now, such limits are offwhich also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans [Note: WSJ must be joking, here. There will not be longer life spans under Obamacare. WSJ gets most of the economics, but they don't get the real impact. Less care means shorter life spans.], or for the increasing incidence of diabetes, heart disease and other chronic conditions...
Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June...
In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty.
The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.
So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost...
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stentssimply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."
The real problem with the healthcare program is that I think Obama understands the budget constraints he is under. This will result in government cutting back on more and more specific procedures.
ObamaPlanners think in terms of aggregates. Notice they are always talking in terms of healthcare costs in terms of GDP and total government budgets. They simply refuse to think in terms of the way free markets work, i.e., individuals making choices, with their own damn money. For ObamaPlanners, it's take the money through taxes, through forced health "insurance" for youth. Then they use the power of controlling this money to sit with GE's Jeffrey Immelt, Carlyle's David Rubenstein, BigPharma and other to divvy up the loot, cutting the services actually provided, and allowing the schemers to pocket a huge chunk. This is all simply pure evil, and deep down most of the plotters know it.
Pelosi’s MengeleCare is right out of the Nazi death camp plans.
It’s not hard to understand what the “death panel” is. It’s just a logical extension of what they want to do.
Make the demand for a service infinite due to a perceived price of “free”, and halve the supply by making providing the service to be an onerous task -
then you MUST ration through a “board of experts”. This rationing results in increased pain and suffering for some based on only the board’s expert rationale.
I’ve presented this to a leftist apologist, and what I got was - “It’s better than having the insurance companies ration care”.
The major issue they don’t address is whether we can pay out of pocket for the better stent, the better treatment. Will we be able to do this?
I am about given up on health care but just am thinking about the recurrence of my cancer and if I can use every cent I have to fight it or will that be “elitist” of me.
Well, I agree that this sort of individual scrutiny would not happen. It's far more likely that the government would decide "After age 75, no one gets cancer treatment." That would feel less like a "Death Panel" but it would certainly be a terrible abuse of government.
How serious of a problem could Obamacare become?
Greg Mankiw, who never says anything negative about anyone, or anything, other than Paul Krugman, had this to say about Obamacare on his blog:
Here are some basic principles of supply and demand: If a government policy increases the demand for a service, the price of that service tends to rise. If the government prevents prices from rising, shortages develop. The quantity provided is then determined by supply and not demand. In the presence of such excess demand, the result could be a two-tier market structure. Consumers who can somehow pay more than the government-mandated price will be able to purchase the service, while those paying the controlled price may be unable to find a willing supplier.
Well, I think he is talking about Obamacare, this is Mankiw afterall. But, it is a major warning that shortages are a very likely outcome of Obamacare in its current structure.
He then clips this from a WaPo story:
A plan to slash more than $500 billion from future Medicare spending — one of the biggest sources of funding for President Obama’s proposed overhaul of the nation’s health-care system — would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others, according to a government evaluation released Saturday.
The report, requested by House Republicans, found that Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether.
Congress could intervene to avoid such an outcome, but “so doing would likely result in significantly smaller actual savings” than is currently projected, according to the analysis by the chief actuary for the agency that administers Medicare and Medicaid. That would wipe out a big chunk of the financing for the health-care reform package, which is projected to cost $1.05 trillion over the next decade.
More generally, the report questions whether the country’s network of doctors and hospitals would be able to cope with the effects of a reform package expected to add more than 30 million people to the ranks of the insured, many of them through Medicaid, the public health program for the poor.
In the face of greatly increased demand for services, providers are likely to charge higher fees or take patients with better-paying private insurance over Medicaid recipients, “exacerbating existing access problems” in that program, according to the report from Richard S. Foster of the Centers for Medicare and Medicaid Services.
Though the report does not attempt to quantify that impact, Foster writes: “It is reasonable to expect that a significant portion of the increased demand for Medicaid would not be realized.”
The House report and Mankiw are missing one element, though. Under Obamacare it will be the government that will determine what can and can’t be paid for under any given health insurance program, so what is likely to happen is that Obama’s team will cutback significantly on what can be provided to those with the best insurance to provide more to the Medicaid crowd. Somehow they will get that money over to the Medicare crowd through some kind of enforced coverage by insurance companies of Medicaid recipients. Afterall, they are going to force the “insurance” payments of the young to be applied for the elderly. Likewise, they will do so with the “insurance” payments of the rich. In other words, there will be less care for everyone. The U.S. will become the Big Havana. Mankiw is correct in hinting that it is going to be a mess. I don’t think, however, that he is any where near understanding how big a mess it will be.
Pelosi et al., IMO, plan to destroy (via denying care) as many Americans as possible using their MengeleCare designed to fool the clueless of their intent. The Germans didn’t try to hide their murder.
Instead of boxcars and camps, they will use Hospice Care as their final solution.
And who coin the term “Death Panels”? Supposedly someone we are told is a “joke” and has no future in national elected office.
and when democrats are in power, they will deny coverage to republicans, and when republicans are in power they will deny coverage to democrats.
Not a politically winning formula. That's why no one elected proposes it. Take a poll “Do you want the government to provide you with ‘affordable’ xxx by taxing those that make more than you and don't need all their money?”
If this health care bill passes and results in the disability or death of a family member, I think similar consequences should be visited on the appropriate congressional representative who voted for it.
The founders knew of this, and set limits on what the gov’t was able to do for and against subgroups of the populace.
Yes on the former, no on the latter. Conservatives inherently don't see/use the gov't "sword" as a weapon to use against political opponents.
I really want to agree with you MrB, but power corrupts, and absolute power corrupts absolutely. with this much power at their hands, each side will feel compelled to use it to remain in control
neither party has a lock on virtue, although I do tend to agree that republican hands are less dirty than democrats’.