Here’s to Your Health

What is he thinking?  Obama says he wants to pay for his supposed health care reform by cutting reimbursement to hospitals and most health care workers for the care they provide to the neediest people.  Sounds like robbing Peter to pay Paul.

Over the next ten years he wants to reduce payments to Medicare providers by $110,000,000,000, claiming that cutting payments to hospitals will encourage efficiency and thus reduce costs.  But underpayment for services, which has always been Medicare’s practice, has done nothing to reduce costs so far.  The hypocrite-in-chief claims that the costs of CT and MRI imaging, for instance, can be spread out to other patients, and thus reduce the need for government money, but all this does is shift costs to other consumers who are privately insured or pay out of pocket—just as Medicare has always forced providers to do.

Hospitals have gotten used to absorbing the costs of caring for Medicare patients.  Difficult as Medicare has made it for old people to get routine, preventive health care, once they are sick enough to show up in the emergency department, they will get taken care of.  The hospitals don’t have much choice, of course, since the government basically forces them to provide care to anyone who shows up in their emergency rooms.

However, the drugmakers and pharmacies have never been so “civic-minded.”  Because Medicare patients commonly do not take prescribed medications due to their high costs, the government introduced a prescription drug benefit a number of years ago.  This plan is bizarrely complex and confusing, but has assisted some old people, some of the time, in paying for their drugs.  Inadequate as it is, however, Obama apparently believes it is far too generous and wants to eliminate $75,000,000,000 from the program’s budget.

And the president plans to go even further than squeezing those who care for old and disabled younger people (some of whom qualify for Medicare).  He also intends to cut $106,000,000,000 in federal subsidies to hospitals that treat uninsured patients.  These are the folks who are too young for Medicare, have low-paying jobs without employer group insurance plans, but are too “wealthy” for Medicaid.  Precisely the group of people that reformers claim to be the most concerned about.  One wonders how paying less to those who provide care to these folks will make them better off.

Playing Politics

To Obama and the rest of the crew in DC, health care reform is not about getting people healthier, but about politics.  Since they have already made sure their own health needs have been well taken care of at the expense of the taxpayers, the politicians have absolutely no personal investment in whether americans end up better or worse off after the reform.  But they do wish to be seen as solving problems (which have largely been caused in the first place by government intervention), even as they create new ones and make some existing ones worse.  A key part of fooling people into believing that government intervention is the best mechanism for improving the health care system is making it seem like everyone else is to blame for the sorry state we find ourselves in.

Obama recently preached to physicians about the evils of practicing defensive medicine and thus increasing health care costs, but said he supports unlimited monetary awards to people who claim bad medical outcomes were caused by malpractice.  He wants to change reimbursement methods so services are bundled, which he claims will discourage physicians from ordering optional imaging and other tests, which are often expensive.  Since he also believes these same doctors should continue to be held accountable if they don’t have these costly procedures performed and a patient or their family believes that it contributed to the patient’s continued illness or death, he is putting physicians in an impossible position.  The doctors are blamed by Obama for ordering expensive tests, and then blamed by patients for not ordering them.  And Obama plays the hero by standing up to the physicians.

While the reforms advocated by the president and others will result in doctors and hospitals having their payments cut, seeing their malpractice insurance bills rise, and being increasingly told how to provide care by bureaucrats, their expenses are also continually driven up by endless, arbitrary, government-sponsored rules and regulations.  For example, the feds will force providers of all sorts to switch to ICD-10 (the latest version of the International Classification of Diseases) by 2011 in order to bill Medicare.  As usual, the private insurers will follow the government’s lead and require this change as well.  But this “simple” change in billing procedures will cost providers millions of dollars to implement, and they will be forced to swallow the cost of the changeover or pass it on to their privately-insured or paying customers.  And then the providers and private insurers will likely be blamed once again for how costly health care is.

How Not To Care for Sick People

 Despite the demonstrated drawbacks of current government health insurance schemes and funding mechanisms, there are some advocates of health care reform who want to replace the current system of mixed government and private insurance with a single-payer, even more thoroughly government-run, conglomerate.  And more scary, some claim that the government has already shown its ability to provide comprehensive, quality health care, using the Veterans Affairs (VA) health care system and Indian Health Service (IHS) as examples of well-run, caring medical providers.

This contention of would-be reformers is, perhaps, the most absurd of all.  It is certainly not coming from the consumers of either one of these systems.  During my long career as a health care provider, I have seldom heard anything but complaints from people who are essentially forced to seek their care in VA or IHS institutions.  Virtually everyone who qualifies for care in these systems, but can afford to get it elsewhere, will.

The VA system not infrequently ends up in the news because of inadequate or dangerous treatment of patients, whether that is botching radiation therapy for prostate cancer, exposing people to HIV and hepatitis viruses by failing to correctly disinfect colonoscopes, or failing to assist those wounded either physically or mentally in the most recent american war.  But these are just especially noticeable failings of a system which routinely provides rotten services to those who seek care in its facilities because it is the only provider they can afford.

The IHS provides services to a similarly captive population, providing care, in most cases, only for those who qualify based on their ethnicity.  Besides institutionalizing segregation, which should, in itself, condemn it as a model for health care reform, it, like the VA, fails to provide adequate care to many of its charges.  I live in a city with many residents who qualify for IHS services through the local alaska “native” health institutions, and it is clear that when people can afford other options besides the “native” system, they will use them.  The system is hopelessly corrupt and wasteful and uses its virtual monopoly over provision of health care to a certain ethnic group to aggrandize its administrative staff and mismanage its funds, while treating those it is charged with caring for as wards.  Hardly a model for a kinder, gentler health care system.

Food, Drugs, Administration

Just as the track record of the feds in providing either insurance or direct care inspires anything but confidence, the government regulatory bodies they have charged with overseeing various aspects of health care have consistently failed to either protect the public, contain costs, or promote positive developments in the prevention or treatment of illness.  Maintaining these institutions costs lots of money and none of the reformers are suggesting they be pared back or even eliminated.  On the contrary, the health police are likely to see their powers extended under any widespread reform scheme.  For an example of what that may look like, consider recent developments at the Food and Drug Administration (FDA).

The FDA has always been an institution of bureaucratic control, not innovation.  Supposedly charged with protecting americans from unsafe drugs, its role has all too often been to block access to proven therapies while guarding the monopoly patents of drug manufacturers.  The FDA has thus helped keep people ill by deciding what drugs they should be allowed to use, and has charged them for this service by consuming billions of dollars in tax revenues, as well as further billions in “user fees” from businesses it forces to submit to its rules and regulations.  These regulated businesses, in turn, pass on the cost of these fees to consumers and their insurers.  Which leads to more costly private insurance premiums.

This “watchdog” has lately been up to no good again.  For one thing, it is forcing manufacturers of long-acting narcotics to come up with Risk Evaluation and Mitigation Strategies.  These will be programs that will make manufacturers engineer their drugs so that they will not work correctly if altered; and/or they will be programs requiring indoctrination and registration of prescribers.  Either approach will not only be costly, but will also serve to limit access to these drugs for people who would benefit from them.  The purported rationale for this increased policing of pain medications is that some people have come to harm by their improper use.  But long-acting narcotics are no more likely to harm people when used improperly than are other kinds of drugs.  What really bugs the FDA is that some people use these drugs for recreation, not therapy.  And squelching unapproved use of pleasurable substances by outlaws is much more important to bureaucratic busybodies than seeing that people in pain have access to effective remedies.

And since they don’t have enough other important matters to keep them busy, the politicians have just authorized the FDA to regulate tobacco.  Since preaching, taxation, and banning have not eliminated tobacco use, the government has decided it needs to add more police powers to its anti-tobacco campaign.  From restricting additives to further regulating advertising, the FDA will spend time and money on browbeating tobacco makers and users instead of getting safe therapeutic drugs to sick people, which, one would have thought, is supposed to be its mission.

This diversion is justified by claims that tobacco-related diseases cost $100,000,000,000 a year to treat.  As my mother used to say, figures don’t lie, but liars figure.  The drug cops manipulate the data in two ways: they don’t compare this cost to the cost of treating other diseases that are not related to smoking; and they fail to point out that smokers, since they tend to die earlier than non-smokers, actually save “society” money by smoking.  Not to mention the fact that the taxes they pay to maintain their habit support all sorts of programs that benefit others.  But smokers are an easy target for our guardians to pick on, making it appear that they care about our health while all they really care about is their income and their power to push other people around.

Throwing Good Money After Bad

Whatever form reform takes, somebody will have to pay for it.  A bill now before the senate would cost in excess of $1,500,000,000,000 over the next decade (and would end up providing coverage to only a third of those currently without insurance).  And the money to fund it will be extorted from taxpayers, of course.

During discussions of health care reform, we hear constantly about how the greed of private insurers is what makes health care in the united states so expensive and inefficient.  But the ability of government to consume wealth and produce crap, at best, is unrivalled by any private institutions.  Look at the $600,000,000,000 that was taken from working people and funneled into the military death machine in 2008.  And the demand for taxes will never stop.  Medicare and Social Security are already on the road to bankruptcy and will have to be “saved” by increased taxes.  Why in the world should anyone believe that the politicians will display better financial stewardship of any new programs created as part of this so-called reform?

Medicare, the FDA, the VA system, the IHS.  What other arguments does one need that any further government intrusion into health care should be greeted with dread.  As badly as people’s needs and wants may be met by the current system, expecting that those who believe Medicare is a good model for health care provision will make things better is a recipe for disappointment.  Like so many other reformations, health care reform, as currently understood, will just replace one bad system with another.

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