Health Care Rationing

Long time readers of this site know that my biggest concerns about a "universal" government run health care plan center around the very real possibility of health care rationing. That concern is, in large part due to the circumstances surrounding the health of my 73 year old mother. The Logical Mother has (among other conditions) a weak immune system, rheumatoid arthritis, no thyroid, a bad heart, bad circulation and myriad of other ailments large and small. Four years ago, due to an undiagnosed electrolyte imbalance, she collapsed in her home. She lived alone and my sister (who lives nearby) was out of town when it happened. She had just moved into this home and I had no phone numbers for neighbors when it happened. When my sister and brother in law found her, she was hours from death. It was only due to the heroic efforts of the EMTs and the phenomenonal staff at Alexian Brothers Hospital in Hoffman Estates IL that she is alive today. Based on what President Obama said last Wednesday night - she would have been allowed to DIE THAT DAY under his vision of health care reform. After her collapse, my mother spent the next year and a half in the hospital trying to figure out the cause of her collapse and the many others that followed. We moved her into an assisted living facility annd it was there that a cut on her foot got infected with a MRSA infection. After weeks of fruitless treatments, her doctors went out on a limb and prescribed a long series of treatments that included heavy doses of antibiotics and treatment in a hyperbaric chamber. After 9 weeks of some pretty grueling (for a clausterphobic) treatments, the infection was cleared up and the blackouts, borderline dementia and heart issues that were unrelated to her heart blockage she is healthy (for a 73 year old with rheumatoid arthritis) and talking about travelling - something that 5 years ago would not have been discussed. Again - none of this would have been possible in a Canada Care/Britian care type system that lacks neo-natal ICU beds and mandates that only women between the ages of 39 and a half and 40 are eligible for in-vitro fertilization treatment (among other odd restrictions).

President Obama, last Wednesday night said that we needed to face the reality that we can not treat everyone for everything that sometimes "heroic" measures need to be stopped. Even my mother, a STAUNCH Obama supporter and former health care worker, realizes that his health care plan would have meant that she would not be around today...and she is not fond of that idea at all.

Bring In The Stunt Groom

So today was a very busy outside of the house day. Most of our gardening done and the Junior Logician is off visiting his grandmother so the Logical Husband and I spent most of the day at the farmers market and walking the dogs and taking pictures of the capital area and basically just enjoying an absolutely splendid early summer day in Utah. As a result, I didn't get to any of my emails until very late today. One of the daily must reads is my electronic version of the New York Times. They honestly do have some decent stories....unless they are reporting on President Obama and then the love fest starts.

It was a bit like planning the dream wedding only to have a hurricane rip away the chapel roof as you make your way down the aisle. ABC News and the White House probably thought they had scored a coup in arranging “Questions for the President: Prescription for America,” a prime-time opportunity (with a followup session on “Nightline”) for Barack Obama to explain his health care proposal to the voters and for ABC to monopolize an hour-plus with the most famous man in the world. And then came Iran. And Mark Sanford.

Wait - Mark Sanford??? The story broke on Sanford before the President's hour long market re-rollout (because the program has been out for a while now). If he had mentioned the latest trio of celebrity deaths (Ed McMahon, Farrah Fawcett and Michael Jackson) I could maybe see making a case for it. But then again how could the "most famous man in the world" be overshadowed by a mere electon or a couple of celebrity deaths.

And, well, there was the fact that it was about health care reform. The result: the 10 p.m. show drew 4.7 million viewers, or nearly 3 million fewer than a competing repeat of CBS’s “CSI: New York” and less than half what the evening’s top draw, NBC’s “America’s Got Talent,” attracted in the previous hour. Well, could the president’s plan have got a second-day bump at America’s water coolers? Not likely.

Oh OK - there are the obligatory references to Farrah and MJ...Oh course there is no mention of the real news like the pending vote on Cap and Trade but then again who cares about climate change...RIGHT????

So who did tune in? Certainly more than a few people who are simply curious or worried about the future of their insurance plans, as well as a few us who are paid to pay attention and, of course, bloggers, who are simply masochists for this kind of thing.

Not this blogger - I was engaged in my weekly Wednesday volunteer activity with 4H. However, the Opiniator was gracious enough to provide us with a wrap up of the blogosphere's reaction to the whole thing. After quoting the ABC chief and the Business and Media Institute's reactions to it, the Opinator gets to the meat/light supper/salad of the reactions.....

Scarecrow at FireDogLake’s Oxdown Gazette, however, thinks the network lured the president into a devilish trap:

For its part, ABC insisted on having Charles Gibson and Diane Sawyer, instead of informed, qualified health care experts, guide the conversation. That was a mistake, but not the worst of ABC’s offensive conduct.

Sawyer’s main contribution was to introduce her own uninformed biases/opinions in framing issues and introducing questioners. Gibson’s primary role was to reveal his own misconceptions and then literally read talking points from a Republican letter — an obvious ransom extracted after days of Republican whining about giving the President air time on a critical public issue.

Gibson’s other role was to interrupt the President every few minutes to announce a commercial break. The all too frequent commercial interruptions served as an apt metaphor for how private commercial interests demand our attention and extract their profits while limiting our ability to discuss critical public policy issues.

Emphasis mine...Damn those pesky commercial breaks! Maybe Scarecrow would have been happier if Donald Trump had just purchased this hour instead of "buying" Monday Night Raw - then he could have run it commercial free (as he did last Monday night). Then we could treated to Dwayne "The Rock" Johnson starting the hour with the intro "Can you SMELL what Barack is cookin'?" Then all Charlie and Diane would need to worry about doing is bowing in proper deference to the President lest they suffer a three count and be "traded" to MSNBC.

The Baltimore Sun’s David Zurawik thinks the problem wasn’t the message, but the medium:

Let’s make one thing clear right from the start: ABC News did not give President Barack Obama a free pass in its prime-time special Wednesday night to sell his plan for a radical overhaul of the health care system.

There were people in the town hall setting who asked pointed questions, and if you listened very closely, it was obvious after a while that Obama did not have any very good answers when it came to specifics. Furthermore, anchorman Charles Gibson, who moderated the discussion, asked solid follow-up questions of the president.

But, ultimately none of that mattered much, because the majority of viewers can’t or don’t listen very closely when such vast amounts of information, opinion and statistics are thrown around as they were Wednesday night on ABC. Television does not work like that. In the manner that TV does work, Obama had his way from early morning to latenight on ABC Wednesday to push his agenda for massive social change on healthcare. In short, he owned ABC’s airwaves.

Zurawick is correct in that the media was part of the problem but I don't think he gets the "why". Most people turn on the television to tune out. With few exceptions (like political junkies) people use television to escape their daily lives - that's one reason why the moniker "the idiot box" has been used to describe the media almost from day 1.

The Opinionator then quotes Jake Tapper's and my dear friend Ed Morrissey's posts on the subject as well as a response to Ed from Pete Able at the Moderate Voice (for the record I do think calling that exchange Obama's "Dukakis moment" was a bit of a stretch Ed). He also quoted a rather common sense proposal from Shannon Love at Chicago Boyz....

We should create a legal requirement that political elites have to use the same system they foist on everyone else. They should have to wait for hours in doctors’ offices. They should have to wait weeks or months for tests. They should be fobbed off on emergency rooms if they get sick over the weekend. They should be denied any Hail Mary test, medication or procedure. They should get the entire politically-managed health-care experience.

This standard should extend to all elected officials, political appointees and their immediate families.

Such a law would create a built-in feedback loop that would prevent politicians from ignoring the health of the people.

However, the common sense quote of the piece comes from my BTRadio partner in punditry Jazz Shaw (again at the Moderate Voice).

The President once again trotted out the same quote I’ve heard repeatedly when he’s been asked about competition in the private industry. He wants to be “absolutely clear” that if you have a health plan you like, you can keep it! Of course you can keep it. But will you? If your current plan through your employer costs you a couple hundred dollars per month, like mine does, and suddenly there’s a government run plan available that promises roughly the same level of coverage for one hundred bucks per month, how many of you will stay with your old plan? I don’t see why I would. I’d like to save more than one thousand dollars per year, wouldn’t you? Sounds great, but then what happens to this huge industry and all of its various employees when most of us bail out? Is American health insurance, as an industry, too big to fail?

That is something that Jazz and I discussed on our show last Wednesday because that IS the million dollar question. IF the "public option" is so much cheaper than the private option to the point where Americans dump their private insurance en masse will we then have to bail out the insurance industry the way we bailed out the automobile industry or the financial industry? I understand that not all of those employees of the current insurance industry will probably not lose their jobs, but easily one half will and those that don't lose their jobs will grossly under-employed. What will THAT do to our economy? What kinds of jobs will President Obama "create" to replace the lost insurance industry jobs? More fast food jobs? More road repair jobs? The people that are losing these insurance jobs are not people who can repair roads or dig trenches.....and that is the dirty little secret of government job creation. It is a secret that NO POLITICIAN will tell you - but anyone who has worked in a government job, knows exactly what I am talking about.....

Of Ganders And Geese

So last night was the ObamaCare infomercial. I didn't watch it last night as we had dog training, but ABC News has an interesting story up today about one of the key exchanges in the townhall portion of the event. (HT HA)

President Obama struggled to explain today whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people -- like the president himself -- wouldn't face.

The probing questions came from two skeptical neurologists during ABC News' special on health care reform, "Questions for the President: Prescription for America," anchored from the White House by Diane Sawyer and Charles Gibson.

Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, said that elites often propose health care solutions that limit options for the general public, secure in the knowledge that if they or their loves ones get sick, they will be able to afford the best care available, even if it's not provided by insurance.

Devinsky asked the president pointedly if he would be willing to promise that he wouldn't seek such extraordinary help for his wife or daughters if they became sick and the public plan he's proposing limited the tests or treatment they can get.

The president refused to make such a pledge, though he allowed that if "it's my family member, if it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care.

Emphasis mine. We all want the best of care for our families Mr. President. That is why so MANY of us have been fighting the nationalization of our health care system. We want our local doctors to be the ones to make the decisions - not a bureaucrat in DC. That local doctor will know what is best for the patient while the bureaucrat in DC will not. It's that simple.

Why Do We Need Health Care Reform?

The biggest reason that government run health care proponents use as a reason why we need to do this is the "fact" that 45 million Americans don't have health insurance. Larry Elder took a look at that number and found it to be "wanting:.

About 45 million Americans lack health care insurance. Or do they? ...

Nearly half of the 45 million fall in the category of my 26-year-old nephew. He smokes cigarettes, dates, eats out, goes to movies and, like all young people, lives through his cell phone. With a slight change in priorities, he could afford health insurance, the cost of which at his age and health starts at about $100 a month. Take a look at a Reason Foundation video of interviews with a bunch of non-health-insured 20-somethings.

These Gen Xers copped to dropping money on clothes, booze, nightlife, the latest tech gizmos and other things of interest to them. With a change in priorities, these young folks -- far more representative of those without insurance than the forlorn husband and wife sitting on a porch swing -- could both afford and qualify for health insurance. They simply consider it a low priority.

So let's do the math....of the 45 million with "no" health care, some 22 million are eligible for health insurance but choose not to buy it. That is not a valid reason to take over an industry this large.

Millions more can access health care -- through SCHIP (State Children's Health Insurance Program), Medicaid or other government programs. But for whatever reason, 11 million people simply refuse to take advantage of them.

So of the remaining 23 million without health insurance, 11 are eligible for existing government programs! That brings the total number of people "without" insurance down to 12 million - a large number to be sure but as a percentage of the entire US population.....

What about criminals without insurance? More than 2 million Americans -- with access to health care, by the way -- use jail, prison or penitentiary mailing addresses. And for every one behind bars, how many live among us who survive by theft, drug dealing, prostitution or some similar career path? Taxpayer health insurance for them, too?

Actually they already get taxpayer funded health care in the prison infirmary. That brings us down to roughly 10 million or so without health INSURANCE. I stress the word insurance here because as Mr. Elder states, not having insurance does not equate a lack of health CARE.....

Lacking health care insurance is not the same as lacking health care . By law, most emergency rooms must provide health care -- to both legals and illegals. Yes, they stand in line, but no health insurance does not equal no health care.

That is a point I have made on MANY occasions.

Mr. Elder closes asking the same questions that most thinking people are asking today.....

Do we allow a complete government takeover of the section of health care it doesn't already run, for 10-15 million or so without health insurance on a persistent basis? Again, 255 million Americans already have it. Many millions more could get it if they wanted to. And 89 percent of Americans are satisfied with the care they now receive.

There are plenty of ways to fix the problem without bankrupting the country and rationing care. One solution (from the House GOP Caucus) would give health care tax credits to low income Americans, eliminate wasteful spending (unnecessary tests and the like), allow small business to band together in a buying block in order to get insurance for themselves and their employees and introduces liability reform as ways to bring the high costs of INSURANCE down to an affordable level.

When you look at the FACTS of the situation you see that there is no real need for a complete take over of the health care system by government. The only real "reason" for it, given the facts is is simply that it is a power grab - another way for big government to take yet another piece of your precious freedom away - thanks to President Obama and the House Democrats.

The Devil In The Details Part 2

The next most over-used meme to defend ObamaCare is "we are the only civilized nation to NOT have single payer care". Well as my momma used to say "if your friends all jumped off of a bridge would you do it too?" There are a multitude of reasons as to why that argument is specious at best, however my friend Gary Gross has probably the best reason why we should not rush to single payer...in a nutshell it is HEALTHIER to live here - our odds of surviving major disease is much better here than it is in any of these other "civilized" countries that have single payer health care.....

Jack Kingston cited two startling comparisons on cancer survival rates.

The survival rate for breast cancer in the United States is 84%; in Britain, it’s 69%.

The survival rate for prostate cancer in the United States is 92%; it’s only 51% in Great Britain.

That last statistic was a jaw-dropper for me. Think of the difference between 9 men in 10 surviving in the United States vs. 1 in 2 men dying of prostate cancer in the UK.

Think about it - men in the "great civilized" nation of Great Britian with it's single payer plan have a 50/50 shot of surviving Prostate Cancer. Yeah that is something to aspire to all right.

Meanwhile the Campaigner in Chief is busy back-pedaling away from the Kennedy Health care bill as more and more details about the costs and restrictions and pork attached to the bill are coming out.....

"This is not the Administration’s bill," White House press secretary Robert Gibbs said in a statement following the Congressional Budget Office's analysis of Sen. Ted Kennedy's health care reform legislation, "and it's not even the final Senate Committee bill."

And yet that is exactly what the President was campaigning FOR when he went to Green Bay last week and Chicago yesterday.....

Meanwhile the estimated cost of this bill keeps climing....can you say FOUR TRILLION DOLLARS? That is what one independent group says will be the true 10 year cost of this bill when you factor in all of the variables that the CBO left off!

As I said yesterday, I agree that we need reform but this is NOT the reform that the American people were promised or wanted. It's time to drive a stake into the heart of this bill so that the discussion can turn to REAL reform - a compromise that includes voices from ALL sides of the debate - not just the side that the government and the media want you to hear.

The Devil In The Details (Or But We MUST Do Something...)

We MUST do something...that is the plaintive refrain of the defenders of ObamaCare - we must do "something"... but is this really the "something" that we want? That is the question that must be asked. For example, do we want or need a health care "reform" program that taxes the health insurance benefits as if it were income? How about one that will tax things like soft drinks or that Big Mac you had for lunch? That is what the Democrats in the Legislature are proposing. Do we want a health care reform that actually cuts health care benefits for Medicare and Medicaid recepients while spending money on "Community Make-Over" programs and spending on streetlights, sidewalks, grocery stores and jungle gyms? Do we really want a health care "reform" bill that will spend approximately $1,000,000,000,000 (that is 1 TRILLION dollars) more than we are currently spending on health care? Do we really want a health care "reform" package even the AMA finds to be unworkable?

Oh I fully agree that something needs to be done, but the devil is (as always) in the details and the details of THIS so-called reform bill shows that this Congress and this President are not serious about real reform - they are only serious about enacting single payer health care and in the process putting several hundred million more people (in the insurance industry ALONE) out of work.

Is that really the kind of reform we want?

Update: Oh and according to the CBO this plan still leaves roughly 30 MILLION people uninsured (HT Ed Morrissey)

The Congressional Budget Office has tried crunching the numbers on Barack Obama’s plan to reform health care, which Obama says will save money and protect the uninsured. The CBO director on his official blog says, “Wrong!” — on both counts. The reform plan will cost more than a trillion dollars over the next decade, and while it will put 39 million people on insurance plans, it will drive off more than 23 million more from their existing plans. The cost doesn’t include Obama’s public plan option, either:

According to our preliminary assessment, enacting the proposal would result in a net increase in federal budget deficits of about $1.0 trillion over the 2010-2019 period. When fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges. At the same time, the number of people who had coverage through an employer would decline by about 15 million (or roughly 10 percent), and coverage from other sources would fall by about 8 million, so the net decrease in the number of people uninsured would be about 16 million or 17 million.

These new figures do not represent a formal or complete cost estimate for the draft legislation, for several reasons. The estimates provided do not address the entire bill—only the major provisions related to health insurance coverage. Some details have not been estimated yet, and the draft legislation has not been fully reviewed. Also, because expanded eligibility for the Medicaid program may be added at a later date, those figures are not likely to represent the impact that more comprehensive proposals—which might include a significant expansion of Medicaid or other options for subsidizing coverage for those with income below 150 percent of the federal poverty level—would have both on the federal budget and on the extent of insurance coverage.

A net decrease of 16-17 million would still leave about 30 million uninsured, according to the figures thrown around by ObamaCare advocates. It would simply exchange individuals in the uninsured category, and those most likely to lose their coverage would be those in lower-income jobs, as well as people working in small businesses and startups.

Is this really the kind of change you want?

But What KIND of Reform Is it?

Nicholas Kristof, writing in the NY Times yesterday doubles down on Canadian Style health care with a column under the headline "This Time We Won't Scare Off". In it he talks about one woman who had a positive experience with the system as if that one story will be enough to off sent the hundreds of reports of bad experiences with the system (many of which I have reported here). Meanwhile, President Obama was back on the campaign trail in Green Bay Wisconsin trying to sell his nationalized health care system to the American people. One of the comments that he made (in addressing the critics of his plan) was the comment that "no one in DC" is proposing socialized medicine. Or really Mr. President? Why is it then that your Administration met with the Jack Layton, the ND member of Parliment, who drew up THEIR socialized medical program? Mr. Layton even contradicted the President with this comment prior to his meetings WITH the Obama Administration.

Module body

"We know the Americans can't just simply adopt our model, walk it across the border and put it in place," Layton said in an interview Saturday after making a speech to the Ontario NDP provincial council in Toronto.

"But the principles of universality, of access and of insuring that health care's available to everybody, those kinds of principles are very much motivating the Obama administration."

Emphasis mine. Another meme that the President and his sycophants are perpuating is the meme that there are no alternatives being proposed. The only truth to that comment is that there are no alternatives that THE MEDIA IS REPORTING! The real truth is that there are alternatives as this op-ed shows.

To be effective, health care reform must include insurance coverage for everyone, encourage prevention measures, and reform the inefficiencies in our system to ensure the future strength of our economy. CPR—Coverage, Prevention, Reform—is a plan I have proposed that sets up a system where every American will be required to purchase meaningful health insurance to ensure each family will be protected against bankruptcy if a family member becomes seriously ill or injured. No family should lose their home or life-savings because of illness or injury. For those who may not be able to afford this plan, you will have assistance getting coverage. This proposal also aggressively focuses on the need for more robust preventive care and creates incentives for people and businesses to work toward better health sooner, rather than later when such measures may not work and crisis treatment is much more costly. By offering first-dollar coverage for early health screenings and immunizations, this program will create the foundation for healthy lifestyles and reduce the need for later treatments. Further, by rewarding employees for taking part in employer-sponsored programs, which often include programs to help people quit smoking, fitness club membership options, and affordable access to programs like Weight Watchers, CPR creates incentives that will motivate Americans to take control of and improve their personal health. The third component of CPR entails much needed reform of the way we pay for health care in this country. As it stands now, health care constitutes 17% of the U.S. economy, an amount that totals more than $8,000 annually for every person in the U.S. We already have more than $38 trillion in promised Medicare benefits over the next 75 years that we don’t know how to pay for. The President himself has stated, "The biggest threat to our nation’s balance sheet is the skyrocketing cost of health care." We don’t need more health care that spends more taxpayer dollars to grow government; we need better health care that offers Americans peace of mind and quality care at prices they can afford.

This is coming from the President's first pick for the Commerce Secretary. But wait - the sycophants say - the President says that this is going to save everyone (including the Government) money. Well I think we should wait for the CBO to weigh in on this to be certain, but if past performance (of the President's cost savings claims) are any indication, the CBO is going to be singing a different tune - AGAIN!

Senator Gregg closes with this thought.

Reform starts with paying for quality, not quantity. According to a study at the Dartmouth Institute for Health Policy and Clinical Practice, as much as $750 billion is spent each year on procedures or health-related services that don’t necessarily help patients get better. For example, when discharging patients, hospitals have an obligation to provide patients with a care plan to ensure they don’t end up readmitted. However, Medicare pays more to hospitals when a patient ends up back in the hospital. And physicians are paid more when they order more tests, procedures and office visits, whether you need them or not.

Ask yourself: Would you pay your dinner bill if the waiter spilled your first plate all over the floor, brought you a replacement plate, and then charged you double? We have the information and ability to change how we pay for health care; we just need to begin implementing the policies to do it, such as informing providers and the public of their performance compared to other providers in their locality and around the country. Payment incentives can also be instituted to improve care by encouraging physicians to coordinate care for patients, thereby eliminating unnecessary procedures and tests. Efforts such as these will improve quality and reduce costs.

President Obama has said that health care reform needs to be passed "right away". The last time we heard that it was the stimulus package and we all know how well that has worked - right? Rather than rush this bill throw and get even more flawed legislationi (like the stimulus) let's take the time to thoroughly and completely discuss ALL options for health care reform. After all, if the reform is that necessary - isn't it a good idea to make sure that everyone's concerns are addressed?

Where The Rubber Gloves Meet the Road

In the comments of my last post, Todd off handedly remarked that "The Logician needs to come out of the ideological world and move into reality.". Well I was going to reply in the comments, but I ran into so much "reality" that it evolved rather quickly into it's own post.

Reality #1 - Doctors and health care professionals do not want this. Hugh Hewitt has run a series of letters from practicing physicians who have written to him about just how bad this is going to be for doctors and patients alike. For example we have this from Doctor M.

Hugh,

I am a pediatric neuroradiologist. I take care of children with severe neurological diseases, tumors, trauma, etc. I am an Associate Professor at the University of _________Medical School and practice at Children's Medical Center in ______. I am also a researcher using state of the art MRI. I can tell you that if we go to a single pay system, it will destroy the kind of healthcare and research which has allowed us to lead the world.Currently we have the best subspecialists in the world and free access and referral for state of the art care. As an example, I was on staff at another children's hospital in a large Midwestern city a couple of years ago and had a young boy with a large carotid artery aneurysm. We did not have the pediatric expertise in our city to treat him, but I have world class colleagues in another city who treat these things for a living, so I made some phone calls. The boy went to UT Southwestern Medical Center in Dallas, was treated and now faces a normal life. This kind of subspecialty referral care will end with rationing. This is unacceptable. Rationing would have forced that boy to "take the best available locally" or would not pay for the expensive interventional procedure which was life changing for this boy. Also, if they destroy medicine, what motivation will there be for the best and brightest to enter medicine.

From another doctor we have this...

Dear Mr. Hewitt, I am a physician (M.D.) practicing geriatric psychiatry in Texas for the last 16 years. I am a member of the Association of American Physicians and Surgeons (aapsonline.org) and am so opposed to government intervention in medicine that, although all of my patients are Medicare recipients, I have "opted out" of Medicare which means that all of my patients must pay out-of-pocket to see me and I cannot bill Medicare for any services. I can work with individual patients so that they can afford my services, and I can treat some patients for free! Under Medicare I am not allowed to do that.

From a third we have this....

I am a 66 year old Pediatrician currently transitioning into retirement. I echo the comments made by the Sr. VP for medical affairs. My junior associate who is taking over has already informed me that she will no longer go to the hospital - too much work, too great a risk, too little return for the effort, etc. The 200 bed hospital I attend at has 0NE Pediatrician left on staff my age who just had surgery and walks with a brace. A new Pediatrician hired by the hospital is one month from joining him but has yet to get her state license - ipso facto cannot see patients. There are three other Pediatricians in the community. None have staff privileges except for a half-timer. The hospital has about 700 births a year and a drawing area of 250,000. God help them.

The hospital has critical shortages of all primary care specialties, i.e. Family Practice, Internal Medicine, and Ob-Gyn. Why ? Two reasons. (1)The government artificially distorts the market. 75% of my patients are Medicaid in the first year of life. Who the hell would buy insurance when the government picks up the tab? Many need it, but a lot don't. This is an industrial region, not a farming region, even if it looks rural. My parents work for large corporations. (2) Women doctors.75% of Pediatric residents and 52% of entering medical students are female. They won't move to small towns and rural zones. They won't work as many hours or as many years. It takes 3x as many women as 2 male doctors to do the work.

From a 4th....

I can hardly believe there are that many doctors who want a single payer system. IMO, the only doctors that would want this are either lazy, or do not have what it takes to make it in private practice.

A national health care system WILL BE a nightmare and complete disaster. It will be inefficient on a scale yet not even imaginable. Americans will also be shocked at how poor, rationed, and delayed their care will be. There will be many people who will be permanently injured or allowed to die because the government will establish some bul**hit evidence based criteria on allowing certain treatments.

Finally from a hospital exec....

I listen to your show on pod cast, so I was unable to comment last night. An issue which you did not mention, but is critical to the situation is the accelerating doctor shortage. I am a senior physician executive who spent 31 years in the Air Force and completed my career as commander at ______ Medical Center....I am currently Sr. VP for Medical Affairs at a small hospital system in ___.

The major problem with every effort to "fix" health care is that they focus on controlling the price that the consumer pays. No one ever takes into consideration the cost of producing that care. This will have a major and increasing impact on the way forward.

Currently, the US is short of physicians and is not producing them at a rate of replacement. Add to that the fact that a 30 year old physician is a completely different animal than a 50 year old physician. Most "old" physicians came into the profession at the time it was considered a calling. Yes, they were compensated (monetarily and otherwise) very well. But for that, they accepted 100 hour work weeks and being on call for months at a time. It was part of the social contract and they just accepted it as part of the life of a physician.

The current crop of physicians do not have the same work ethic. Similar to other members of their generation, these docs expect to "have a life." They are unwilling to work the same hours as their elders - at any price. Additionally, 50% of most medical school graduates are women who statistically have a much shorter career. You can see that every time one of the old guys retires, you need more than one new graduate to cover the load.

The proposed changes that are ahead will undoubtedly encourage many of the old docs that there is no point in working beyond the point that they can retire. Yes, the fact that many of them have been hurt badly in the crash will keep some at work. But not a day longer than they have to. Then it will be harder for all of us to find a physician to take care of us.

These doctors all work within the already broken health care system and all agree that the Administrations cure will make the patient terminal. THAT my friend is reality!

Here is a little MORE REALITY for you Todd. Meet Katie Brickell. Katie lives in the UK where they have "universal' insurance. At 19, Katie went to the doctor to get a PAP smear done. She was told she had to wait until she was 20...National Health Service (NH) guidelines. When she turned 20, she went back only to be told that the guidelines had changed and she had to wait until she turned 25 (the American Cancer Society recommends 21 years AT THE LATEST)! At 23, Katie was diagnosed with cervical cancer and she was told that she only had two years to live because the cancer was so advanced! IF she had been able to get at PAP smear done at 19 or 20, doctors could have detected it sooner and possibly stopped the cancer before it had gotten to the terminal stage (as most cancers are).

Now meet Dr. Brian Day - a Canadian physician. Dr. Day is advocating for more patient choice in Canada because the current system is actually KILLING PATIENTS due to the extremely long waits that terminal patients face in the Canadian system. Also meet Dr. Karol Sikora from the UK who is advocating the same in his country.

Meet Rick Baker. Mr. Baker is a Medical Broker in Vancouver. He helps Canadian citizens find life saving medical treatment in other countries that are denied to them in Canada. Listen to the story he tells about a client of his who was given ONE WEEK TO LIVE and was told by the bureaucrats that he had to wait indefinitely for the life saving surgery that he got in the US within 24 hours of contacting Mr. Baker.

Then there is Lindsay McCreith and Shonna Holmes, two people I wrote about earlier. These folks had to come to the US to get lifesaving surgeries that were denied to them under the "compassionate" Canadian Health Care system.

THESE are the realities of "free" government health care...not the utopian pipe dream that the redistributionists would have you believe. So now you tell me....how compassionate is it to tell someone that they have 1 week to live unless they get lifesaving surgery that the government says they can have in 6 months? Is it any more compassionate then telling someone that they can have the surgery for a sum that they can not afford? Personally I don't think either one is too horribly compassionate, but scrappinng the system we have now (where it can be had for a price) for a system where you can't get it when you need it is not the answer. A better answer is to get government out of the equation altogether so that the patient can chose the plan that fits them best and makes sure that the patient and the doctors are the ones in charge - not some bureaucrat in Washington DC.

Primum Non Nocere

First, do no harm (aka the Hippocratic Oath even though Hippocrates supposedly had nothing to do with it) is something that is drummed into medical students from the first day that they enter med school. Well that principle is about to become a thing of the past.....

Patients count on their doctor to do whatever is possible to treat their illness. That is the promise doctors make by taking the Hippocratic Oath.

But President Obama's advisers are looking to save money by interfering with that oath and controlling your doctor's decisions.

Ezekiel Emanuel sees the Hippocratic Oath as one factor driving "overuse" of medical care. He is a policy adviser in the Office of Management and Budget (OMB) and a brother of Rahm Emanuel, the president's chief of staff.

Dr. Emanuel argues that "peer recognition goes to the most thorough and aggressive physicians." He has lamented that doctors regard the "Hippocratic Oath's admonition to 'use my power to help the patient to the best of my ability and judgment' as an imperative to do everything for the patient regardless of the cost or effects on others."

Emphasis mine.

Now isn't that what doctors are supposed to do - to do everything possible for their patient? According to the administration the answer to that is "oh heck no!"

But President Barack Obama is pledging to rein in the nation's health care spending. The framework for influencing your doctor's decisions was included in the stimulus package, also known as the American Recovery and Reinvestment Act of 2009.

The legislation sets a goal that every individual's treatments will be recorded by computer, and your doctor will be guided by electronically delivered protocols on "appropriate" and "cost-effective" care.

So you and your doctor are no longer going to be in charge of your heathcare - some bureaucrat in DC with a set of charts will be the one to decide whether you live (get treatment) or die (not get treatment).

Heading the new system is Dr. David Blumenthal, a Harvard Medical School professor, named national coordinator of health information technology. His writings show he favors limits on how much health care people can get.

"Government controls are a proven strategy for controlling health care expenditures," he argued in the New England Journal of Medicine (NEJM) in March 2001.

Government controls - isn't that just a lovely euphanism for rationing?????! For all of you who accused me of over-reacting earlier I just have four little words for you.....I TOLD YOU SO!

Least you think that this is another "unintended consequence" - the administration is fully aware of what they are prescribing.

Blumenthal conceded there are disadvantages:

"Longer waits for elective procedures and reduced availability of new and expensive treatments and devices."

Yet he called it "debatable" whether the faster care Americans currently have is worth the higher cost.

Now that Blumenthal is in charge, he sees problems ahead.

"If electronic health records are to save money," he writes, doctors will have to take "advantage of embedded clinical decision support" (a euphemism for computers instructing doctors what to do).

"If requirements are set too high, many physicians and hospitals will rebel - petitioning Congress to change the law or just resigning themselves to ... accepting penalties," he wrote in NEJM early this month.

Emphasis again mine. So getting the care you want, when you need it is not worth the cost to this guy?

Essentially under the administration's plan to reduce health care costs we are going to have to accept the fact that some faceless DC bureaucrat has control of what care you get - not you and your doctor and that care is going to rationed or we are going to get the care we want and face fines and jail time!

Is that the "Hope and Change" (tm) that YOU voted for?????

Cancelled...

Imagine you are the parent of a three year old who is in need of life saving surgery. No worries, you say - I have government provided health care. My child will get the life saving treatment she needs....the government said they would provide it........

A three-year-old girl waiting for vital heart surgery has had her operation cancelled three times in as many weeks because of a shortage of hospital beds.

Ella Cotterell was due to have an operation to widen her aorta artery in her heart on Monday at Bristol Children's Hospital, but her surgery was cancelled 48 hours before because all 15 beds in the intensive care unit were full.

No before all you lefties start screeching - yes I fully understand and admit that we have had situations here where a hospital's beds are all full. I am NOT saying that never happens here. However, the fact that there are only 15 ICU beds in this particular hospital does say something about state of health care in Britian. Especially in a speciality hospital such as Women's and Childrens Hospital where little Ella was to have her surgery.

This is not necessarily a failure of universal care as much as it is a failure of today's modern medicine administration. While we don't know from the article the nature of the "emergencies" that caused little Ella's surgery to be cancelled, we have to wonder about a system that does not have the flexibility to move the surgery to a different hospital (this child's aorta is very weak and could rupture at any moment) or one that, if rescheduling is the absolute only option, has to wait weeks before they can even give you a new date!

The problem with health care in America (and as we see here in the UK as well) is that it is not responsive to the patients - only to insurance and insurance administrators. Changing out administrators (from insurance companies to the government) is not going to make health care better. Making the system more accountable to the patients will - which is why Universal Healthcare is, in the end, a real killer.

Putting The "Patient" Back Into Patient Care

One of the rallying cries of those who are behind government taking over health care in the US is that this will "improve quality" knowing full well that it would be political suicide to be against "improving the quality" of health care. The problem for these folks is that what they are proposing will do just the opposite!

The Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics." But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients...
One key quality measure in the ICU became the level of blood sugar in critically ill patients. Expert panels reviewed data on whether ICU patients should have insulin therapy adjusted to tightly control their blood sugar, keeping it within the normal range, or whether a more flexible approach, allowing some elevation of sugar, was permissible. Expert consensus endorsed tight control, and this approach was embedded in guidelines from the American Diabetes Association. The Joint Commission on Accreditation of Healthcare Organizations, which generates report cards on hospitals, and governmental and private insurers that pay for care, adopted as a suggested quality metric this tight control of blood sugar.
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.

I think everyone would agree that reducing the preventable errors (surgical equipment sewn up in patients, lack of cleanliness etc) is a worthy goal, but treating individual patients with individual health issues as a factory product that needs to be identical at every turn does the patient a dis-service. People, who are critically ill, do not always react positively to the introduction of a new chemical into the mix...

But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.

Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt. Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.

And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.

So what is a nanny stater control freak to do? Here's a radical thought....let the doctors treat their patients as INDIVIDUALS...not cogs in a machine...

Human beings are not uniform in their biology. A disease with many effects on multiple organs, like diabetes, acts differently in different people. Medicine is an imperfect science, and its study is also imperfect. Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials. To that end, a good doctor exercises sound clinical judgment by consulting expert guidelines and assessing ongoing research, but then decides what is quality care for the individual patient. And what is best sometimes deviates from the norms.

However, that will never happen if the nanny stater control freaks have their way! But these controls have other adverse effects on the eventual care that a patient would get.

Yet too often quality metrics coerce doctors into rigid and ill-advised procedures. Orwell could have written about how the word "quality" became zealously defined by regulators, and then redefined with each change in consensus guidelines. And Kafka could detail the recent experience of a pediatrician featured in Vital Signs, the member publication of the Massachusetts Medical Society. Out of the blue, according to the article, Dr. Ann T. Nutt received a letter in February from the Massachusetts Group Insurance Commission on Clinical Performance Improvement informing her that she was no longer ranked as Tier 1 but had fallen to Tier 3. (Massachusetts and some private insurers use a three-tier ranking system to incentivize high-quality care.) She contacted the regulators and insisted that she be given details to explain her fall in rating.

After much effort, she discovered that in 127 opportunities to comply with quality metrics, she had met the standards 115 times. But the regulators refused to provide the names of patients who allegedly had received low quality care, so she had no way to assess their judgment for herself. The pediatrician fought back and ultimately learned which guidelines she had failed to follow. Despite her cogent rebuttal, the regulator denied the appeal and the doctor is still ranked as Tier 3. She continues to battle the state.

What person in their right mind would want to put up with that kind of regulatory nonsense?

Rather than government taking control of health care, what we need to empower the patients and encourage them to take more control of their health care. It's not easy. You expect your doctor to be an "expert" at what they do and dealing with them can indeed be intimidating - especially when you are sick. However, no one knows your body and how it reacts to things better than you do (or you should) and you are the first to know if something is working or not! No government agency will be able to tell you how you feel and no government agency will be there for you when you have a health emergency - but your doctor will. Why not let the doctors and the patients work as partners in a patients care? Isn't that what it is supposed to be?

From The Horses Mouth

While President Obama was running around Europe touting the virtues of a health care system he has never had to navigate, a politician who LIVES with the system the President so envies was here in the states talking about the realities of Euro-Canadian Health Care (HT HA)



What began with the "best of intentions" has made people sicker and people die sooner thanks to Euro-Canadian Care...and that is what President Obama wants for your children?

Health Care Solutions

I have spent a lot of time slamming Universal Health Care lately so I thought I should at least talk about a workable alternate. My friend Gary Gross (at LFR) has the story of a bill working it's way through the Minnesota House that would provide more coverage, to more people and will end up saving the state a pretty penny to boot.

REP. GOTTWALT’S HEALTH CARE REFORM INITIATIVE UNANIMOUSLY PASSES COMMITTEE

ST. PAUL - State Rep. Steve Gottwalt, R-St. Cloud, today presented a health care reform bill (HF1865) that would improve how Minnesota provides health care coverage to low-income adults, while saving the state an estimated $100 million per year.

Gottwalt presented the Healthy Minnesota Plan (HMP) to the Health Care and Human Services Policy and Oversight Committee, which unanimously approved the bill, moving it on to the Health and Human Services Finance Division.

The HMP would cover 84,000 Minnesota adults currently on MinnesotaCare with a more generous private market benefit package, and a deductible covered mostly by the state. The plan would pay providers market rates for the health care they deliver, eliminating cost-shifting, and opening more health care access to those enrolled in the plan.

The HMP would save state administrative costs, provide greater flexibility for the enrollee, tap into savings of large private insurance pools, and fit well with other health care reform initiatives. Gottwalt described the bill as a “demonstration project that will improve care for 84,000 Minnesotans, and save the state about $200 million in the coming biennium.”

The bill (HF1865) can be found here. MNCARE is Minnesota's SCHIP program for those outside of the state. Under Rep. Gottwalt's bill (which has heavy bi-partisan support I should add), MNCARE would cover everything that other health care plans cover - eyewear, dental, prescriptions, preventative medicine - the whole 9 yards! Premiums and co-pays are based on the insured's ability to pay which gives it more flexibility than the current MNCARE plan. All in all, it is a win-win reform.

These are the types of health care reform that we should be looking at in each state and in DC. It really is the best of both worlds in that it makes insurance available to more people, at a reduced cost and without the government taking over a huge sector of the private market. A hearty "well done" goes out to Rep. Gottwalt and his co-sponsors. Way to lead.

More Universal Health Care Horror Stories

Yesterday, in response to my post about Universal Health Care, Richard posted a like to a side by side comparison between US health care and Canada. As I noted in the comments, his side by side did not take into account stories like this which have become a daily event in Canada and Great Britain.

One man died as a result of failings in his care and it is likely that a second man's death could have been avoided, the Health Service and Local Government Ombudsmen ruled.

Patients with learning difficulties were treated less favourably than others, resulting in "prolonged suffering and inappropriate care", their report said.

When their relatives complained about the care given to their loved ones, they were left "drained and demoralised and with a feeling of hopelessness".

I mean can you imagine this happening in America?

When Dany Bureau's stomach started to hurt last week, he figured it was just because of something he ate.

So the 21-year-old Gatineau student went to bed, thinking he'd feel better by the morning. But when he woke up the next day, the pain was still there, and it was getting worse.

He headed to Gatineau Memorial Hospital, thinking that doctors would soon figure out what was ailing him and take care of it.

He never imagined the ordeal that would follow: The young man was turned away from five hospitals, got lost in an ambulance and, 28 hours after he was diagnosed, he had a burst appendix removed -- in Montreal.

Because Wakefield's Gatineau Memorial Hospital does not have surgical capacity, the doctor who diagnosed him with appendicitis last Friday started looking around for one that did. Usually, patients from Wakefield are sent to Hull or Gatineau, but on that night, there were no available beds at either.

28 hours and 5 hospitals later.....that's the compassion of "Universal" Health Care for you folks. Get used to it because if the "progressives" in charge of the White House and Congress have their way, this will soon be in YOUR future.

Refuting Universal Care

One of the stories that I read while in the hospital that I wanted to post on was this one (HT Ed at HA). While I don't disagree that health care reform is necessary, I do disagree that the government taking over this industry is a disaster of epic proportion. I have shown multiple examples of how government run health care has killed people, but this is probably the most detailed point by point refutation of the idea that I have seen.

Here are the author's Top 10 arguments against the reasons for ObamaCare.

1. Comparing US Health Care To Other Developed Countries
2. US Health Care Spending Is More Than We Can Afford
3. Reform Overhaul Will Yield Major Savings
4. Increased Evidence-Based Medicine And Health Information Technology Will Significantly Improve Care and Reduce Costs
5. Present Administrative Costs And Insurer Profits Are Too High
6. US Consumer Dissatisfaction Requires Drastic Health Care Changes
7. Health Care Costs Are So High They Are A Major Cause Of Personal Bankruptcy
8. The Number Of Uninsured Is So Large That Drastic Health Care Changes Are Necessary
9. More Preventive Care Will Better Serve Consumers And Save Costs
10. Health Care Consumers Are Being Served By Drastic Health Care Changes

Here are a couple of Kessler's arguments against ObamaCare.

1. Comparing US Health Care To Other Developed Countries: Those pushing for government-run health care are fond of comparing the US unfavorably to other developed countries with heavier government-run or directed systems. Actually, the US is more successful on comparative costs, efficiency of resource use, and outcome.

Typical of misleading statistics, a US advocate of government-run health care touts a report from the Organization for Economic Cooperation and Development (OECD), comprised of the 30 most developed economies, favoring universal coverage as exists in most of the other OECD countries. The OECD report is actually titled a “working paper” by the three researchers. The encyclopedia defines a “working paper” as “a document created as a basis for discussion rather than as an authoritative text.” This OECD “working paper’s” statistics are misleading.

More accurately, a January 2009 analysis of the data gathered from the OECD points at life expectancy as the single best measure of outcomes. Excluding deaths by injury, to focus on health related outcome, “the US does the best of all the OECD countries” having the longest life expectancy.

2. US Health Care Spending Is More Than We Can Afford: As it has become more evidenced that the US does not compare unfavorably, the push for heavier government involvement has shifted toward saying we can’t afford the current and future costs. The affordability claim is exaggerated. We can afford more than previously, have chosen to, and benefited.

Our ability has greatly increased to pay for and enjoy a higher standard of living, allowing a shift in priorities. From 1901 to 2003, the percentage of personal expenditures on the necessities of food, clothing and housing declined by half from 79.8% to 50.1%, while the quality and amount has increased. Home ownership increased from 19.1% to 67%. Other personal discretionary spending was able to increase from 20.2% to 49.9%, including all the modern conveniences and pleasures. Voluntary sharing of the bounty has also increased as the percent given to charities has doubled. Personal spending for health care increased from about 2% to almost 5%. Although some may be pressed to spend on health care, the overwhelming majority can and do.

3. Reform Overhaul Will Yield Major Savings: Price Waterhouse analyzed the primary cost drivers in health care. Leading the pack are new technologies, public demand for broader coverage and access, and defensive medicine. ObamaCare is not proposing restraints on lawsuits, tort lawyers being a major constituency. Health care consumers’ demands for fast access to the latest and best is not contradicted.

The Lewin Group is the leading consultants to government and private groups on health plan costs. Lewin says the two closest Congressional proposals to Obama’s stated design, from Senator Baucus and from Senators Wyden and Bennett, would increase National Health Expenditures, while dramatically increasing employer costs. It is reported that Senator Baucus is expected to be the “architect” of the emerging detailed plan, and the Wyden-Bennett proposal enjoys major support, the Obama administration saying it will hand off detailing to Congress.

7. Health Care Costs Are So High They Are A Major Cause Of Personal Bankruptcy: President Obama publicly claimed last week that “The cost of health care now causes a bankruptcy in America every thirty seconds." ABC News Director of Polling examined that claim and found it “simply unsupportable.” Examination of the basis for Obama’s claim and of other studies found the numbers vastly overstated.

8. The Number Of Uninsured Is So Large That Drastic Health Care Changes Are Necessary: That about 16% in the US are uninsured is repeated as cause for universal coverage schemes to cover them that at the same time grossly changes the health care system and costs affecting the other 84%. Even if the other 84% were not negatively affected, the uninsured count is actually an overblown statistic.The definition of uninsured includes all those lacking coverage any time in a year. Those lacking coverage for more than a year is 11%. The long term uninsured is primarily among working-age adults with low education.The Kaiser Foundation offers a recent analysis of the uninsured. 19% can afford coverage but don’t purchase it. 25% are eligible for current programs but don’t enroll. That leaves 56% for whom affordability is considered too difficult, needing assistance. About 5 million, over 10%, of the uninsured are illegal immigrants, who tend to have low educations. About 19% of those needing assistance are illegal immigrants.

Now I am not going to delve into the final sentence there - that is another post for another day, but suffice it to say that the illegal immigrants here who do not have health care mostly likely WOULD have health care back in their home countries....if they were there.....

However, the entire last paragraph is one that bears further scrutiny. 11% of the American poplution is uninsured and of that 11%, 44% have health care available to them they just don't bother to get it for whatever reason. Add in the 19% who are illegal immigrants and the number of American citizens who can not afford health care is really down to about half of what the advocates of universal health care say it is.

It is not that I don't have compassion for the 5% to 8% (depending on whose numbers you use) American citizens who need help obtaining health care. However, the government taking over this large portion of the economy will not do the job nearly as well as private charity will. Most hospitals have a portion of their budgets written with a buffer built in for people who can not pay (thanks to the Logical Mother who has been in Nursing and Hospital Administration for her entire adult life for that information). Government could (for example) encourage larger assistance of the vulnerable by offering tax breaks to doctors and hospit