Published in the New York Post on August 17, 2009
Washington is all atwitter about “death panels”: President Obama derides the idea that his health-care reform calls for them; the Senate is stripping “end of life” counseling language from its bill — and last Friday the voice of the liberal establishment, The New York Times, ran a Page One story “rebutting” the rumor that ObamaCare would create such boards to decide when to pull the plug on elderly patients.
But all those protests miss the fundamental truth of the “death panel” charge.
Even without a federal board voting on whom to kill, ObamaCare will ration care extensively, leading to the same result. This follows inevitably from central features of the president’s plan.
Specifically, his decisions to (1) pay for reform with vast cuts in the Medicare budget and (2) grant insurance coverage to 50 million new people, vastly boosting demand without increasing the supply of doctors, nurses or other care providers.
Whether or not he admits it even to himself, Obama’s talk of cutting “inefficiencies” and reducing costs translates to less care, of lower quality, for the elderly. Every existing national health system finds ways to deny state-of-the-art medications and necessary surgical procedures to countless patients, and ObamaCare has the nascent mechanisms to do the same. With the limited options that Obama’s vision would leave them, many will find that “end of life counseling” necessary and even welcome.
“Reform” would cut care to the elderly in several ways:
* Slash hundreds of billions from Medicare spending, largely by lowering reimbursement rates to doctors and hospitals for patient care.
If a hospital gets less money for each MRI, it will do fewer of them. If a surgeon gets paid less for a heart bypass on a Medicare patient, he’ll perform them more rarely. These facts of the marketplace are not only inevitable consequences of Obama’s cuts but are also its intended consequence. Without them, his savings will prove illusory.
* Expanding the patient load by extending full coverage to 50 million Americans (including such “Americans” as illegal immigrants) without boosting the supply of care will force rationing decisions on harried and overworked doctors and hospitals.
People with insurance use a lot more health-care resources — so today’s facilities and personnel will have to cope with the increased workload. Busy surgeons will have to decide who would benefit most from their treatment — de facto rationing. The elderly will, inevitably, be the losers.
* The Federal Health Board, established by this legislation, will be charged with collecting data on various forms of treatment for different conditions to assess which are the most effective and efficient. While the bills don’t force providers to obey the board’s “guidance,” its recommendations will still wind up setting the standards and protocols for care systemwide.
We’ve already seen Medicare and Medicaid lead a similar race to the bottom with their formularies and other regulations. With Washington dictating what every policy must cover and regulating all rates, insurers and providers will all have to follow the FHB’s advice on limiting care to the elderly — a de facto rationing system.
* In assessing whether to allow certain treatments to a given patient, medical professionals will be encouraged to apply the Quality-Adjusted Remaining Years system. Under QARY, decision-makers seek to “amortize” the cost of treatment over the remaining “quality years of life” likely for that patient.
Imagine a hip replacement costing $100,000 and the 75-year-old who needs it, a diabetic with a heart condition deemed to have just three “quality” years left. That works out to $33,333 a year — too steep! Surgery disallowed! (Unless of course, the patient has political connections . . . )
Younger, healthier patients would still get the surgery, of course. The QARY system simply aims to deny health care to the oldest and most infirm, “scientifically” condemning them to infirmity, pain and earlier death than would otherwise be their fate.
In short, ObamaCare doesn’t need to set up “death panels” to make retail decisions about ending the lives of individual patients. The whole “reform” scheme is one giant death panel in its own right.
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The bottom line is well people do not cost anything and only those who are sick incur costs associated with making them well again. While an argument can be made that preventative care (e.g., mammograms, PSA tests, etc.) are for the well to prevent catastrophic events later there generally is no exception to this rule.
For the most part insurance companies use pooled payments under the assumption not all patients require treatment simultaneously. So the only way to cut costs is like Dick Morris says is to reduce the treatments that people receive and that would have to be seniors since they tend to need more treatments.
Kind of ironic that while we seniors (I am 58 years old) were working and paying Federal income taxes, Medicare taxes, and Social Security taxes over the course of a 30 year career nobody complained.
As a matter of fact there is less of any generation today than there was yesterday. Back in the 60s and 70s there were newspaper articles about all the surpluses in Social Security - since most baby-boomers have not retired where in the hell did this money go. Guys like LBJ and Ted Kennedy could not keep their hands off the money and borrowed against the trust fund ‘knowing’ baby-boomers would not retire for another 40 years.
To say I am outraged is mild. Obama first said we needed health care reform, and then he said it was insurance reform and now he is saying it is moral or religious reform. Obama care is like the Post Turtle (those who live in the country know what this is) and is when you’re driving down a back road and you look along the highway and see a turtle balanced on top. The turtle certainly didn’t get up there by himself (i.e., he was voted in). He doesn’t belong there (no experience); he can’t get anything done while he’s up there (except talk in rhetoric); and you just want to stop help the poor thing down (vote him out of office).
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I believe that we are faced with massive inflation that will affect the cost of everything. It’s intentional.
The stimulus, cap and trade, massive spending budget, etc; it’s going to be resolved by printing money and reducing the value of our money. I think that Obama is planning to inflate his way out the massive debt. As an exaggerated example, a $10 trillion debt doesn’t look very bad when compared to the cost of a $1 trillion apple. This really hurts people on fixed incomes, like seniors. The Obama administration says that they are targeting only “rich people” but all of his actions seem to target the elderly and middle income people. Maybe not with direct taxes, but through the back door with increased costs for energy and pass-through taxes from corporations, just to name two issues.
The seniors in particular need to understand this. They are the most vulnerable. Yes, we should address some of the things that could be improved in health care, but let’s not throw out the baby with the bath water. There nothing wrong with the baby part.
John H
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