23 March 2011

Death Panels Forever!

One of the truisms in Left Blogistan, where I frequently hang out, is that "reality has a well-known liberal bias." Fortunately, that matters less to those unfettered by actual facts, a point illustrated today by Senator (yes, really, a US Senator) Ron Johnson who, in a Wall Street Journal op-ed piece performed a reprise of 2009's Lie of the Year: Death Panels wherein bureaucrats ration care:

ObamaCare and Carey's Heart

My daughter probably wouldn't have survived in a system where bureaucrats stifle innovation and ration care.

Some years ago, a little girl was born with a serious heart defect: Her aorta and pulmonary artery were reversed. Without immediate intervention, she would not have survived. [...] If you haven't guessed, this story touches my heart because the girl is my daughter, Carey. And my wife and I are incredibly thankful that we had the freedom to seek out the most advanced surgical technique. The procedure that saved her, and has given her a chance at a full life, was available because America has a free-market system that has advanced medicine at a phenomenal pace.

I don't even want to think what might have happened if she had been born at a time and place where government defined the limits for most insurance policies and set precedents on what would be covered. Would the life-saving procedures that saved her have been deemed cost-effective by policy makers deciding where to spend increasingly scarce tax dollars?

Yes, that dystopian future where we stand aside an allow infants to expire from treatable illnesses would be terrible. It is, incidentally, not the dystopia which we currently inhabit. The dystopia now is one in which 46 million americans do not have access to routine care, and those infants born to parents unlucky enough to be uninsured may receive heroic lifesaving care on a charity basis -- or maybe not, depending on the whims of chance and the severity of their illness. Most hospitals will perform heart surgery on an otherwise dying infant and eat the cost (or retroactively enroll them in medicaid), but if your child has, for example, moderate severity cerebral palsy, good luck getting him or her the intensive physical therapy, occupational therapy, and speech therapy that will be needed to get her functioning at her best possible level. You need insurance to get thigs like these, and sometimes to get lifesaving treatment -- and getting more people insurance is the whole point of the PPACA.

That's the world as it is, until 2014 anyway. It was a terrible decision to defer implementation of the PPACA (aka "ObamaCare") until then, but that's water under the bridge. So am I to take it from Sen Johnson's testimony that at that time we will suddenly be in a situation where the government will be imposing limits on what lifesaving procedures must be covered by insurers? You may be surprised to learn that the answer is ... yes! The funny thing, the insidious lie at the heart of Sen Johnson's heart-tugging testimony, is that the government is setting minimum standards for coverage, not maximum standards. In fact. several republican governors have criticized the standards set by the PPACA as being too high.  Previously, your private insurance, purchased in your behalf by your employer probably had a lifetime limit of how much it would cover -- likely $2 million, though policies vary. If your kid happens to be a cardiac kid, you can blow through that in just a couple of operations and ICU stays. ObamaCare outlaws these lifetime coverage caps, and sets mininum standares as to what insurers must cover, and cost-effectiveness is not part of the equation. Also, ObamaCare bans insurance companies from discriminating against children with pre-existing conditions.

"But wait!" A chorus of commenters are ready to retort, " What about the CER death panels, where the government will pick and choose which therapies to cover?" It is true that this research is going to be done, and likely that it will be utilized in reimbursement decisions in the future. However, the C stands not for "cost" but for "comparative" in which we will try to determine which of multiple treatments for a given disorder is the best. And yes, in a world where health care consumes 16% of GDP, cost should be a component of rational, value-based purchasing. But that assumes that there are multiple accepted treatments for a given condition, and does not in any way imply, as Senator Johnson falsely insinuated, that patients' lives will be weighed and valued by bureaucrats. But like many opponents of the PPACA, Johnson seems to be railing not against what the bill is, but against the bogeymen of what he fears it could someday be. 

Bottom line: the PPACA leaves the commercial, employer-sponsored insurance that about 58% of americans have untouched. It leaves medicare and medicaid essntially untouched, but possibly marginally more efficient. For those on the individual market, it will make insurance radically more accessible. And for those currently uninsured, it either opens the individual market to them, opens the individual market with subsidies, or puts them on medicaid. That's it. Nothing which would prevent a commercially-insured child from getting her heart fixed. 

Oh, and as an aside, Sen Johnson cites some cherry-picked and misleading statistics about the cancer care in the US compared to other countries. I would refer you to The Incidental Economist for an evisceration of that talking point. 


  1. Obamacare does not leave commercial insurance untouched; the cost of insurance will be dramatically increased to cover the costs of eliminating the lifetime maximum benefits and the pre-existing condition exclusions. It's already happening.

    Obamacare does not leave Medicare untouched; it assumes that the 30% physician pay cut in 2012 will go into effect, rather than being overturned as it has been every year. If that happens, many more physicians will opt out of Medicare leaving Medicare patients with worse care than they get now.

    Obamacare does not leave Medicaid untouched; it dumps millions of patients into this worthless "insurance" pool. Ever try to refer a Medicaid patient to a Gastroenterologist or an Orthopedist? It simply isn't possible in many areas, unless they pay cash.

    Reality is unbiased, and it does not bend for liberal dreamers.


  2. Interesting that in the UK, with our non free market state healthcare system, complete with rationing and all that stuff, kids with TGA still get surgery, and still survive.

  3. Very well said. A lecturer in the Health Policy unit of my preclinical years say something like "The US spends so much because we innovate! It's like paying a lot for a high-end car!"

    I really wanted to raise my hand and say, "No, professor, it's more like paying a lot for a clunker someone threw together in their garage. Because we outpay nearly every other country and underperform on nearly every health metric. That's not innovation, that's inefficiency."

    But peer pressure and a desire to get to lunch kept me quiet.

  4. Emma - I lived in the UK too, and despite long waits for treatment, I totally agree that people do get great healthcare. If only we could follow that example on this side of the pond (well, they do up north, so really, this side of the pond and the norther border...)

  5. "But wait!" A chorus of commenters are ready to retort, " What about the CER death panels, where the government will pick and choose which therapies to cover?"

    So this is worse than having the insurance companies decide which therapies they will or won't cover . . . how? That's what we have now. The difference being, as I understand it, under the new plan, is that the insurance companies won't be able to abruptly cancel your insurance when you get sick so they don't have to pay out large claims.

    The bastards pulled that shit on me years ago - they were happy to take my premiums, but the moment I had a claim they decided I had a pre-existing condition (even though it wasn't diagnosed until months after the insurance went into effect) and that they "should not have issued the coverage" and cancelled my policy. It took filing a formal complaint with the state's insurance board and a lawsuit to get them to take the "uninsurable" designation off my record. (For ALLERGIES, none of which were bad enough to cause anaphylaxis. Go figure.)

  6. Do you mean "...unlucky enough to be UNinsured"?

  7. Christina -- yes, thanks. #Ineedacopyeditor

  8. you won't change practice behavior or control costs with cer unless there is built in legal protection.

  9. That evil CER:

  10. "likely $2 million, though policies vary. If your kid happens to be a cardiac kid, you can blow through that in just a couple of operations and ICU stays"

    I think these are the most pressing lines of you post. Why does it cost 2 million dollars for "a couple operations and icu stays". Whats worse the greed that provided an exhuberant economic bubble followed by a deep multiyear recession, or the medical complex that has somehow rationalized exploding healthcare costs. Have all the tort reform you want as long as the medical field takes a look in the mirror.

  11. Well, there are places where politicians decide to let people die in order to fund tax breaks.

    But, they are not related to PPACA.

  12. While the idea of "Death Panels" is silly, and this Senator is most likely telling lies he thinks his target audience wishes to hear, the underlying problem is real.

    The healthcare bill does in part take ultimate responsibility for health care decisions away from where it belongs, in the hands of the patient and the family, hopefully advised by competent, caring physicians.

    You know at least some of what happened with my son. We decided to withdraw care after talking with the doc and extensive research on the illness he had. Though the outcome would have been the same, there is a world of difference between us making that decision and the state deciding that it would be a waste of time and money to keep things going.

    The other personal argument I have against this is my father's situation at the VA a few years back. (The VA, by the way, is where we should be looking to see how the federal government runs health care, that's the only place they truly run it 100%, and it's a disaster). My Dad needed a liver transplant - the usually reason. The VA had five places at the time that could do them, they were going to send him about 1500 miles from home to get it done, but decided history of heart problems made it so they couldn't do it. There were places, much closer, that would have done it with the heart history had he been a few months older and on Medicare. The risk would have been great, and the outcome far from assured, and of course he didn't live long enough to find out. The problem I have isn't that he died, that likely would have happened anyway, the problem is that the state made the decision to allow him to die rather than doing the transplant. It's likely the same decision I would have advised, knowing his chances and the likely outcomes, but the decision was made by the state, not the family, and that's just plain wrong.

  13. How much longer are you going to beat the "45 million" dead horse? Come ON, anyone who can read is now aware that when illegal aliens and those who chose not to purchase health insurance are factored out, the real number of "Poor, uninsured Americans" gets closer to 12 million.

    And as Vince stated, look at the VA to see how well federally socialized medicine really works!

  14. C is for comparative. Comparing what? COSTS to benefits.

    CBO: Comparative Effectiveness: generating better information
    about the COSTS and benefits of different treatment options.

    i.e., if Tx A costs $1000 and is 90% effective and Tx B costs $1500 and is 95% effective which will the Federal Goverment choose to cover?

    If 100,000 people are receiving treatment then choosing A will save half a million dollars and help 90% of those affected. CER will analyze whether the extra 500K is worth spending to help another 50,000 people. hmm, budget's pretty tight, sorry hun, maybe next year.

  15. Pardon me. That's another 5,000 people not 50K.

  16. Part of the deficit savings "game" that the bill played with the CBO was that starting in 2016, the states would be entirely responsible for covering Medicaid. They can't even cover what they have now!! Who is going to pay for these "45million" people or as was recently and correctly stated, 12million people? Medicare reimbursement to physicians IS cut in the bill. Who in their right mind is going to take on a Medicare patient if they're not getting paid (aside from ED physicians)? $500 million was also raided from Medicare in order to pay for other parts of Obamacare. This actually was worded so that it would be counted twice in the eyes of the CBO. Yet another game played to show deficit savings. Businesses are going to be forced to pay more for employee coverage - especially those that are providing the mini-med plans, because they can't meet the minimum requirements of the MLR ratio set in the bill. Hence the need for all the waivers. Shadowfax wanted this to be enacted immediately? - how many businesses would have gone under or discarded all benefit insurance in order to pay the fine because it is cheaper? Covering preexisting conditions is only going to cause all private insurance to raise their rates. Law of Unintended Consequences - something liberals can't see.


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