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.

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?

Throw Momma Under The Bus

Greg Hengler at Townhall.com posted video of Obama Health Care policy advisor Stuart Altman's testimony in the Senate.



Get that - the elderly are not cost effective. Are you willing to throw your momma under the wheels of the Hope and Change express just so you can have YOUR health care today? Will you sit quietly by when your children do the same thing TO YOU??? That is where we are headed people. Are you ready?

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?????

How Does This Stimulate The Economy?

Hidden in the depths of the President's "stimulus" package is something that should make all citizens cringe.

Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

The author brings example after example...

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Emphasis mine......think about that. Your doctor is no longer has the autonomy to treat you as an individual and as he sees fit. He has to turn first to a federal bureaucrat to see what treatments the government will allow!

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment?

So if your doctor does not abide by their ill-defined rules he can be fined...and guess who pays those fines in the long run?

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

HOLD THE PHONE!!!!! As long time readers of this blog know, senior care is a hot button issue for me because I am in dealing with aging parents and the problems that come with old age. You have also read more than a few posts about how the UK system has denied seniors the health care that they need. I have been "assured" time and time again by liberal commenters that we are not going toward a British style system and yet here is the President's ONLY CHOICE for HHS secretary saying that his system is modeled after the Brit's system! So much for those "assurances".....

Contrary to the President's threats, we have to slow this bill down. More permanent damage to the US economy will be done by passing this so-called "stimulus" then there will be by taking the time to pull out the non-stimulative portions of the bill. Send it through committee...let the "cooling saucer" of the Senate take the time to do what the "worlds greatest deliberative body" does best....debate and deliberate. Nothing that we do in a hurry will fix the economy - but (as we have seen from Wall Street of late) something done fact can certainly hurt the economy. Wall Street does not like this bill and neither does Main Street. It's time for the President and the Legislature to listen to the people that put them into office.

Case Study: Shona Holmes

Earlier this week, someone sent me this IBD Editorial.

TORONTO — My country promises everyone quality health care coverage that is free at the point of service and financed through taxes. But unfortunately for me and millions of Canadians, the actions of our government all too often belie that generous pledge.

Canada's cost-conscious, government-run system wasn't there for me when I needed it most. Even worse, it continues to overlook the most fundamental rule of health care — that patients ought to come first.

As America considers ways to reform its health care system, I hope that my experience reminds decision makers that more government intrusion in health care is a poison pill.

Since the emailer did not include a link to the editorial, I had to wait to research it. Well today I finally had a chance to search up Shona's story and what I found blew my mind. First here is Shona's story on the Mayo Clinic's website.

Shona Holmes was in trouble: The list of her symptoms included headaches, sleeplessness, dizziness, low libido and, worst of all, rapidly deteriorating vision. Her family doctor in Canada ordered an MRI, and a brain tumor was detected. But it would take months for her to get on the appointment calendar of a neurologist or endocrinologist in Canada.

"I knew in my gut that I had to see someone and could not wait five to six months," she says. So she called Mayo Clinic and got an appointment the same day.

For Holmes, a 31-year-old native of Waterdown, Ontario, traveling far from her husband, other family members and friends was difficult. She knew there would be several appointments and a battery of diagnostic tests. But she knew it had to be done. So, flying solo, she headed for Mayo Clinic in Scottsdale, Arizona.

Shona needed life saving brain surgery immediately. However, like her fellow countryman (and fellow OHIP member) Lindsay McCreith, Shona found out that the free health care she was promised came with life threatening strings. She was told that she could not see a specialist for at least six months...six months which, according to the Mayo Doctors, she didn't have the luxury of waiting for. Shona's doctors from the Mayo Clinic made calls to OHIP pleading for an exemption for Shona. They were unable to make any headway with the administrators of the plan. So Shona finally got on emergency appointment with a neurosurgeon and an endicronologist and they refused to accept the Mayo Clinic diagnosis. One of the Ontario "specialists" told Shona that she was simply suffering from migranes - even though she was going blind (as a result of pressure from the tumor on her optic nerve)!

Shona went back down to Scottsdale where she underwent successful surgery to remove the tumor. Since she has come home, Shona has started waging a new battle....a battle for health care options in Canada. She has even gone as far as to post (on You Tube) a video describing what she went through along with an interview that she did with an Ontario television station (starts at the 5:14 mark). Watch for the reaction of the female reporter when Shona tells her that what she did in going to the US for treatment was illegal!

Shona is working to make a positive change come out of her negative experience. It is an experience that all Americans (especially Minnesotans) should pay close attention to as this could some day be our fate as well.

Shona says it best when she says "free health care is great...if you can access it".

Denial of Health Care Comes To The US

Contrary to the protestations of the supporters of government run health care, rationing of services is a very real prospect. Just ask Barbara Wagner of Oregon.

EUGENE, Ore. — After weeks of bad news, things turned Barbara Wagner’s way this week.

Last month her lung cancer, in remission for about two years, was back. After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, Wagner was notified that the Oregon Health Plan wouldn’t cover it.

It would cover comfort and care, including, if she chose, doctor-assisted suicide.

According to administrators of the state run plan, treatment of advanced cancer that is meant to prolong life or change the course of the disease is not covered. Excuse me....isn't that why we WANT health care....to prolong our lives and change the course of diseases? No???? Silly me - what was I thinking???? What is worse is that this is a change in policy, contrary to what the plan administrators claim.

Officials of LIPA and the state policy-making Health Services Commission say they’ve not changed how they cover treatment of recurrent cancer.

But local oncologists say they’ve seen a change and that their Oregon Health Plan patients with advanced cancer no longer get coverage for chemotherapy if it is considered comfort care.

It doesn’t adhere to the standards of care set out in the oncology community, said Dr. John Caton, an oncologist at Willamette Valley Cancer Center.

Well DUH - of course it does not adhere to the "standards of care" set by the oncology community. The doctors in the oncology community want to CURE their patients...not kill them. Remember the Hippocratic Oath - first do no harm?????? Apparently that does not apply to state bureaucrats!

Thankfully for Ms. Wagner, the "evil" pharmaceutical company that manufactures the drug has offered the treatment for free.

This is the kind of "care" that all Americans (not just Minnesotans and Utahns) can expect should government run health care become a reality. Is this really the kind of care we want for our aging parents or our children or even ourselves? Somehow I think the answer is a resounding no!