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"We'll deny treatments, then pay you whenever" - the winning formula of government health care

On Friday, Mickey Kaus posted a scathing rebuke of the unbelievable strategy that the Obama White House and their accomplices in the press seem to be formulating in order to sell socialized medicine to the American public:

Democratic blogger Ezra Klein appears to be positioning Dem health care reforms as a way to cut costs, on the grounds that a reformed system will be able to make "hard choices" and "rational" coverage decisions, by which Klein seems to mean "not providing" treatments that are unproven or too expensive--when "a person's life, or health, is not worth the price." Matthew Yglesias' recent post seems to be saying the same thing, though clarity isn't its strong suit. (He must have left it on Journolist.)

Isn't it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: "Our plan will deny you unnecessary treatments!" Or maybe just "Republicans say 'yes.' Democrats say 'no'!" Is that really why the middle class will sign on to a revolutionary multi-trillion dollar shift in spending--so the government can decide their life or health "is not worth the price"? I mean, how could it lose?

But then Kaus goes on to opine that this strategy is, in fact, misleading; Kaus supports government health care because he thinks the government will be less likely than for-profit insurers to deny treatment:

Take Arnold Kling's example of a young patient with cancer, where "the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200." No "rational bureaucracy" would spend $20 million to save a life, Kling argues. I doubt any private insurance company is going to write a policy that spends $20 million to save a life. But I think the government--faced with demands from patient groups and disease lobbies and treatment providers and Oprah and run, ultimately, by politicians as terrified of being held responsible for denying treatment as they are quick to pander to the public's sentimental bias toward life--is less likely to be "rational" than the private sector.

I think Kaus' reasoning is completely backward. If you are treated unfairly by a private citizen or private business entity, you can petition the government to pass legislation that will prevent the situation from occurring again. You can also sue for restitution in civil court, yet another venue for redress that is provided by the government.

But if you are treated unfairly by the government, it's a whole different ball game. Lawmakers and bureaucrats are extremely reluctant to take responsibility for mistakes or to blame colleagues when things go wrong. If you are wronged by the Bureau of Health (or whatever it will be called) then to which other government agency do you turn for help? Are government agencies really going to sue each other on behalf of an ordinary citizen? The thought of intra-agency lawsuits seems even more ridiculous. Even if lawsuits were successfully filed, the elephantine way that government bureaucracy moves would guarantee that very few people ever received justice.

Here's the bottom line -- we need to look no further than the aftermath of Hurricane Katrina, specifically the finger-pointing and utter abdication of responsibility by the Army Corps of Engineers, to see how the government reacts to large-scale bureaucratic failure. In my opinion, the government would respond aggressively to major problems within a nationalized health care system only if there were a lot of paper-pushers on bottom of the bureaucratic totem pole who could be routinely scalped without harming tenured government employees. Such a system is, of course, doomed to failure; ask the survivors of the Soviet military how their "vertical stroke" plan worked out.

And there's another negative aspect that the cheerleaders for nationalized health care seem reluctant to talk about: the government is lousy at paying its bills.

Here in Oklahoma, the state employee health insurance plan, HealthChoice, is currently $80 to $100 million behind in claims processing and payments to health care providers.

Dr. Marc Siegel, a Fox News medical contributor, recently discussed this problem in the Wall Street Journal:

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

Back in 1993, Bill and Hillary Clinton offered one possible solution to this problem -- their proposed government take-over of health care criminalized any private practice of medicine outside the scope of the government program. Critics quickly seized upon the draconian nature of that rule and used it with great effectiveness in their campaign to defeat HillaryCare.
Most Americans wanted affordable health coverage, not a program that sent doctors to jail for visiting an elderly neighbor in their spare time, or renewing prescriptions for family members.

No one is denying that our current health care system is deficient. Right now, one of our most serious problems is the shortage of doctors -- there are not enough primary care physicians for every American to have an annual physical examination, and not nearly enough specialists to pinpoint and treat all the ailments that would be discovered during those routine physicals: heart disease, high blood pressure, diabetes, digestive diseases, breathing disorders, sleep disorders, anxiety, depression, etc.

A massive government insurance program clogged with red tape and stingy with its payments is certain to drive away health care providers. When that happens, we will be worse off than we are now -- only those who can afford to pay for treatment out of pocket will receive the best medical care, while the rest of us will be stuck waiting in line in overcrowded, understaffed public clinics. And if doctors are forced to assimilate their practices into the government system or face criminal penalties, then it is a no-brainer that the number of health care providers will shrink dramatically. After all, how many people will want to invest 15-20 years (honors high school - honors undergraduate - medical school - internship - residency) to become a slave of the state, overworked and pushed around by bureaucrats?

Whatever happens, it looks like the road ahead for health care in America will be a very rocky one indeed.


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Comments (21)

"No one is denying that ... (Below threshold)
Jake:

"No one is denying that our current health care system is deficient."

Good, glad we're not denying that. The real question for you is HOW deficient you believe it to be. Worthy of real change? New ideas? Or not deficient enough to make anything more than minor incremental improvements?

Jake -You highligh... (Below threshold)
apb:

Jake -

You highlighted a single sentence, and didn't understand the context. If the deficiency is because of lack of care providers, and the gummint caps pay, how will the number of providers ever increase?

That turns out to be a simple supply/demand problem that the left simply don't have the mental capacity to think through. The left, as shown through multiple failed economies, would prefer to command economics to behave the way they'd WISH it to - against all human nature of incentive and excellence.

I just want someone to be able to name a single well-run gummint program at any level. Amtrak? DMV? School systems? NASA/Goddard?

I see that another reminder... (Below threshold)

I see that another reminder is in order, Michael...the ground has shifted beneath the feet of cynics like you, tomorrow will be a new day.

The example about the $100,000 treatment is a red herring. There will BE NO $100,000 treatments available in our brave new world. This 1:200 example will never see the light of day, so to even question whether it would be funded is a waste of time. If a treatment is effective, but 'expensive', the cost will simply be lowered. Purveyors of the cure will be politely asked to treat their fellow men for a more 'fair' rate...say, $100? Drugs used in the treatment cost too much? Drug makers will be asked to make the cost of their drugs more 'fair' to their fellow man.

Not enough doctors, you say? Well, when you have no choice but to participate then you solve that problem rather easily - and when private insurance is outlawed (as in Canada) or, more likely, 'priced out of the market' by the government (easily accomplished by subsidizing health care out of the federal budget as another inverse-surplus line-item until the cost appears so low that a private enterprise cannot hope to compete), then what else are you going to do with that medical degree? It'll be so much more 'fair' to have everyone working for ObamaBlue Health Care (a FREE health care provider) 'fairly' distributed to required professions. We certainly won't need so many obstetricians, so those existing practictioners will be 'fairly' redistributed to things like geriatrics and 'family planning services'. In the brave new world no one will need to worry about moral objections, they will simply not be allowed because it is not 'fair' to allow someone to refuse to give you an abortion when you want one or grow an ear on your arm, etc. And bonus payments to doctors becoming providers of ObamaBlue FREE Health Care Inc will ensure a steady stream of new doctors, willing to be sorted into the required specialties according to the public's needs and their own abilities. In order to ensure that the public is treated 'fairly', minor adjustments to the tax code according to new occupational descriptors will be implemented with little fanfare, since they are simply making the tax code more 'fair'. These very minor adjustments that will not affect 95% of the population in ANY way will ensure that anyone attempting the practice medicine outside the umbrella of ObamaBlue for a fee, instead of for FREE at a properly licensed clinic (when it is open), will have any excess profits returned to the public's pool of funds where it will be used to fund ObamaBlue operations. Additional licensing, testing, application, reapplication, triplicate application, relicensing, and approvals will be handled by a new branch of the government run by a 'healthcare czar' operating out of the White House. Congress will, naturally, pass appropriate regulations to ensure that any non-ObamaBlue providers are not treating patients using unsafe, ineffective, or non-cost-effective treatments that are not otherwise available to other citizens who are not fortunate enough to be able to otherwise bypass the 'fair' safety net of ObamaBlue (did we mention we're FREE?).

Of course there may be a few adjustments required in the ownership, leadership, and/or operations of drug manufacturers to ensure that their vital work to research and develop new drugs despite the fact that they will no longer be able to recoup losses through profits on their work continues. It is more 'fair' to have everyone contribute to the operating budget of these new ObamaBlue subsidiaries (proud makers of FREE drugs) by having their budget as a line item in the federal budget and their workers' salaries determined by a board of highly skilled political appointees. The products, assuming they are determined safe by the FDA, 'effective' by another board of highly skilled government employees, and 'cost-effective' according to highly trained Congressmen, will be distributed, for FREE, by local ObamaBlue providers according to comprehensive, non-discrimanatory, 'fair' regulations...whenever a supply is available.

It's not that hard, Michael, you just need to think outside the box.

APB -"If the de... (Below threshold)
JLawson:

APB -

"If the deficiency is because of lack of care providers, and the gummint caps pay, how will the number of providers ever increase?"

It's a very simple three-step process.

1. Obama decrees it.
2. Then a miracle happens.
3. Unicorns in white coats take the place of physicians and work for horse feed.

Of course, with horns and hooves there'll be a little collateral damage, especially in delicate surgeries (anything more delicate than whole-limb amputations...) but that's only to be expected and we'll soon get used to it.

The whole process has worked SO well for other command economies in the past, it'll work perfectly THIS time if we just throw more money at it than ever before!

Medical treatment and hopit... (Below threshold)
Flu-Bird:

Medical treatment and hopitaliztion only for those who show loyalty to OBAMASES THE GREAT

"Unicorns in white coats... (Below threshold)
apb:

"Unicorns in white coats take the place of physicians and work for horse feed"

And I'll bet the members of our Politburo
Congress will have private unicorns, while the proles will be stuck waiting six months for their MRI's, eh?

Man, lefties are SO stupid...

Falze:Just where d... (Below threshold)
epador:

Falze:

Just where did you get that turbocharger for you sarcaster. It is awesome!

Health care in your country... (Below threshold)
hyperbolist:

Health care in your country is worse than in Japan, France (yes, that France), Sweden, Norway, Denmark, Australia, and (arguably) Canada. Costs way too much.

But don't let improving the health care system get in the way of your ideological stubbornness.

epador - not sure, it start... (Below threshold)

epador - not sure, it started showing up around the middle of January

Seems to me I remember Cana... (Below threshold)
apb:

Seems to me I remember Canada having horrific wait times for specialist referrals, ultrasounds, MRI's, and CT scans. Last time my daughter had a problem, referral/MRI was 1 week.

So, hyper - what's your definition bad health care here? If you have no insurance but show up at a hospital with symptoms, you're cared for; right down to a cold. The rest of us already pay higher premiums due to care for the have-nots.

What's your expectation?

"when private insurance is ... (Below threshold)
John S:

"when private insurance is outlawed (as in Canada)..."

That's absolute nonsense. Everyone in Canada buys private insurance to supplement the government insurance. Only a bum living under a bridge is forced to trust his life to the government's medicine. And the Canadian system wouldn't work at all if there wasn't the option of crossing the border for timely treatment.

Hyper"Health care ... (Below threshold)
retired military:

Hyper

"Health care in your country is worse than in Japan, France (yes, that France), Sweden, Norway, Denmark, Australia, and (arguably) Canada. Costs way too much.

But don't let improving the health care system get in the way of your ideological stubbornness.
"

So umm why do Canadians, your countrymen, cross the border to get health care in America? Yeah that is what I thought ASSHAT.


The problem with health car... (Below threshold)
FG:

The problem with health care is the cost of insurance and the cost charged to insurance.

I went to get my eye exam. On the phone I was told that the bill would be $96.00. When I showed up and gave them my insurance card they told me I owed $74.00. When i questioned them they said that the $96 was for uninsured people and the insured charge is $148.00. I walked out after telling them that it was wrong to do that.

No wonder insurance and health care is so expensive. And the Obama plan is to throw tax payer money at it.

Yes, horrific waiting times... (Below threshold)
hyperbolist:

Yes, horrific waiting times. I once had to wait four weeks to see a dermatologist. Eczema almost killed me!

My dad was diagnosed with prostate cancer two months ago. Two weeks ago, after a series of tests, he had his prostate surgically removed. Total cost: zero dollars, apart from the month of billable work he was not able to do.

And that's in spite of the fact that the Conservative government has been deliberately underfunding the national system for the past few years to try and turn public opinion against it, in favour of a two-tiered system like in Alberta or England. Hasn't worked so far.

I know that the American system does have some advantages over some of the ones I glibly mentioned for the sake of comparison, but it's equally glib to state that shorter waiting times makes your system preferable to ours or other universal models.

apb: I think that a modern society ought to have--at bare minimum--a health care system that delivers quality care with no chance of inflicting devastating costs on end-users. And I don't think a functioning health care system requires for-profit insurance companies acting as a filter between providers and end-users.

The bureaucracy associated with a 'socialized' system isn't any worse than that which you deal with through insurance companies... is it?

Not to worry, retired military. Once your system is upgraded to something worthy of a first-world democracy, Canadians will still probably visit your country for elective health care needs, as we do for other things that cost less in the United States. As for the more essential treatments, our system would be able to deliver it if our Prime Minister would read the f*cking Romanow Report that was commissioned to explain exactly how much money is needed to fund a system that would eliminate the need for Canadians to go elsewhere for our health care. But at least they're making it easier for doctors to immigrate and begin practicing, a small step in the right direction.

I never said our system is perfect, but yours sure as hell isn't either. There are better systems in the world, and all of them involve more government. So long as you refuse to accept that as even a conceptual possibility, there's no point discussing the merits of mixed-model or universal health care with you.

When was the last time a fe... (Below threshold)
GarandFan:

When was the last time a federal bureaucrat was held accountable for a decision they made? Don't throw any politician's or political appointee's names out. The bus was made for them. I'm talking a major fuck up by a federal employee, where a decision they made blew up in their face.

That's some hardcore denial... (Below threshold)

That's some hardcore denial there.

Should we start shooting down the helicopters rushing pregnant women with troubled pregnancies to US hospitals for treatment now? Maybe divert them to Cuba? Sure, you might have great facilities for ONE premature birth in an entire city. Wow, great. Keep on hoping that a second baby doesn't start coming before that one's out of the incubator.

Lame.

All right, hyper:F... (Below threshold)
apb:

All right, hyper:

First off, I hope your old man does well and fights off the cancer.

"Total cost: zero dollars" - it isn't really zero. The money came from somewhere; what's the tax structure? Do you have a large number of free-loaders and a small number hit by taxes? Is it progressive (still free-loaders at the bottom) or do all citizens pay a fair share?

Of course Canada doesn't have a military to speak of, so you're freer to spend on social programs. Really kind of nice to have the States as an ally there. Your % of GDP spent on military is less than half spent in the US.

Even so, the coverage and wait times are not showing effective use of the money. Your old man should have had test results in 2 weeks; sounds like you owe thanks it wasn't a more aggressive cancer. Why 6 weeks?

Sad fact is, there are NO better systems in the world. Almost all premier medicines are created here - leading to generics downstream - that save lives all over the globe. Cut out earning incentives for drug companies and the progress made in medicine would be a fraction of what it is now.

Don't make the mistake of assuming quantity makes up for all ills. Imported (cheap) doctors? Come on! You're still not catching on to the level of quality that comes from controlling cost; any system controlled by the gummint WILL turn into the next version of the DMV.

Um, Rumsfeld comes to mind.... (Below threshold)
hyperbolist:

Um, Rumsfeld comes to mind.

Falze: wtf? Are you having a separate conversation with a Nicaraguan or something?

Total cost for him out of p... (Below threshold)
hyperbolist:

Total cost for him out of pocket is zero dollars. Obviously the money comes from a pool of funds, much of which comes from taxpayers. And he wasn't a high priority patient: cancer detected early, estimated 95% chance of successful treatment, so he was treated well before the cancer had a chance to spread. By all accounts there is virtually no chance of it having spread.

The procedure costs far less in Canada than it does in the United States. World-class doctors and nurses and an excellent facility--in the hospital for two days, and free (yeah, I know: "free") home care for the week following that.

Canada has less of a military than it needs, but it's not like the United States needs to spend half of what it does. Some Americans seem convinced that without your formidable military advantage, some foreign power--Russia? China?--would just gobble up every defenceless nation. That isn't going to happen. There will never be conflicts like WWI/WWII again. (And if there is one, it's pointless discussing how to prepare for it because everyone will die.)

As for imported doctors, would you have a problem with someone educated in India performing surgery on you? I wouldn't. It's not like a graduate of the Nigerian Clown-College of Surgical Butchers would qualify to work in a hospital here. The idea is to have objective measures to evaluate a physician's level of skill--or, more economically, all of the institutions from which the applicants have graduated. Pulling a medical degree out of a box of cereal in Indonesia does not mean you get to practice medicine in Canada.

And I don't understand the notion that if Pfizer and Merck and the rest of them were unable to bilk insurance companies (and the insured) with exorbitant prices for their meds, that all of a sudden they would stop doing research. Really? They wouldn't adapt like good capitalist entities? And I think that the government should invest billions more in research at universities instead of letting drug companies surreptitiously define what it means to be 'healthy', as they have done for the past fifty years.

yeah, right. i actually re... (Below threshold)

yeah, right. i actually read the news, hypertroll.

I have no idea what you're ... (Below threshold)
hyperbolist:

I have no idea what you're talking about. Feel free to provide a link to whatever horror story you're referencing, Falze.




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