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Death Panel? No, Death Council? You Bettcha


Michael F. Cannon, the director of health policy studies at The Cato Institute, explains that President Obama really has proposed a new government panel that would enhance Medicare's ability to deny care to the elderly and disabled based on government bureaucrats' arbitrary valuations of those patients' lives.

Sorry folks, Sarah Palin is (partly) right - [Detroit Free Press]


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Comments (22)

Who needs a panel or a coun... (Below threshold)
jim m:

Who needs a panel or a council when Obama has declared that he is a "partner" with God "in matters of life and death"?

Yeah! Barry has taken to pr... (Below threshold)

Yeah! Barry has taken to preachin. I would rather he stop lying. ww

Call them by any other name... (Below threshold)
Zelsdorf Ragshaft III:

Call them by any other name. End of life is what? Groups of people who make decisions on governmental issues are what? Panels? What we have here is end of panels.

I once saw a statistic that... (Below threshold)
jim m:

I once saw a statistic that on average 50% of your lifetime medical expense was incurred in the last 6 months of your life.

So what the Dems are wanting to do is just eliminate 50% of health care costs by predicting when that last 6 months is. What they are really doing is proposing to determine when it is by bureaucratic fiat.

Barry has tired to sell so ... (Below threshold)

Barry has tired to sell so many lies, I wonder that he can keep everything straight, seeing as he says different things to different groups.
Guess when you are omniscient, you can take both sides of any issue.

jim m: "So what the Dems... (Below threshold)

jim m: "So what the Dems are wanting to do is just eliminate 50% of health care costs by predicting when that last 6 months is."

Worse. MUCH worse.

The Dems don't want to "predict" when the last 6 months is...they want to DICTATE when that last 6 months is.

My mother got cancer surgery at age 82. She now has YEARS and YEARS of life left until she reaches those "last 6 months". If her Doctor hadn't been able to do the surgery...those "last 6 months" would already have expired, and her along with it!

Justrand - that's pretty mu... (Below threshold)
jim m:

Justrand - that's pretty much what I said.

Medicare, Medicaid, Social ... (Below threshold)

Medicare, Medicaid, Social Security, the Post Office, the Cluncker program are all out of money. Do the math, there is no money to begin with, so if they go with national health care they are forced to ration care. In most cases the older you get the more you need medical care and medicine. You are near the end of your life...so naturally the elderly are going to be denied health care that is now available to them. And the very disabled. They want the masses "healthy" and stupid and clueless. Politicians (especially demos) think they are gods anyhow so this is just taking one step further. Of course when they get old it going to be a different story. They will hang on as long as they can...by that time I don't think they will be wanting to meet the real GOD.

I'm too lazy to look up the... (Below threshold)

I'm too lazy to look up the Democrat talking points to attempt to counter this rehash of what we already knew.

I'm sure someone will be by to help shortly.

In the mean time, as long as the government, or an insurance company, or anyone who is not the patient, holds the purse strings, they will want to make decisions on how the money is spent. When the patient holds the purse strings, they can decide for themselves how to spend their own money, as long as there is a free-market system of medical care. If we cherish and desire this freedom, we need to nurture and support a free-market medical system AND stop being dependent upon others (insurance or government) to provide the money to pay for our health care. The health care system is capable of caring for those who can't afford care, given a change in culture, plus less regulation and special interest powers granted by government legislation and rules.

That is the crux of the mat... (Below threshold)
jim m:

That is the crux of the matter.

Insurance companies or the government will hold the purse strings. What makes our system work is that if you aren't happy with your insurance provider you complain and your company eventually changes it or offers more options. In a single payer system there is no choice and correspondingly no incentive for that provider to provide better service.

One need only look as far as the VA to see the truth of that. VA hospitals rank as some of the poorest, most ill equipped hospitals around. For veterans such as my father they are often a choice of last resort.

Dems are on record that they ultimately want single payer and in the short term they want something that will pave the way for it at the very least. The problem here is that there is no compromise. There is no way to provide single payer for those very few who want it (the vast majority of those who are in favor would not actually choose to use a government system even if offered. Just check the responses of Obama and congress to see the truth of that) and at the same time provide choice for the larger majority who don't want it.

"...given a change in cu... (Below threshold)

"...given a change in culture..."

Ignoring for the moment that culture is basically impossible to manipulate programmatically, what kind of change are you talking about, epador?

jim m...I kow. I was just ... (Below threshold)

jim m...I kow. I was just spelling out the difference between "predicting" when something will happen, and CAUSING it to happen. :)

It amazes me that the fans ... (Below threshold)

It amazes me that the fans of this legislation refuse to acknowledge what is so transparently obvious to the rest of us. Health care rationing is inevitable if this legislation passes.

You can dress up the language any way you like, and the result will be exactly the same. People, particularly old people and the seriously ill, are going to suffer needlessly and die early because of it. Obama's IMAC language simply confirms what most of us already know.

I want no part of it.

Who needs facts when you ha... (Below threshold)

Who needs facts when you have the Cato Institute to feed you bullshit, right Kev?

President Obama really has proposed a new government panel that would enhance Medicare's ability to deny care to the elderly and disabled based on government bureaucrats' arbitrary valuations of those patients' lives.

Bullshit. IMAC's recommendations would have nothing to do with individual patients, and the council is designed (much as MedPac, the Republican-established council it replaces) to eliminate waste. Since Congress won't touch Medicare at all, preferring to let the waste continue rather than be accused of messing with seniors health care (they just shelve and ignore MedPac's recommendations, which the council has no authority to enforce), it has become necessary to come up with a different system.

But let's look at what Cannon wrote, which Kevin endorses so enthusiastically.

Enter the Obama administration, which submitted to Congress legislative language that would create IMAC and give it broad authority to recommend "reforms to the Medicare program." In effect, IMAC would enable Medicare to overcome the political resistance to government rationing.

Really? This council would overcome political resistance? The council members would be appointed by the president and approved by the Senate, and their recommendations must be approved by the president, and can be rejected by the Congress (within 30 days of presidential approval). Cannon believes that the president and Congress are not subject to political pressure? He believes that this council could ram through changes to Medicare that would restrict medical services to seniors, and no one would have to answer for it? Ridiculous. Congress and the White House would have to answer for it.

But let's look at the council and what it's supposed to do, shall we? From the CBO:

The Administration's proposal calls for an Independent Medicare Advisory Council (IMAC) consisting of five members who are either physicians or have specialized expertise in medicine or health care policy. Those individuals would be appointed by the President and subject to confirmation by the Senate.

Beginning with fiscal year 2015, IMAC would be charged with making annual recommendations to the President for changing federal payments for various services covered by Medicare. Under the Administration's proposal, each annual package of recommendations would have to be designed so that implementation would not be expected to increase aggregate Medicare spending over the subsequent 10-year period, as compared with expected spending in the absence of those proposed changes. Determination of the effect of the council's recommendations on net Medicare spending would be made by the Chief Actuary of the Centers for Medicare & Medicaid Services (CMS). In addition, the council could make recommendations for reform of the Medicare delivery system (but those recommendations would not have to be provided annually).

The President would have to approve or disapprove the council's recommendations as a package. If the President approved a set of recommendations, implementation would commence no sooner than 30 days after that approval unless the Congress enacted a joint resolution to disapprove the package of recommendations. (It would generally take far longer than 30 days to fully implement the council's recommendations.) Under the proposed legislation, the first potential reductions in spending would not go into effect until fiscal year 2016.

So I guess the council will just be full of evil doctors who want to kill grandma, by recommending payment rates for services, all years in advance? This is just silly. So what's it all about?

On Tuesday, doctors and hospital executives from 10 cities with below-average cost growth gathered in Washington for a conference called, "How Do They Do That?" They were a diverse lot, only some of whom hailed from providers resembling the Mayo Clinic. While crediting a range of factors for their success, they generally agreed about what ails American medicine.

When Dr. McClellan, who helped organize the conference, asked how many people thought the fee-for-service system was "archaic and fundamentally at odds" with good practice, most hands shot up. In effect, they were siding with Dr. Shadid and against a system that provides incentives for more and more care, regardless of its benefit.

"There are no consequences right now to over-utilization," Dr. Anthony F. Oliva, chief medical officer of the Guthrie Healthcare System, in northeast Pennsylvania, said later. "If you don't have consequences, you won't change the culture. If you don't have consequences, the people that are killing themselves to control cost are going to say, 'Why am I doing this?' "

This fee-for-services model is exactly what the IMAC is supposed to address, by moving towards a quality-based payment model. The Mayo Clinic, among many other hospitals and physician groups, approve:

Late yesterday, Mayo Clinic became aware of the concept of development of an Independent Medicare Advisory Council. We applaud the direction of this proposal. We view favorably the concept of an independent body that can move Medicare to a "value- based payment" model. An independent Medicare advisory commission focused on defining value, measuring it, and finding ways to pay for value could have significant, positive impact on health care for the long term. While we think the proposal's timeline of 2014 is too long to wait to see value-based reforms, we look forward to working with the administration on refining and strengthening their new proposal. This, and other, bold concepts have the potential to "bend the cost curve" in U.S. health spending without compromising health.

I guess Mayo secretly supports death panels too, eh?

Btw, anyone notice that Cannon never references the text of the amendment to support his assertions? Anyone wonder why that is? Nah, you would do that, would you (or read it yourselves, for that matter)? It's much more fun to believe silly death panel stories.

Oh yeah, the OMB says the council would save about $2 billion, in case you were wondering.

Wow $2B.Health car... (Below threshold)
jim m:

Wow $2B.

Health care is 1/6th of the economy. That's $2.2T. Glad to see that we're making some inroads on how much health care costs.

Sound the trumpets we've save 0.088%

consider me underwhelmed.

Meanwhile The Mayo Clinic has come out against a single payer system. And I would suggest that their statement here is in favor of a system which would allow swifter changes in payment policy by Medicare and Medicaid where the current problem is that they will not pay for the newest technology and treatments many of which actually do save money in addition to saving lives.

Mantis - The problem with t... (Below threshold)
jim m:

Mantis - The problem with this council is that it could go either way. People with Health Care Policy expertise sounds an awful lot like "politicians who have no real medical expertise". Few people would be content with a panel composed of such individuals.

Mayo's statement also conveys some uncertainty regarding the definition of value. What is value? Are we going o define it in terms of cost effective treatment? Or shall we define it in terms of deciding which individuals deserve to be treated.

The proposal allows either interpretation and until otherwise demonstrated many will choose to not trust the government. Heck, with Cash for Clunkers imploding so spectacularly, why should we?

Mantis - from the Mayo Clin... (Below threshold)
jim m:

Mantis - from the Mayo Clinic--

Although there are some positive provisions in the current House Tri-Committee bill - including insurance for all and payment reform demonstration projects - the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.

From Mayo's open letter to Congress from 7/22 it is clear that they are pleading for a system that will pay for successful outcomes and that such a system is the opposite of what we have with Medicare.

In short, Mayo is not a supporter of the current Dem plan.

1) Culture changes that en... (Below threshold)

1) Culture changes that encourage better communication, procedure and safety (hyper must have missed my many previous missives on this).

2) Fee for service isn't the problem. It's the person receiving the service isn't the one really paying for it that is the problem.

3) Outcome payment isn't all it's cracked up to be UNLESS you are part of a large system. It spells the death of private practice, and its likely such a system would end up having the larger systems cherry-picking patients likely to have good outcomes and dumping those who don't. Currently cherry-picking is steered towards those with "good reimbursement" versus those that don't.

4) The business model of the FQHC depends upon enhanced reimbursement for the care of Medicaid patients to offset the complexity of caring for them as well as caring for uninsured patients. Basically, by paying primary care providers what they are worth, then they also can provide reasonable care to the uninsured.

Outcome payment is great fo... (Below threshold)
jim m:

Outcome payment is great for patients with reasonably good prognoses. The problem comes with more medically complex cases and determining who falls into which category is not simple.

Err too far one way and high risk patients get dumped and die unnecessarily. Err the other way and you way overpay for service.

Getting back to why the current system works pretty well after all...

What I don't get is the lau... (Below threshold)

What I don't get is the laughable proposition that adding 45 million new people to the public plan, including illegals, and perhaps a million government-paid, permanent administrators (it's 1.4 million in the UK to prop up their monument to bureaucratic idiocy - the third largest employer on the planet) is somehow going to be free and that somehow it's going to be better.

Both ideas are patently ridiculous.

Does Obama really think we can't figure that out or something?

I just listened to an audio... (Below threshold)
jim m:

I just listened to an audio on redstate.com where an Air America guest asserts that Obama may be a fascist in reference to his deal with PhARMA.

Game. Set. Match.

Bobdog..."Does ... (Below threshold)


"Does Obama really think we can't figure that out or something?"

Bluntly? Yes. How many people bought his 'Hope and Change' crap? How many people think he's an incredible intellectual - despite never having seen his grades and transcripts? How many people objected to his Stimulus spending? How many people have bought into the post-racial fantasy of the man? How many people have voted for what the MEDIA told them he was, instead of looking for themselves and checking out his history?

I'd say he's got good damn REASON to think the people would overlook pretty much ANYTHING he might propose, no matter how fiscally insane!

And now he's finding out he ISN'T the King, with his every word automatically becoming law. Must be a hell of a shock!






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