Category: Health Care

If you listen to the radio, you may have heard our ads urging Gov. Martinez to veto SB 208. The ads are posted below:

The furor about Death Panels has recently resurfaced. Unfortunately, public attention is focused in the wrong direction. Death Panels ARE part of the Healthcare “Reform’ Act, just not where the newspaper pundits tell us to beware.

HR 3590, perversely titled the Patient Protection and Affordable Health Care Act (PPAHCA), will provide funding for end-of-life planning and hospice care. That is certainly a good thing and is not a Death panel. Doctors have always been able to talk with terminal patients about easing our final days. Paying them seems only fair, is money well spent, and is NOT a license to kill us. End-of-life care does not constitute a Death Panel but the Cost Effectiveness Commission* does.

*I created the name “Cost Effectiveness Commission” because I simply could not use the name the government gave it. Their name – Patient-Centered Outcomes Research Institute (PCORI) – is as gratuitous and disingenuous as its parent PPAHCA. The PCORI is budget-centered and population-focused but what it does not do is make the individual patient’s welfare of primary importance.

Similarly, the self-styled “Patient Protection and Affordable Health Care Act” a) does not protect patients; b) comes with a price tag over $1 trillion, which is certainly not affordable; and c) most critical, it can never, ever provide health care, maybe health insurance for some. Only providers can offer care, and providers are becoming in short supply as a result of PPAHCA.

The U.S. government does not have a monopoly of gratuitous, disingenuous naming. The British are more than our equals with their NICE (National Institute for Clinical Excellence), which reports to their NHS (National Health Service.) NICE is the opposite of nice. The new Director of Medicare – Dr. Don Berwick – has publicly stated that he wishes to replicate both the NHS and its NICE here in the U.S.

What does NICE do and more important, what has been the result? This is vital to us because what has already happened in Great Britain is what Dr. Berwick and the Obama Administration want to see repeated here.

NICE evaluates expensive medical treatments and compares the short-term medical outcomes with the expenses incurred for them. The Panel then recommends what is cost effective on a national basis, given limited funds, and thus what should be covered and what should not. Obviously, what is not covered (call this funded) is not offered to patients and therefore is unavailable to all but a fraction of a fraction of 1% who can pay out of pocket $100,000 for a coronary bypass operation, $250,000 for a transplant, or $120,000 every year for kidney dialysis.

As a result of NICE recommendations, the NHS has cut or is cutting maternity benefits, hospice care, and both heart surgery as well as kidney dialysis over certain ages. This is not what anyone would call being “nice” to patients. The NHS also uses approval-but-delay (queueing) to avoid paying for health care. I know this first-hand.

The NHS applied “queueing” to my English mum when she broke her hip at age 79. They approved her surgery and then scheduled it for over two years later expecting that she would die before the operation and thus they would avoid the cost.

That is what NICE and NHS has done. That is what PPAHCA and the Cost Commission will do here. That is what is called a Death Panel.

A Death Panel is a group of people who decide who shall live and who shall die. In the Court system, the judges are legally trained individuals who follow a set of rules called laws, which rules must pass our – very public – inspection and approval. Those who are sentenced within the legal system are people found guilty of wrongdoing.

A Death Panel in the healthcare system is still a group of people who decide who shall live and who shall die. In contrast to the Court system, those who are sentenced to death in the health system are guilty of nothing and die by natural but often preventable causes.

Suppose our shiny new Cost Commission decides, just as the British did, that heart surgery over the age of 65 is not deemed “cost effective.” I am 67 years old. If I have a heart attack, I might need a bypass operation. Because government regulations do not allow such a procedure in someone my age, I do not get it. I die. It’s that simple. That is how the Cost Commission effectively will be a Death Panel.

If you read the PPAHCA legislation, particularly Section 6301, you will become totally confused with the apparent limitations, constraints and justifications in the law. It seems to say that the government cannot use the research – the results of the Cost Effectiveness Commission or PCORI work – as statutory limitations on care. However they obfuscate, the government’s suggestions – call them recommendations, advisories or maybe guidelines – WILL be implemented as policy. The British NHS is doing that there right now with its service cuts, and the same thing will be coming soon to a hospital near you.

No doubt there are people reading this saying to themselves, Well maybe so, but that doesn’t apply to me because I have private, not government, health insurance. Sorry, I must reply, you too will be sentenced by a Death Panel.

Private insurance companies follow government guidelines regarding benefits, exclusions, and payment schedules. Whatever Medicare does, the private insurers follow suit. So effectively, whatever the government Cost Commission declares ‘not cost effective’ will instantly become unavailable to 99+% of the population.

When the government rations medical care by approving or denying payment, they determine who gets care and who does not. However they rationalize what they do, any group that decides who lives and who dies is a Death Panel.

Is that how we want a government “of the People, by the People and for the People” to act?

Addendum
Several people wrote the Rio Grande Foundation with questions and concerns about this article as originally written. Two common themes were that the PPAHCA makes no mention of a “Cost Commission” and that any such Commission did not have the statutory power to function as a Death Panel. Because of these comments and suggestions, I revised the original article to the above form to respond and clarify.

J. Deane Waldman MD MBA is the author of “Uproot U.S. Healthcare,” Tenured Professor in both the Medical and Management Schools at University of New Mexico and Adjunct Scholar for the Rio Grande Foundation.

Our next governor has a huge plate of problems to deal with on Day One of her administration starting next month, and I would have preferred to lessen her decision load, but unfortunately, I’m afraid I’m going to pile on one more — ObamaCare.

Twenty states have joined in an amended federal lawsuit against the Reid/Pelosi/Obama nationalized health care plan.

Granted, my doctor is kind of a career curmudgeon, so it didn’t surprise me a bit last week when I was in his office for a routine checkup, he started in on the legislation.

He’s not a partisan politics kind of guy. He hates all politicians. He originally came to New Mexico recruited as the chief medical officer at a major hospital in Albuquerque. He quit after several years and opened his own single general practice. I asked him why he quit the major hospital, and he simply replied, “I got tired of the bureaucratic mess.” He thinks ObamaCare will make things even messier. And so do I.

Quite simply, ObamaCare is a national disgrace and its legislation clearly exceeds constitutional authority. It is patently unconstitutional for the federal government to break the backs of New Mexicans by trampling the Constitution, and then threaten to use IRS agents to enforce this ridiculous plan.

As written, the bill states if a New Mexican citizen doesn’t have health insurance and takes no action, he or she will be committing a crime in the eyes of ObamaCare.

Gov.-elect Susana Martinez (and Attorney General Gary King, for that matter) really needs to get that message and make the decision that, like 20 other states and counting, New Mexico is not going to join the unconstitutional coercive actions of the federal government.

The push-back is already happening. This week in the state of Virginia, a U.S. district judge became the first federal judge to strike down the law, siding with the Virginia attorney general in saying that the mandate overstepped the Constitution.

In a few years, New Mexicans taxpayers will be forced to pay millions of dollars for the program and eventually several billion dollars when the federal government forces the entire plan onto the backs of New Mexican taxpayers.

Specifically, the lawsuit, filed in federal court in the northern district of Florida, alleges that the new law infringes upon the constitutional rights of citizens by mandating all citizens and legal residents have qualifying health care coverage or pay a tax penalty. By imposing such a mandate, the law exceeds the powers of the United States under Article I of the Constitution.

Even more, the tax penalty required under the law constitutes an unlawful direct tax in violation of Article I, sections 2 and 9 of the Constitution.

The lawsuit further claims the nationalized health care plan infringes on the sovereignty of the states and the 10th Amendment to the Constitution by imposing onerous new operating rules that New Mexico must follow — as well as requiring our state to spend additional dollars without providing funds or resources to meet the state’s cost of implementing the law.

ObamaCare has just started to kick in

Companies are canceling or threatening to cancel coverage because the new terms of doing business make business uneconomical. In a recent national survey, 70 percent of doctors polled stated they were unhappy with the Affordable Care Act (as ObamaCare ended up being called).

Some insurance companies announced they would no longer write child-only policies. The new rules say that beginning now, no insurer can refuse coverage to an already-ill child, and that the premiums can’t be higher than those charged for well children. (In a few years the “anti-discrimination” rule will apply to adults.)

My curmudgeon doctor aside, how can you run an insurance company when parents can wait until their children are seriously ill to buy coverage — and then the insurer can’t set the premium according to the expected medical services? That’s not insurance. It’s welfare filtered through business.

At issue here is not the details of the more than 2,000 pages of law. It’s the discretionary power the government has acquired because of it. A one-size-fits-all law was written by Congress.

I’m not saying it would be better if there were no components of ObamaCare enacted into law at all. But the second-best solution is ObamaCare without bureaucratic discretion. Sure, if waivers are selectively granted, some of the harms of ObamaCare will be mitigated. But if no waivers can be granted, people will see the full effects of ObamaCare and may rise up to demand its repeal.

Ultimately, ObamaCare may be decided by the U.S. Supreme Court. But a good start towards voicing our point of view about the unconstitutional components of the bill would be to join states challenging them.

There has recently been a great deal of consternation and concern over the rate increase enacted by Blue Cross Blue Shield New Mexico (BCBS). The company, a “mutual” firm which is legally obligated to re-invest any profits back into the company, had originally requested a 24.6 percent rate increase. Then, just as the Public Regulation Commission (PRC) was holding public hearings on the issue, an agreement was reached that allowed Blue Cross to raise rates by 21 percent this year. Approval of the rate hike, absent public input, generated a public outcry.

But I believe that anger at Blue Cross is misplaced. It is our political leaders in Washington and Santa Fe, who have gotten us into this mess and, given the recently-signed health care law in Washington, are continuing to make the situation worse. The problem we face in New Mexico (and nationwide) is the rapid rise in health care costs. The truly unfortunate thing is that Washington’s “reform” bill will do nothing to mitigate this problem and is actually designed to make the situation worse.

Notably, the rate hike agreement applies to individual plans, but not group plans. I happen to own an individual health savings account plan and will be among the 40,000 New Mexicans impacted under this rate hike (this is a much smaller group than the 825,000 adults aged 18-64 who are insured in some form of group plan in New Mexico).

As a result of the PRC decision, my insurance costs will rise despite the fact that health savings accounts like mine actually reduce health care costs. In Indiana, for example, the state government has given government workers a health savings account option. Participants in the new plan ran up only $65 in cost for every $100 incurred by their associates under the old coverage.

Not only are these “consumer-driven” plans not encouraged in the health care bill, the new law is actually going to make consumer-driven plans like my health savings account less attractive through additional, onerous rules and regulations.

Consumer-driven plans are just one possible solution, however. In a competitive health care market, there would be no need for the PRC to hold hearings on rate hikes, nor there a need for government-enforced transparency. Take the car insurance marketplace, for example. There are dozens of companies competing to provide New Mexicans with the best, lowest cost car insurance. Why is that? The single biggest difference is that car owners pay for their insurance and they have incentives to both shop around and not over-use their insurance.

What can be done? The simple fact is that at this point, if we want to control health care costs, we need to rely on the courts to abandon ObamaCare. This is a real possibility as the federal government has never forced Americans to purchase any product in the past, so there are real Constitutional questions here.

Obama’s health care plan is doomed to fail because, by mandating that individuals purchase health insurance, it only reinforces the third-party payment system and further reduces incentives for people to be responsible and care what they spend on health care.

But the federal health care plan will do little or nothing to cut through any of the other rules and regulations (like coverage mandates, licensing, or liability laws) that have caused prices to rise so rapidly in recent years. An analysis by the Health and Human Services Department stated that “the overhaul will increase national health care spending from 2010-2019.” So, as bad as this 21 percent hike looks now, don’t look for the situation to get any better. In fact, more massive price hikes are on their way under ObamaCare.

To make health care more accessible and less costly, we have a competitive, mostly market-based model to follow in car insurance, but Congress is taking us in the opposite, more heavily-regulated direction that locks in the third-party-payer model that caused these rate increases in the first place. Now, more than ever, we need change, but the change we need is to empower individuals to pay for and wisely use limited health care resources.

Paul Gessing is the President of New Mexico’s Rio Grande Foundation. The Rio Grande Foundation is an independent, non-partisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility.

Advocates of government-provided health care point to European systems as models. “Socialized medicine is good, and you get it free,” they say.  Well I have friends and relatives in Europe, mostly in the Netherlands, and I’ve spent considerable time dealing with the Dutch medical system on behalf of my mother.  I’ve learned that it’s not all that good and most certainly is not free.

Dutch medical care appears to be adequate, though there’s often a long wait for a specialist.   In particular, medical care for the elderly is tightly rationed.  If you’re past a certain age, no more pap smears (which detect cancer), mammograms, hip replacements, or other treatments deemed “not cost effective.” In other words, someone in authority thinks you’re not worth it.  So live in pain, or pay for treatment yourself.

I am no expert in health care, so I can’t compare Dutch doctors to Americans in technical terms.  But I will say that our doctors here in America are more personally interested in their patients and spend more time with them.  In contrast, Dutch doctors tend to be less personal. You are assigned to a doctor, and if you don’t like him it’s very hard to switch.  Moreover, you’re assigned to one in your neighborhood, with the result that people in richer neighborhoods get the best doctors.  So much for the equality that socialized medicine is supposed to bring.  Anyway, considering the quality of the care, I much prefer our Albuquerque doctors, nurses, and hospitals.

This may all change if the White House has its way on health care reform.  I doubt that our doctors will be so charming when their Medicare reimbursements are reduced, patient loads go up, and regulations multiply.

What about the price the Dutch have to pay? In Holland, everyone is covered by a government-run health insurance, but they have to pay for it.  For example, a retired couple pays around $400 a month, deducted from their pension.  Working people pay more. Some dental procedures require a large copayment.  But these fees fall far short of the huge costs of socialized medicine, and so much of the funding comes from Holland’s heavy taxes.  Their income tax can reach a maximum marginal rate of 60 percent.  Most goods are subject to a value added tax of 19 percent.  Cars and gasoline are heavily taxed, and a flock of other taxes also are collected.  So it’s either premiums, taxes, or some of both.

Socialized medicine costs plenty.  And it’s not “the government” that pays; it’s everyone. Those who think that socialized medicine will relieve them of the costs of insurance are deluded.

Agnes Brown is an Albuquerque resident and American citizen. She was born in Amsterdam, Holland, cared for her mother’s end-of-life needs under the Dutch health care system, and maintains many contacts in the Netherlands.

New Mexico Sen. Dede Feldman — and many advocates of a government takeover of U.S. health care — is adamant that a so-called “public option” be included in any reform package passed by Congress. In a recent opinion piece, Feldman cited Medicare as a model, saying it “has been one of the most popular programs in U.S. history…” and that it has been successful at keeping down administrative costs and providing basic coverage to virtually all seniors.

Thus, Medicare is the government-run health care model America needs to cure its health care woes which are, in the view of Feldman and others, caused by hospitals, pharmaceutical companies and insurance companies. The possibility that government could be at fault for any health care problem never seems to cross her radar screen.

Well, I’ve got news for Sen. Feldman and those who want “Medicare for all”: Medicare is at the very root of what is wrong with American health care — and to an extent our economy — and a massive expansion of the program would quickly bankrupt the nation. For starters, Medicare’s expected future obligations exceeded premiums and dedicated taxes by an astounding $89 trillion. That’s about 5 1/2 times the size of Social Security’s ($18 trillion) unfunded liability and about six times the size of the entire U.S. economy.

The massive deficits our nation currently faces are a big problem, but they pale in comparison to those that have resulted from Medicare, a program that scrimps on administrative costs — as Feldman notes — but loses billions each year in fraudulent claims.

For starters, according to an Associated Press story late last year, the inspector general for the U.S. Department of Health and Human Services found that 70 percent of Medicare payments in 2008 for patient medical supplies for the elderly and disabled should not have been approved.

One of the major objectives of health care reform is improvement in the delivery of services to Americans. The need for improvement is obvious. A news story by MSNBC, based on an investigation by a subcommittee of the U.S. Senate Homeland Security Committee, reported that more than a billion dollars in claims were paid between 2001 and 2006 without valid medical diagnostic codes. The result has been a host of cases involving senseless waste.

For example, in some cases cited by the report, leg amputees were approved for medical shoes; wheelchairs were prescribed for patients with sprained wrists; and walkers were provided for paraplegics who would never take another step.

Of course, when Medicare does try to cut costs, it usually does so by cutting reimbursements to doctors. This results in cost-shifting from the government onto the backs of private insurers, employers, patients, and most of all, doctors. The most recent data available show that Medicare alone shifted $48.9 billion in costs onto the backs of the private sector one year. This number doesn’t even include Medicaid, another costly government program, which shifted $39.9 billion in much the same way.

The fact is that there is no “free market” in American health care. Government, mostly through Medicare and Medicaid, pays for approximately 50 percent of all health care in this country. What it doesn’t pay for directly, government regulates with a heavy hand in ways that further drive up costs. These regulations include state mandates, licensing and the bureaucratic and costly Food and Drug Administration to name just a few.

“Medicare for all” will only result in greater indebtedness, higher taxes and dramatically increased waste, fraud and abuse, the costs of which will be paid for by all of us. Until Congress and legislators wake up and realize that government is not the solution to our health care problems, rather it is creating and exacerbating the problems we now face, the costs of paying for our health care will rise, placing an ever-greater burden on our society.

Rather than relying on bigger government to solve our problems, policymakers should work to limit government’s role to paying for only the neediest — preferably at the state level. They should also restore the doctor-patient relationship by empowering consumers to shop around for the highest quality care at the best prices. Those steps will lead to what we all want: better care, available to greater numbers of people and at reasonable costs.

Paul Gessing is president of the Rio Grande Foundation; a non-partisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility.

The Following are a few examples of the ways in which socialized medicine around the world has had a negative impact on patients in dire need of treatment. If a similar system is enacted here in the United States, Americans in need of medical care will encounter many of the same problems.

• *Natasha Richardson: The province of Quebec lacks a medical helicopter system, common in the United States and other parts of Canada, to airlift stricken patients to major trauma centers. Montreal’s top head trauma doctor said Friday that may have played a role in Richardson’s death

“It’s impossible for me to comment specifically about her case, but what I could say is … driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn’t set up for traumas and doesn’t match what’s available in other Canadian cities, let alone in the States,” said Tarek Razek, director of trauma services for the McGill University Health Centre, which represents six of Montreal’s hospitals.

• In Canada, Diane Gorsuch waited over two years for a surgery to fix the clogged arteries leading to her heart. She twice had appointments to get that heart surgery. Both appointments, however, were cancelled. Before her third appointment came, she suffered a fatal heart attack.
• In Great Britain, Mavis Skeet had her cancer surgery cancelled four times before her cancer was determined to have become inoperable. Another Brit, Brian Booy, became the ultimate victim of bureaucracy in that he was finally assigned an appointment for bypass surgery a year after he died from a heart attack.
• Swedish Prime Minister Goran Persson had to wait for eight months for a hip replacement. As a result he suffered in great pain and was unable to perform some of his governmental duties. The latest data shows that about 60 percent of Swedish patients needing a hip replacement wait more than three months.
• Alice Mahon, a former member of the British parliament, needs the drug Lucentis to slow her macular degeneration. Because of delays due to the National Health Service not yet having approved Lucentis at the time of her diagnosis, Mahon lost much of the sight in her left eye.
• In Australia, eight-year-old Kyle Inglis has lost 50 percent of his hearing while waiting nearly 11 months for an operation to remove a tumor in his ear. Kyle is one of over 1,000 children waiting over 600 days for ear, nose and throat surgery in Warnbro, a suburb in Western Australia.
• In Great Britain, the National Institute for Health and Clinical Excellence, the government agency that decides which treatments the National Health Service will pay for, has effectively banned Lapatinib, a drug that was shown to slow the progression of breast cancer, and Sutent, which is the only medicine that can prolong the lives of some stomach cancer patients.
• Banning beneficial drugs due to cost is nothing new in Britain; NICE forbade the use of Tarceva, a lung cancer drug proven to extend patients’ lives, and Abatacept, even though it’s one of the only drugs that has been shown in clinical testing to improve severe rheumatoid arthritis.
• The Swedish government system refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves.  Why?  According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so “would set a bad precedent and lead to unequal access to medicine.”

For more information on how we can reform health care in New Mexico in free market ways that empower patients and give the individual, not government bureaucrats, control over health care, go to www.riograndefoundation.org or our blogwww.errorsofenchantment.com. If you’d like to host a representative of the Rio Grande Foundation at your meeting, please give us a call at 505-264-6090.