As Americans spend the next few weeks discussing health care reform, I thought it might be helpful to share some articles (and one panel discussion video) that I’ve found especially insightful.
Washington Post editorial, July 26, 2009
But Mr. Obama's soothing bedside manner masks the reality that getting health costs under control will require making difficult choices about what procedures and medications to cover. It will require saying no, or having the patient pay more, at times when the extra expense is not justified by the marginal improvement in care.
Betsey McCaughey, Wall Street Journal, July 30, 2009
But legislation now being rushed through Congress—H.R. 3200 and the Senate Health Committee Bill—will reduce access to care, pressure the elderly to end their lives prematurely, and doom baby boomers to painful later years.
The Congressional majority wants to pay for its $1 trillion to $1.6 trillion health bills with new taxes and a $500 billion cut to Medicare. This cut will come just as baby boomers turn 65 and increase Medicare enrollment by 30%. Less money and more patients will necessitate rationing. The Congressional Budget Office estimates that only 1% of Medicare cuts will come from eliminating fraud, waste and abuse.
[See also Dr. McCaughey’s rebuttal of PolitiFact’s Truth-O-Meter re: “End of Life Counseling” here.]
Senator Sam Brownback, National Review, August 3, 2009
One particular provision in the Democratic bill has seniors worried, and rightly so. A new “Center for Health Outcomes Research and Evaluation” could ration access to medicines and treatments based on the government’s assessment of the value of a human life and the “cost-effectiveness” of treatment.
Raymond Arroyo, EWTN, July 25, 2009
Here’s to your health, unless you are too old, too young, too disabled or any combination of the above. The health care reform bills wending their way through Congress should be focused on the well being of each citizen. Instead, it seems the bills, designed to contain costs while simultaneously extending health coverage to everyone, target certain vulnerable groups including the elderly, the pre-born, and the disabled. It all comes down to cost. How to pay for this colossus remains a question on the Hill. But the consensus seems to be: raise taxes and ration care. Both ideas have been woven into the current health care bills.
Betsey McCaughey, New York Post, July 24, 2009
[Obama health policy advisor Dr. Ezekiel] Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens... An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).
Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.
He explicitly defends discrimination against older patients: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).
Thomas Sowell, Real Clear Politics, August 4, 2009
If we can be so easily stampeded by rhetoric that neither the public nor the Congress can be bothered to read, much less analyze, bills making massive changes in medical care, then do not be surprised when life and death decisions about you or your family are taken out of your hands-- and out of the hands of your doctor-- and transferred to bureaucrats in Washington.
David S. Broder, Washington Post, July 26, 2009
If President Obama has his way, another such unelected authority will be created -- a manager and monitor for the vast and expensive American health-care system. As part of his health-reform effort, he is seeking to launch the Independent Medicare Advisory Council, or IMAC, a bland title for a body that could become as much an arbiter of medicine as the Fed is of the economy or the Supreme Court of the law.
The Heritage Foundation, July 30, 2009
7. Who Makes Medical Decisions? What is the right medical treatment and should bureaucrats determine what Americans can or cannot have? While the House and Senate language is vague, amendments offered in House and Senate committees to block government rationing of care were routinely defeated. Cost or a federal health board could be the deciding factors. President Obama himself admitted this when he said, "Maybe you're better off not having the surgery, but taking the painkiller," when asked about an elderly woman who needed a pacemaker.
National Review editorial, July 30, 2009
The public option is certainly a weakness of the current House Democrats’ bill, one that could destroy the private-insurance market over time. But the rest of the bill takes the same federal-government-knows-b
est approach. It uses mandates on employers and individuals to force tens of millions of Americans to buy the level of insurance coverage the federal government demands. For those who cannot afford this level, it offers subsidies in the form of a new entitlement. And it increases the federal role in telling doctors and hospitals what constitutes appropriate medical practice.
The mandates -- effectively, they are taxes -- will reduce wages, limit new hires, and increase prices. The subsidies, enormously expensive from the outset, can be expected to grow with time to cover a larger and larger share of the population, just as Medicaid has done, and for the same political reasons. And having the government dictate medical practice worsens care and will inevitably lead to rationing.
Thomas L. DiLorenzo, Mises Daily, July 28, 2009
Price controls, or laws that force prices down below market-clearing levels (where supply and demand are coordinated), artificially stimulate the amount demanded by consumers while reducing supply by making it unprofitable to supply as much as previously. The result of increased demand and reduced supply is shortages. Non-price rationing becomes necessary. This means that government bureaucrats, not individuals and their doctors, inevitably determine who will get medical treatment and who will not, what kind of medical technology will be available, how many doctors there will be, and so forth.
All countries that have adopted socialized healthcare have suffered from the disease of price-control-induced shortages. If a Canadian, for instance, suffers third-degree burns in an automobile crash and is in need of reconstructive plastic surgery, the average waiting time for treatment is more than 19 weeks, or nearly five months. The waiting time for orthopaedic surgery is also almost five months; for neurosurgery it's three full months; and it is even more than a month for heart surgery (see The Fraser Institute publication, Waiting Your Turn: Hospital Waiting Lists in Canada). Think about that one: if your doctor discovers that your arteries are clogged, you must wait in line for more than a month, with death by heart attack an imminent possibility. That's why so many Canadians travel to the United States for healthcare.
Thomas Sowell, Real Clear Politics, August 5, 2009
If this new medical scheme is so wonderful, why can’t it stand the light of day or a little time to think about it?
The obvious answer is that the administration doesn’t want us to know what it is all about or else we would not go along with it. Far better to say that we can’t wait, that things are just too urgent. This tactic worked with whizzing the “stimulus” package through Congress, even though the stimulus package itself has not worked.
Any serious discussion of government-run medical care would have to look at other countries where there is government-run medical care. As someone who has done some research on this for my book, “Applied Economics,” I can tell you that the actual consequences of government-controlled medical care are not a pretty picture, however inspiring the rhetoric that accompanies it.
The Cato Institute Policy Forum
Michael D. Tanner, Cato Institute, August 2009
The reality, however, is that every government-run healthcare system around the world rations care.
In Great Britain, the National Institute on Clinical Effectiveness makes such decisions, including a controversial determination that certain cancer drugs are "too expensive." The government effectively puts a price tag on each citizen's life...
Free-market healthcare reformers, on the other hand, want to shift more of the decisions (and therefore the financial responsibility) back to the individual.
Arthur B. Laffer, Wall Street Journal, August 5, 2009
Rather than expanding the role of government in the health-care market, Congress should implement a patient-centered approach to health-care reform. A patient-centered approach focuses on the patient-doctor relationship and empowers the patient and the doctor to make effective and economical choices.
A patient-centered health-care reform begins with individual ownership of insurance policies and leverages Health Savings Accounts, a low-premium, high-deductible alternative to traditional insurance that includes a tax-advantaged savings account. It allows people to purchase insurance policies across state lines and reduces the number of mandated benefits insurers are required to cover. It reallocates the majority of Medicaid spending into a simple voucher for low-income individuals to purchase their own insurance. And it reduces the cost of medical procedures by reforming tort liability laws.
Deroy Murdock, National Review, July 20, 2009
Health-care reform should give Americans the option of using money tax-free to purchase whatever kinds of health insurance make them happy. If employers offer such plans, lovely. If not, individuals should be encouraged, through tax-free Health Savings Accounts, to buy their own policies and maintain them throughout their careers. This dramatically would reduce the tragedy of “job lock,” whereby employees put up with bosses and duties they cannot stand, merely to keep employer-furnished health coverage.
Mark Steyn, Orange County Register, July 31, 2009
How did the health-care debate decay to the point where we think it entirely natural for the central government to fix a collective figure for what 300 million freeborn citizens ought to be spending on something as basic to individual liberty as their own bodies?
There is a lot of wisdom in the above articles, but I’m most impressed by the common sense of ordinary Americans, like the citizen from Pennsylvania who told Senator Spector:
“What I see is a bureaucratic nightmare, Senator. Medicaid is broke. Medicare is broke. Social Security is broke. And you want us to believe that a government that can’t even run a Cash for Clunkers program is going to run 1/7th of our U.S. economy?”
I couldn’t have said it better myself.
- Sarah Palin