Michelle:
Health and Human Services Secretary Kathleen Sebelius tried to reassure citizens in New Orleans this week that Obamacare bureaucrats will make sound medical decisions for all Americans. She failed. Under the government-run plan, she promised, a team of health care experts will recommend what should be covered: “I think it would be wise to let science guide what the best health care package is.”
I guess it didn't occur to her that doctors know some science - and they also know something else: they know their patient. No two patients are alike. People do not want an "approved treatment protocol" - they want to work it out with a doc who is working for them, and is not a de facto civil servant. I think what Sebelius means is not "science": she means a board of cost-containing medical efficiency experts.
However, I do not think anybody wants a government to have that sort of power. Governments create omnipotent monopolies.
It's one thing for a private medical insuror to tell you they don't cover in vitro fertilization, and another for the government to tell you that you cannot have it because "science says" that it's not cost-effective. In the former case, it's a freely-entered association, as Milton Friedman would say, and if you want the in vitro badly enough, you can save your pennies and get one. Furthermore, I'd much rather make an appeal to a private biz than to the government.
We suspect that the government wants two things: 1. To get more folks on the Government Plantation and, 2. To control Medicare costs. Re the latter, the O might be right that it may have been unwise for his Grandma to have a hip or knee replacement when she was dying from cancer - but he is correct that 80% of medical costs occur in the final year of life. However, unless somebody has terminal cancer or something comparable, how do you know it's somebody's final year of life in advance?
Another related issue is the equating of "health care" (a dumb term) with medical insurance. I suppose with the high costs of medical technology and hospital treatments, those costs are out of reach for the average person (which is why we buy cheap catastrophic, ie high-deductible medical insurance) but, for most purposes in life, a regular office visit for a bad sore throat or a camp physical doesn't cost very much at all, while an ER visit for your bad sore throat can set you back $750.
We agree that it is foolhardy for anybody who is not wealthy - especially for a family - to carry no catastrophic major medical insurance, because bankruptcy sucks. We also think it is foolish for people to expect insurance to cover every office visit: the whole point of insurance is supposed to be that you hope you never need it.
However, years of Medicaid (for the poor), Medicare (which pays for everything, at low rates), union-driven medical benefits and work-related medical benefits have produced a sense of entitlement and, we would argue, have driven up the cost - and the quality - of medical treatment in the US.
What is the right role for government in medical care? We don't know, and we don't trust anybody who says they know. Fact is, government already controls much of it via Medicare, Medicaid, and now SCHIP. It has been incrementalism at work, with the long socialist view. One thing we do know is that fewer and fewer Docs want to accept Medicare, and few ever accepted Medicaid except for charity clinics and inner city Medicaid mills staffed by foreign medical graduates.
Why do so many Docs opt out of Medicare? Because of the paperwork requirements and the unsustainable rates of reimbursement. When people get a doctor's bill, they often forget that it's not a bill for his time: it's a bill for his rent, his machines, his two nurses, his insurance coder, his bookkeeper, his receptionist, his staff's benefits, his malpractice insurance, etc. Your local Internist and Pediatrician is not getting rich on $65 office visits these days. In fact, they are struggling.
No, the big costs are tests, some medicines, hospitalizations, cancer treatments, dialysis, the ICU, etc. The big ticket items - and those costs are not compressible. They can only be rationed if costs are to be cut. We do not think those costs should be cut, because we believe that such decisions are a matter of personal choice and freedom and, as they always say, "All you have is your health." Or your disease, as the case may be.
We wish we knew the right answers to all of these issues but, despite the problems, we will say one thing: With the best, most innovative and most available medical care in the world, one must be extremely careful about messing with it. Freedom is always messy. We re-link Cardinal at Tigerhawk's defence of American medicine.
From another point of view, a quote from an annoyed Vanderleun's Who, Whom?, which reiterates our Roger's thoughts about The Plunder Economy:
Who—whom?" Who shall be forced to give up the health care that they like (most Americans), and whom shall receive health care they (supposedly) ain't got -- for free -- at a cost to everyone else of trillions in dollars and immeasurable quantities of freedom and privacy and security.
Who (shall give)? You and hundreds of millions of others. Anyone who has a job, or makes things, or owns things that can be taxed. And then have a fee for this or that levied (for the common good). And then taxed again.
Whom (shall receive)? The poor shall be marched to the front of the line; their ragamuffin children with protruding bellies on their shoulders for the photo-op. But right behind them will come.... the slackers, the lazy, the whacked-out, the grifters, the hustlers, the useless, the career recipients of endless government hand-jobs, the hard-core unemployable, the 17% of crack whores that do not work for the government, and a few million others that form the hard, adamantine core of Obama's and the Democrats' aptly named "base."
"From each according to his ability, to each according to his needs," is what's going on here. Except this time the add-on is "Even if you don't need it or want it, because little Susie the crack whore does. P.S. We're gonna slip in some language to pay for her abortion too, just because it will piss you off."
That is a bit cold, Mr. V.
Written by The B and BD together.
