The US Healthcare Debacle

Jeff Deist and Charles Hugh Smith discuss the absurdly anti-market healthcare system in the US, which has been captured both by regulators and insurance lobbyists.

Why do US consumers tolerate not knowing what drugs and procedures really cost? What will it take to allow market pricing in medicine? Will the best and brightest continue to shun medical school in an age of Obamacare? And will the market overcome the system, through cash-only clinics, concierge care arrangements, and medical tourism? If you're outraged by what the state has done to the profession of medicine, stay tuned for great interview.

Thanks Obamacare: My 2015 Medical Insurance Premium is Going Up Over 20%

As a follow up to: Wonderful Obamacare: Average Monthly Premium Costs Before and After the Affordable Care Act, an EPJ reader emails:

Being self-employed, I directly pay my medical insurance (for me and the family).  For years, the premiums have stayed more or less the same – once in a while, I even got a small rebate check from the insurer.  For 2015, my premium is going up over 20%.
 

Over 200,000 Doctors Avoiding Obamacare Plans

The number of physicians nationwide that are declining to accept health plans from Obamacare exchanges is growing.

As of May 2014, over 214,000 doctors wouldn’t participate in Obamacare plans, and that number may be growing, according to AAF, a free-market think tank in Washington. While some Obamacare kinks have been worked out over the past year, exchange plans remain as unfriendly to doctors as ever.

Daily Caller writes:

Obamacare puts physicians — especially the dwindling number of those in private practice — in an especially difficult financial situation, expecting doctors to eat the costs of patients who discontinue coverage and to simply take on more patients to make up for bottom-level reimbursements.

Exchange plans nationwide pay on average significantly less than plans in the private market and even Medicare, according to AAF. While private plans generally pay doctors $1.00 for performing a given service, Medicare averages just $0.80; exchange plans are allowing doctors just $0.60 for the same thing..

The low physician reimbursements are likely borne out of the administration’s strong-handed push to keep Obamacare premium hikes as low as possible. In order to keep price low, insurers have to cut costs somewhere; in exchanges, companies moved to covering just narrow networks with few in-network physicians and offering low reimbursement rates to doctors with the promise that if physicians work even more, they’ll recoup their losses.

But the structure of the Affordable Care Act itself puts doctors who accept plans purchased on Obamacare exchanges at risk of never being paid at all. Obamacare requires insurers who sell plans on the exchanges to keep coverage active even after a customer has stopped paying their premiums, for an extra 90 days.

For the first 60 days after a customer has stopped paying but is still insured, the insurance company has to pay for any care the patient uses. But for any services used in the final 30 days before a customer’s insurance can be terminated, doctors that see those patients won’t be paid at all.

It’s no wonder that in such an unfriendly climate for physicians, many are staying out of Obamacare plans.

Actuaries Raise Life Expectancy for US 65-Year Olds

A decline will eventually set in, once Obamacare begins to have its long term impact of poorer quality healthcare. Life expectancy will be the real measure, long term, of what Obamacare has done to United States healthcare.

Wal-Mart, That Economic Wrecking Ball

By Ilana Mercer

To ameliorate the effects of the Obamacare wrecking ball, Wal-Mart Stores, Inc., is venturing into the business of providing primary health care. For $40, the price of a copay (mine are way more), "you can walk into a Wal-Mart clinic and see a doctor." It's "just $4 for Walmart U.S. employees and family members."

Sandra Fluke: You can have a pregnancy test at Wal-Mart for ... $3.00.

Via MarketWatch:

On Friday, a Walmart Care Clinic opened in Dalton, Ga., six months after Walmart U.S., the retailer’s biggest unit, entered the business of providing primary health care. It now operates a dozen clinics in rural Texas, South Carolina and Georgia and has increased its target for openings this year to 17. A ... cholesterol test [will cost] $8. A typical retail clinic offers acute care only. But a Walmart Care Clinic also treats chronic conditions such as diabetes. (Walmart U.S. also leases space in its stores to 94 clinics owned by others that set their own pricing.)
“It was very important to us that we establish a retail price in the health-care industry because price leadership matters to us,” said Jennifer LaPerre, a Walmart U.S. senior director responsible for health and wellness, in an interview.

Let the anti-Wal Mart jousting begin.

Typically, critics of Wal Mart—for example, Marian Kester Coombs, writing for The American Conservative—will do nothing to trace the mysterious mechanism by which Wal-Mart is said to impoverish. By offering “the lowest possible prices all the time, not just during sales”? What precisely is the economic process that accounts for Wal-Mart’s ability to “expel jobs and technology from our own country”? Competition? Offering a product people choose to buy?

“Protecting the home market,” which is what TAC writer advocates, is to the detriment of consumers. It forces them to subsidize less efficient local industries, making them the poorer for it. To keep inefficient industries in the lap of luxury, hundreds of others are doomed to shrink or go under.

The writer aforementioned also froths at the mouth over “the teenage girl in Bangladesh … forced to sew pocket flaps onto 120 pairs of pants per hour for 13 cents per hour.” It sounds dreadful. However, the economic reality is this: Wal-Mart is either offering higher, the same or lower wages than the wages workers were earning before its arrival in Bangladesh. The company would find it hard to attract workers if it was paying less, or the same as other companies. Ergo, Wal-Mart is a benefactor that pays the kind of wage unavailable prior to its arrival. More material, if the entrepreneur were forced to pay workers in excess of their productivity, he would eventually have to disinvest. What will the Bangladeshi teenage girl do when that happens?

Ilana Mercer is author of Into the Cannibal's Pot: Lessons for America from Post-Apartheid South Africa. ©2014 By ILANA MERCER

Absolutely One of the Strangest Reasons Why Health Insurance Plans are Getting Cancelled Under Obamacare

This sounds to me like some kind of crony method of causing most insurance plans to eventually be flipped into different plans, and perhaps flipped again.

As Carlyle Group co-founder would put it, "The devil is in the details."

The Affordable Care Act Will Push More Women Than Men Into Part-Time Work

Casey Mulligan writes:

The ACA imposes a penalty on large employers (generally those with 50 or more workers) who fail to provide health insurance for each of their full-time employees-defined by the ACA as those working 30 hours a week or more. Because part-time employees do not count toward the penalty, the provision induces employers to reduce more of their workers to 29 hours a week or less-a group now being referred to as the "29ers."...[A] number of positions have traditionally been 30-to-39-hour jobs, and those who occupy these jobs typically will have less trouble adapting to a 29-hour schedule that avoids the employer penalty or allows the worker to get the ACA's new assistance. Women are at least twice as likely as men to be in those positions, which means they are twice as likely to be 29ers once the new health law goes into full effect.

10 Medical Breakthroughs Helped Re-Shape Healthcare This Year:

I expect that medical breakthroughs will dramatically decline once Obamacare fully kicks in. Below, the Cleveland Clinic reports on recent pre-Obamacare breakthroughs :

10. Targeted therapy for cancer

There’s new hope for people with chronic lymphocytic leukemia (CLL), a cancer responsible for 4,400 American deaths per year. After promising clinical trial results, the first-in-class oral drug ibrutinib is expected to be approved by the U.S. Food and Drug Administration for treatment of CLL. The drug targets malignant cells while sparing a patient’s immune system.

9. Heart risk through the gut

In 2013, researchers added a new biomarker to the hunt for heart disease: TMAO. Your body produces TMAO (trimethylamine N-oxide) when your gut bacteria digest choline, which is found in egg yolks, red meat and dairy products. Choline is thought to promote hardening of the arteries. TMAO provides an accurate screening tool for predicting future risks of heart attack, stroke and death.

8. Personal sedation station

Novel, personalized “sedation station” technology will allow healthcare professionals other than anesthesiologists to deliver the light sedation required for life-saving colonoscopies. The technology could help bring the nationwide cost of this crucial test down by an estimated $1 billion per year.

Estimates of How Many People Will Lose Employer-Provided Health Coverage Keep Rising

The below chart shows the year-by-year increase in the estimates by the Congressional Budget Office of how many people will lose employer-provided health-care coverage by 2019.

Another Warning About Switching Your Healthcare Plan

I have posted on this before, but this is a very important topic, so here is a slightly more comprehensive explanation of a key section in Obamacare. 

If  you have been on a continuous healthcare plan since March 23, 2010, it may get very expensive to switch, thanks to certain regulations in Obamacare.

A friend emails:

Read the below carefully, because effective 1/1/14, unless the law is successfully challenged, if you are not “grandfathered” on your plan your plan fees will be based on your earned income—age will not be the major factor in coverage cost any more.  However, for some reason the media has been completely mum about this, and I’m not sure why.  Those that have money will be paying not only for their own coverage, but will be paying for those with lower-than-average incomes who will get tax advantages so that they can purchase affordable income, as well as for the new new automatically included coverages (e.g. maternity) that must be covered in the new mandated plans, all relating to younger folks (which is why income, rather than age, will now be the deciding factor in the cost of health plans) .  Worse, those without health plans will be charged a percentage of income (going up each year) for NOT having a qualified plan!  This may conceivably also affect employers who have switched (or plan to switch) group health plans, so speak with professionals before considering making any changes in your current coverage if you have been on a continuous plan since 3/2010.

From healthcare.gov:

Grandfathered Health Plans

The Affordable Care Act exempts most plans that existed on March 23, 2010 — the day the law was enacted — from some of the law’s consumer protections. This preserves consumers’ rights to keep the coverage they already had before health reform. 

What This Means for You

If you have health coverage from a plan that existed on March 23, 2010 — and that has covered at least one person continuously from that day forward — your plan may be considered a “grandfathered” plan.

This is true whether you are covered by an individual health insurance policy that you had on that date, or you are covered by a job-based health plan that your employer established before March 23, 2010. This is true even if you enrolled in that job-based plan sometime later.

A grandfathered health plan isn’t required to comply with some of the consumer protections of the Affordable Care Act that apply to other health plans that are not grandfathered. 

Donna Brazile Gets Obamanized (Note: Very Painful)

Donna Brazile, apologist for everything Obama, syndicated columnist, television political commentator on CNN and ABC, is bitching about her soaring healthcare insurance premium. She doesn't know why it is going up. I've covered some of the why here and here, but the short and long answer is Obamacare.

Below is her "health care works" cheering on of ACA via a tweet last year, underneath that is a tweet from her today where she is bitching about her healthcare premium climbing and not getting a good answer as to why  it is going up. She still doesn't seem to get that she has been Obamanized. Crony Obama Healthcare= More expensive care + poorer quality care.

LOL, this almost makes Obamacare worth it in terms of entertainment value.

(ht Dan Cotter)

WARNING Health Insurance Under Obamacare: "The More You Make The More You'll Pay"

I have already pointed out how a small businessman in California saw his health insurance premium triple because of Obamacare (See:  First Obamacare Horror Story)

A friend familiar with the industry emails and points me to a summary at the NOLO legal encyclopedia that explains how healthcare insurance premiums are going to become income based. NOLO writes (my highlight)

4. You Can Get Health Coverage If You Need It

Starting in 2014, U.S. citizens and legal residents will be able to buy health insurance through a new system of exchanges run by state government agencies or nonprofits (these exchange programs are officially called "American Health Benefit Exchanges"). Families and individuals whose income is on the lower end of the scale -- up to four times the federal poverty level, or just over $88,000 for a family of four -- will be entitled to credits and subsidies to help with some or all of the costs for coverage.

The amount that an individual or family will need to pay for health coverage will be based on total income -- the more you make, the more you'll pay for coverage. The CBO estimates that 20 million individuals and families will be entitled to receive subsidized health insurance under the new law.

My friend concludes:

The above is one of the more succinct of the articles about the coming law.  #4 is the provision that I was told about by somebody who works at Blue Cross, but the government and even the media has been keeping very mum about it….I usually know about this stuff a mile ahead of time but was really caught, because one provision not mentioned in this article (unless changed, as a lot of these reforms are being challenged) is about the grandfathering of current plans back to sometime in 2010, where if you have had the same policy since then you won’t be charged based on income. 

 Obviously lower income folks will move off of these plans to where they can get cheaper coverage, but those making money will be lucky if this provision sticks and will stay with their current plans.

Most of the new mandated coverage (i.e. maternity care) that will be increasing the costs of the plans are for young folks, but people of all ages, and especially those in higher income brackets, will be subsidizing the costs of the new features of the plan, as well as the cost for those who are in the lowest income brackets and are getting credits to keep the costs of their plans down. 

I’m sure this will become a much hotter topic later this year!

Karl Marx in his 1875 Critique of the Gotha Program:

 From each according to his ability, to each according to his needs.

 Obamacare:

 The more you make, the more you'll pay.

First Obamacare Horror Story

Nancy Pelosi was correct,  only now that the bill has been passed are we going to find out what is in that interventionist piece of legislation, Obamacare.

A California small businessman tells me that he switched healthcare insurance carriers in 2012.  The monthly premium for him and his wife was about $400, but when he received his first bill in January of this year it was for $1,200.  He hasn't been to a doctor in years, his wife has only gone for minor care.

Apparently there is some clause in the Affordable Healthcare Act that results in health insurance firms using a new method to calculate premiums. Those who have health insurance plans that have been in effect since at least 2010 are grandfathered under the old calculation method, but insurance carriers are using a new formula for new plans.

Bottom line: If you have a health insurance plan that you have been using since at least 2010, do not cancel or switch plans without first determining in detail what a new plan is going to cost you and make sure you understand if there are any escalator clauses in any new plan.

Surprise, Surprise, Obamacare Includes a Massive Sales Tax on Your Healthcare Insurance

As Carlyle Group founder and war profiteer David Rubinstein once told me about some legislation, "The devil is in the details."

Maybe this is what Nancy Pelosi meant, when she said that Obamacare needs to be passed so that we can find out what is in it.



Well, we are starting to find out.

Lindsay Boyd at Forbes informs us (my highlights)

While much of the dialogue on healthcare reform centers on the federal mandate of health coverage for all Americans – which many conservatives call the largest tax increase in U.S history – less attention is being given to the massive sales tax increase on the purchase of health insurance also implicit within the legislation that will dramatically escalate costs for employers and consumers.[...]The Joint Committee on Taxation released a reportto Committee of Ways and Means Chairman Dave Camp shortly after the Supreme Court ruling thatrecalculates the costs to insurers, consumers and businesses under the new plan. According to their report – which does not include updated scores for the individual mandate, the employer mandate, or certain other revenue effects – the tax increases that remain on the books will cost taxpayers more than $675 billion over the next ten years. Chief among these will be the sales tax on the purchase of health insurance, totaling $101.7 billion, and making it larger than all the other industry-specific taxes combined.

“The health insurance tax will add a financial burden on families and small businesses at a time when they can least afford it, and it should be repealed, ” says AHIP, a trade association representing health insurance industry providers, in today’s call for the repeal of the health insurance tax before it can take affect. As they report,

· Starting next year the ACA imposes a new $100 billion tax on health insurance. The tax will start at $8 billion in 2014, increasing to $14.3 billion in 2018, and will continue to increase each year.

· The health insurance tax is larger than the device tax and the prescription drug tax combined.

· The health insurance tax will increase costs for individuals and families purchasing coverage on their own, small businesses, seniors and people with disabilities enrolled in a Medicare Advantage plan, and state Medicaid managed care plans.

· The health insurance tax is far greater than the minimum penalty for those who choose not to buy health insurance – further incentivizing young, healthy people to forgo purchasing insurance until they need medical care.

President Obama views the tax revenue generated by the health insurance sales tax and the twenty one other tax hikes in the ACA as essential to fund the his expensive Obamacare reform. John C. Goodman, author of Priceless: Curing the Healthcare Crisis (Independent Institute, 2012) and President of the National Center for Policy Analysis, joins AHIP’s Ignani in his dissention of Obama’s costly healthcare tax increases, claiming they are for American families already wrought with worry amidst an economic recession.

“The ObamaCare health insurance tax hits some of the most vulnerable people in our society, including poor people in Medicaid managed care plans and seniors in Medicaid advantage plans. It is also a tax on middle-income families who were promised by this administration that taxes would never rise.”[...]Unfortunately, as Goodman predicts, “this is only one example of many middle income taxes buried in ObamaCare.” 

Crony Healthcare in Action

Obamacare is pretty much modeled after the monstrosity that Mitt Romney designed for Massachusetts. WSJ has a report on how that experiment is going:

High health-care costs are so sensitive in Massachusetts that when two health-care company executives suggested consumers could help by watching their weight, the Boston Herald ran a sarcastic page-one headline: "It's Your Fault, Fatso."

Here's WSJ on how well RomneyCare is reining in costs:

Four years after Massachusetts passed a health-care overhaul similar to the recently enacted national plan, small businesses are seeing their premiums rise 22% this year. People in the state have some of the highest premiums in the nation.

Then it just turns into Crony Healthcare:

In Massachusetts, a few prestigious hospitals enjoy considerable bargaining power. State and federal authorities are looking into allegations that Partners HealthCare System Inc., which operates Massachusetts General Hospital and Brigham and Women's Hospital, engaged in anti-competitive behavior. Insurers generally swallow the high prices and pass them on to people buying coverage.

What's really scary about this madness is the solution that most in Massachusetts seem to be in favor of:

There is fairly broad agreement on how to fix the system. A state commission —including representatives of government, insurers, doctors and hospitals—recommended in July that Massachusetts adopt a "global payment" system. Health professionals would be paid for caring for patients over a certain period of time, rather than compensated for each test or treatment. Implementing the fixes, though, will take years.

Of course, this nutty solution will result in fewer tests and fewer treatments, but it sure sounds like doctors will have incentive to drag things out over longer periods. This will, of course, result in limits on the period allowed for treatments of different illnesses, and heaven help you if treatment for you is required beyond the period designated for your illness.

Then, of course, there is the favorite solution of every politician for climbing prices, price controls:

[Governor] Patrick's answer is to cap insurance-company rate increases at 7.7% this year. Insurers say that is draconian, and have sued to reverse Mr. Patrick's action.

Picture all this madness at the national level because it is coming with Obamacare. It's all about politicians who have no idea how free markets work and police themselves. It's all about politicians who have no idea of the impossibility of replacing the huge number of calculations made by individuals in a free market, by a central planning authority. It's about politicians who don't understand the incentive system. It's about politicians who fail to understand that the creation of power centers (new regulations and agencies) ultimately leads to those who will attempt to influence and capture the thinking in such power centers. It's about cronyism. In healthcare, it will mean crony healthcare--which will mean less care, care directed toward the treatments offered by those who have captured the regulators. It will mean higher prices for less, and ultimately more pain more suffering and earlier deaths for most of us.

An Object Lesson in National Healthcare

I fully expect Obamacare to be much worse than national healthcare in England, given the size of the United States and the terrible financial situation the country is in before Obamacare even kicks in. That's why I fully expect an eventual dramatic drop in life expectancy once the government takes over healthcare in the U.S.
Here's Tim Hartford horror story with England's NHS. Note that although Harford knows there is something wrong with the system, he has really come to accept much of the delays in the way and American, at this point, would not do. Scary, first come the delays, then the brain turns to mush about the delays. It will happen here.:

When is a wait not a wait? When a bureaucrat holds the stopwatch. That is my conclusion, based on my experience of trying to get a cancer scan on the National Health Service. The NHS commitment is that – with some narrow exemptions – no patient will wait longer than 18 weeks for treatment. I’ve been waiting for a year.

My point is not to claim that the NHS is an institution on the brink of collapse, nor that the figures are being fiddled. Something subtler is going on here: we are bumping up against the limits of what any bureaucracy can know.
The way waiting times are measured by the NHS has evolved over time, as Nick Timmins explained in this magazine on March 13. The latest metric is Referral-to-Treatment, or RTT. The clock starts when a general practitioner (GP) refers the patient; it stops when the patient receives initial treatment. It’s a reasonable enough measure, but it does not tell the whole story.

Take my own case. My mother died in middle age from the same type of cancer that killed her brother and several other relatives. Standing on the brink of middle age myself, I concluded it was time to ask for a precautionary scan.
So I called my GP. I couldn’t get through. I called again. I couldn’t get through. After many failed attempts I made a note to try again in a few days. I wasn’t on the waiting list, but I was waiting.

My first appointment with the doctor generated not a referral but a second appointment. (“Come back with more details of your family history.”) The dance continued for four months, delayed by my own procrastination, the doctor’s part-time schedule, and above all, the understaffed reception desk.

Eventually I secured a hospital consultation, but arrived to find that the computers were down and the scan itself could not be booked. A few weeks – and pestering phone calls – later, I was sent an appointment out of the blue. It was on a day when I was in New York. I called, left messages and wrote to rearrange, but nothing penetrated the bureaucratic fog. I was noted down as a missed appointment, and the clock stopped at fewer than eight weeks.

I’ve no idea how typical my experience is. Nobody does. It is hard for a bureaucracy to measure delays if the delays are caused by an inability to be noticed by the bureaucracy.

(I recently tried again to book a scan, but the online booking system couldn’t find me a slot.)

Friedrich Hayek would not have been surprised at any of this. His 1945 essay “The Use of Knowledge in Society” emphasised the importance of local knowledge: the receptionist is overworked; the patient is in Manhattan; the computer has a bug. It is hard to centralise and process such information. In some cases it is impossible.

I am largely with Hayek, although the point can be pushed too far. John Appleby, chief economist at the King’s Fund, points out that centralised waiting list targets, combined with plenty of extra cash, have pushed NHS waiting times down so far that delays are no longer the chief concern of patients.

 Read the rest here.

What's Really Wrong with the Health Care Industry

By Vijay Boyapati

On May 3, 2010, I gave a talk to a class of students studying public health policy at the University of Washington. I began the talk by asking the students how many of them believed that the current healthcare system in America was flawed; everyone in the class raised their hand. I then asked how many of them believed that the recently passed healthcare legislation, supported by President Obama, was a step in the right direction in reforming America's healthcare system. Once again, everyone raised their hand.


While I agreed with the students on the first point, I disagreed that the recently passed legislation was a step in the right direction. My aim in giving the talk was to present the students with a consistent, libertarian, free-market perspective on healthcare reform, covering both the morality and the economics of why it would be desirable to eliminate government interference in the market.

The Morality of Healthcare Reform

One of the most important factors animating the libertarian rejection of public policy in general is the recognition that any state action must ultimately resort to the use or threat of aggression. As Ludwig von Mises observed,

It is important to remember that government interference always means either violent action or the threat of such action. Government is in the last resort the employment of armed men, of policemen, gendarmes, soldiers, prison guards, and hangmen. The essential feature of government is the enforcement of its decrees by beating, killing, and imprisoning.

Libertarians who value justice and recognize that the use of aggression cannot be logically justified must reject all state action in principle — this includes the use of aggression in implementing healthcare policy.[2]

The Economics of Healthcare Reform

A common argument advanced in support of greater government intervention in the American healthcare market is that a large and growing fraction of the gross domestic product (GDP) is spent on healthcare, while the results, such as average life expectancy, do not compare favorably to the Western nations that have adopted some form of universal healthcare. This argument is spurious for two reasons:

A growing fraction of GDP spent on healthcare is not a problem per se. In the early half of the 20th century, the fraction of GDP spent on healthcare grew significantly as new treatments, medical technology and drugs became available. Growth in spending of this nature is desirable if it satisfies consumer preferences.

Attributing national-health results to the healthcare system adopted by different countries confuses correlation with causation and ignores the many salient variables that are causal factors affecting aggregate statistics (such as average life expectancy). Factors that are likely to be at least as important as the healthcare system include the dietary and exercise preferences of a population.

Another argument commonly used in healthcare-policy debates is that there are almost 46 million people who have no health insurance at all.[3] Again, this is not a problem in and of itself. According to the National Health Interview Survey, 40 percent of those uninsured are less than 35 years old, while approximately 20 percent earn over $75,000 a year.[4] In other words, a large fraction of those who are uninsured can afford insurance but choose not to buy it or are healthy enough that they don't really need it (beyond, perhaps, catastrophic coverage).

The real problem with the American healthcare system is that prices are continually rising, greatly outpacing the rate of inflation, making healthcare unaffordable to an ever-increasing fraction of the population — particularly those without insurance.

Read the rest here.

Vijay Boyapati is a former Google engineer. In 2007 he started Operation Live Free or Die, a grassroots organization to help Ron Paul's 2008 presidential campaign. Since 2009 he has devoted himself to studying Austrian Economics.

Death Will Be the New Health Policy

I am not kidding when I say the life expectancy of Americans will decline under ObamaCare. The evil bastards really think it is their call on how much medical care you get.

Given the structure they are setting up, doctors are going to retire early, which means there will be a lot less of them around, and the creativity that brought about the miraculous increases in life expectancy via new medicines and medical treatments will be suffocated. The only new medical treatments and medicines that will be approved will be those by the politically connected. Think nonsense propagandized H1N1 vaccines on steroids. It will be medical treatment by lobbyists.

At LRC, Karen De Coster has posted some background on President Obama’s nominee to head the Centers for Medicare and Medicaid Services. She writes:

There is an interesting article in CNSNews about Obama’s nominee to head the Centers for Medicare and Medicaid Services, Donald Berwick, who reveals his passion for central planning and all things socialized.The article links to a June 2009 interview with Berwick in Biotechnology Healthcare. Some snippets from the article:

In a June 2009 interview in Biotechnology Healthcare, Berwick was asked: “Critics of CER (Comparative Effectiveness Research) have said that it will lead to rationing of health care.”

He answered: “We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds.’ We make those decisions all the time. The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”

In the same interview, he also said, “The social budget is limited—we have a limited resource pool. It makes terribly good sense to at least know the price of an added benefit, and at some point we might say nationally, regionally, or locally that we wish we could afford it, but we can’t.”

Berwick also talked about his romantic view of Britain’s socialized health care system on page 213 of a report he wrote entitled, “A Transatlantic Review of the NHS at 60,” published on July 26, 2008.

“Cynics beware: I am romantic about the National Health Service; I love it,” Berwick wrote. “All I need to do to rediscover the romance is to look at health care in my own country.”

Lastly, in the 2008 report, Berwick wrote, “Any health care funding plan that is just, equitable, civilized, and humane must — must — redistribute wealth from the richer among us to the poorer and less fortunate.” Here is the 2008 speech where Berwick talks about the “darkness of private enterprise” and lauds a politically accountable system. He adds that “excellent health care is, by definition, redistributional.” 

Free markets are a tough thing for many to understand, despite the fact there are nearly daily reminders that messing with free markets only causes poverty and totalitarianism. The fall of the Berlin Wall and the fall of the Soviet Union are two recent examples. As is the poverty in Cuba and North Korea. Likewise, the current crisis with the European Union can be attributed to a faulty system set up by men in an attempt over-rule free markets.

Forget the theoretical understanding of how a free market works, the Berwick's of the world can't even grasp these object lessons. In their confusion and madness, these men are now focusing on introducing socialism and totalitarianism for the medical sector. Death will ultimately be the new health policy.

(Thanks to Bob Murphy for the tip on Karen De Coster's post)

"Because the Lowest Cost Patients are the Dead Ones."

An anonymous commenter writes below:

A family member of mine works in the pharmaceutical industry. He was talking to a senior VP at an HMO (name unknown) and asked why that HMO didn't authorize the use of a particular drug to fight a specific disease. The response was straightforward and to the point: "Because the lowest cost patients are the dead ones."

Death panels are already in place; it is just a question of whether the US Government does it, the state does it, or a healthcare company does it.

Given the severe government budget strains in the years ahead, the decrease in healthcare services becomes pretty obvious. Let's hope there are loopholes in Obamacare, otherwise we are all doomed to poor quality healthcare.

Life expectancy will decline.

A "Duty to Die"?

by Thomas Sowell

One of the many fashionable notions that have caught on among some of the intelligentsia is that old people have "a duty to die," rather than become a burden to others.

This is more than just an idea discussed around a seminar table. Already the government-run medical system in Britain is restricting what medications or treatments it will authorize for the elderly. Moreover, it seems almost certain that similar attempts to contain runaway costs will lead to similar policies when American medical care is taken over by the government.


Make no mistake about it, letting old people die is a lot cheaper than spending the kind of money required to keep them alive and well. If a government-run medical system is going to save any serious amount of money, it is almost certain to do so by sacrificing the elderly.

There was a time-- fortunately, now long past-- when some desperately poor societies had to abandon old people to their fate, because there was just not enough margin for everyone to survive. Sometimes the elderly themselves would simply go off from their family and community to face their fate alone.

But is that where we are today?

Talk about "a duty to die" made me think back to my early childhood in the South, during the Great Depression of the 1930s. One day, I was told that an older lady-- a relative of ours-- was going to come and stay with us for a while, and I was told how to be polite and considerate towards her.

She was called "Aunt Nance Ann," but I don't know what her official name was or what her actual biological relationship to us was. Aunt Nance Ann had no home of her own. But she moved around from relative to relative, not spending enough time in any one home to be a real burden.

At that time, we didn't have things like electricity or central heating or hot running water. But we had a roof over our heads and food on the table-- and Aunt Nance Ann was welcome to both.

Poor as we were, I never heard anybody say, or even intimate, that Aunt Nance Ann had "a duty to die."

I only began to hear that kind of talk decades later, from highly educated people in an affluent age, when even most families living below the official poverty level owned a car or truck and had air-conditioning.

It is today, in an age when homes have flat-panelled TVs, and most families eat in restaurants regularly or have pizzas and other meals delivered to their homes, that the elites-- rather than the masses-- have begun talking about "a duty to die."

Back in the days of Aunt Nance Ann, nobody in our family had ever gone to college. Indeed, none had gone beyond elementary school. Apparently you need a lot of expensive education, sometimes including courses on ethics, before you can start talking about "a duty to die."


Read the rest here.