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The Right Prescription
The Kennedy-Orszag $700 Billion Fix
How can President Obama and leading Democrats continue to insist that government-run health care will not lead to rationing and exploding health care costs? The explanation to this delusional thinking rests in their belief that each year the American health care system spends $700 billion a year that does not improve outcomes.
It is this article of faith, based on nothing but a back of an envelope calculation by Obama budget director Peter Orszag, that allows leading health care lights such as Senator Ted Kennedy to claim in his recent Newsweek essay that a government run health plan is last best hope "to ensure that someday, when there is a cure for the disease I now have, no American who needs it will be denied it."
Every health care proposal -- including the one with his name on it -- forces up to 100 million Americans to give up the health care plan they have and enter a government run plan, whether it be Medicaid or the new plan in which doctors would be forced into accepting fees that are 30 percent lower.
Will such a system deliver the promise of a cure when you need it? Of course! Kennedy truly believes that only government can "move from a system that rewards doctors for the sheer volume of tests and treatments they prescribe to one that rewards quality and positive outcomes."
His example? "In Medicare today, 18 percent of patients discharged from a hospital are readmitted within 30 days -- at a cost of more than $15 billion in 2005. Most of these readmissions are unnecessary, but we don't reward hospitals and doctors for preventing them. By changing that, we'll save billions of dollars while improving the quality of care for patients."
Senator Kennedy seems sure it's easy to reduce useless admissions and truly believes that wherever people are seen or enrolled they will get the right kind of care. That's because Kennedy believe Orszag's assertion that "$700 billion a year in health care costs do not improve health outcomes. It occurs because we pay for more care rather than better care."
Orszag relies on the Dartmouth Atlas -- a map of Medicare hospital spending in the last two years of life that divides America into five regions ranging from the highest cost per person to the lowest. The Atlas purports to show that Medicare patients in the highest cost areas are no better off than those in lowest cost areas. So if patients in Salt Lake City with cancer cost less than patients in New York City and both die in two years, that means the care in Manhattan was a waste of money. See? From there you assume that more care anywhere wastes money. That's how Orszag came up with $700 billion. The Theory of Relativity it isn't.
The jump from hospital spending on Medicare patients to all health care spending is one leap of faith. The other is assuming patients haven't changed over the 20 years Dartmouth has been collecting data. In fact they have. Fewer people are entering hospitals. People with chronic illnesses are less likely to enter the hospital. Their procedures, if they have them, are done on an outpatient basis. Hence, the smaller percentage of people going into the hospital are increasingly much older, entering for riskier procedures, and sicker than the population as a whole. Yet, this group is Orszag's benchmark for eliminating care and costs across the entire system.
Those that are "sicker" include people like Ted Kennedy who are living longer with brain cancer and other serious illnesses. For instance, according National Cancer Institute estimates, someone Kennedy's age with a brain cancer has less than a 5 percent chance of living five years let alone one. But over a year ago he went through difficult surgery to remove his tumor and received Temodar and Avastin to shrink the remainder of the tumor not surgically removed. He may be a candidate for a new vaccine to beat back his cancer for good.
Yet, Medicare pays for none of those treatments. Soon it will not pay for readmissions related to the kind of surgery Kennedy received. Jack Wennberg, creator of the Dartmouth Atlas that Peter Orszag worships, calls readmissions for cancer patients such as the Senator "'rescue medicine' to people who are in advanced stages of diseases that can't be cured... the costs of such care are very high, both in dollars spent and in providing care that the majority of chronically-ill patients might not want, such as admissions to intensive care and being sent to specialist after specialist."
According to the "reward" system Kennedy proposes and Orszag would implement, neither Medicare nor a government run health system would pay for such care or future advances against cancer, Alzheimer's, and other illnesses. Kennedy's legislation would rob Americans first of choice, then of progress, and ultimately of victory against diseases like cancer, Alzheimer's, and stroke. Health care reform should accelerate innovation and promote choice. Instead, both will be strangled in a failed effort to control costs. In blessing this sordid exercise, Ted Kennedy will be remembered for breaking his promise to the American people.
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Melvin| 7.22.09 @ 7:19AM
Come on people, President Obama and leading Democrats are telling the truth, sort of that the Health Reform Bill will not lead to rationing, at least not for them.
stuart reed| 7.22.09 @ 8:13AM
Mary Jo Kopechne could not be reached for comment.
Tim| 7.22.09 @ 10:20AM
WTF is this "positive outcomes" bullshit? What is wrong with " patients healed" ?
"Positive outcomes" sounds like the quarterly budget balanced so the bookeeper can get his step increase.
Tim| 7.22.09 @ 10:23AM
Dear Mr. Goldberg:
Pardon my bad form asking a direct question but where can I read more about this:
"He may be a candidate for a new vaccine to beat back his cancer for good. "
Thanks
Senator Ted Kennedy| 7.22.09 @ 10:28AM
Quit your whinning about not recieving the same medical treatment as I receive. When you're Emperor, like I am, the people will take care of you too!
BTW, don't address me as sir, I've worked hard for the title Emperor and you need to address me as such!
hoads| 7.22.09 @ 10:54AM
The Dems are relying heavily on the Dartmouth Regional Variances studies to justify their "30% of healthcare is wasted on treatment that does not improve outcomes". I'm still trying to figure out how they are measuring outcomes. I wonder if they surveyed those who received treatment to determine if the patient thought his or her hip replacement or cardiac stent was "wasteful"---NOT. That's because healthcare reform that is on the table is about "the system" and not about the individual. It doesn't matter if you are satisfied with the results of your medical treatment. You are merely a statistic in a government database.
The Dartmouth studies measure nothing but differences in volume of medical treatments. Nothing in these studies determines if the medical treatment was warranted or not or addresses variances in the medical acuity of the population. These studies erroneously conclude that variances in medical treatment are the result of overutilization. Unless further studies examine individual medical data and verifies that a patient's baseline history and examination did not provide evidence of the need for a certain medical treatment then, these studies are nothing more than a cursory survey and are being spun to provide a basis for rationing.
copilot| 7.22.09 @ 11:05AM
Why was Ted Knighted by QEII ? Because MI5 knows about the 1.5 million candlepower searchlight off a Huey that was set up at eye level on that bridge. When he tried to cross they hit the switch. Cops found telltale marks and noted a rapid boat departure just afterwards - light and battery cart probably pitched over the side. Suspect? E Howard Hunt. Also the small barometric bomb slipped in the luggage compartment of Ted's plane killing 2 and breaking Ted's back. MI5 also knows that what happened to JFK jr. was NOT an accident. A lot of people are now finding out about that - including Obama and Holder.
Marc Jeric| 7.22.09 @ 11:54AM
When I worked in France 5 years, while waiting for mu US refugee visa, I was under their socialized health care. As a designer I was a member of insured masses - long waits, crowded hospitals with dying patients parked in corridors. After a promotion to engineer-supervisor I found myself in a special health care program for "cadres" - that's what the French call their inteligentsia. No waiting at all, private hospitals and clinics. I understand that a similar two-tier system exists in Great Britain's socialized health care system. Perhaps Abu Hussein from Kenya could buy his way to nationalized health care with a similar arrangement.
Michael Tomlinson| 7.22.09 @ 12:29PM
To Senator Ted Kennedy who whined "to ensure that someday, when there is a cure for the disease I now have, no American who needs it will be denied it." Paraphrasing Barack Obama "take a pain pill and die you fat old rapist murdering bastard."
Paul from SA| 7.22.09 @ 12:46PM
Marc Jeric,
That's the first I've heard of that (a two-tiered system) in France. I'm not surprised, but am surprised it hasn't been reported.
-------------------------------------------------
I watched that Orszag fellow on the morning talk shows last Sunday. I don't believe he answered a single question directly or even indirectly. I don't trust the guy. He obviously has been rehearsing how to evade all objections -- like a slick salesman.
I used to post as Bob| 7.22.09 @ 2:33PM
There are terms being used by the One and all those pushing this that are very nebulous. Improved outcome and more effective treatment are a couple of the more sinister. People hear them and think from their current frame of reference, their individual needs and desires.
What they are meant to think when they hear these terms is that when I as a patient go to the doctor or hospital, Obamacare will provide me more effective treatment leading to improved outcomes. I will feel better, I will live longer, my mother will have a better quality of life, and grandma’s condition will be better managed; all for less money; all from the perspective of the individual.
They have been speaking all along from the global perspective. They will be defining effective and improved from the perspective of all patients and the system and including factors foreign and often antithetical to the interest of the individual.
Nuanced double speak, intentionally using words they know will be understood exactly opposite of their intentions.
They will be defining quality, effective and improved and we will be paying with our hard earned money, freedoms and our lives.
Grzmlyk| 7.22.09 @ 4:22PM
Hey "I used to post as Bob" - you can't be the Bob that's been trolling this site the last several months. You sound much too human. That's a good thing.
And I don't think that Bob gives a damn about anything but proving himself superior. Reality doesn't seem to make a dent in his statistical tables.
But your thoughts are right on the money. Obama doesn't give a damn about anyone but feathering his and the Dems' nest for perpetual, de facto dictatorial rule. I love his three-prong stool of control:
Education reform: To control what we think;
Healthcare reform: To control what we feel;
Energy reform: To control what we do.
He is the biggest threat to this country's well-being since FDR - and the stakes are higher today.
I pray we are beginning to see the cracks. He IS extremely brittle. But the MSM has so much invested in this would-be dictator, I fear they will continue to save his bacon.
I used to post as Bob| 7.22.09 @ 6:55PM
I posted as Bob for a while and then one day the troll signed up using that name.
I think we have to keep the pressure on relentlessly. IF we let up even a little The One, The Dems and the media will regroup and try to cram this agenda through.
I communicate daily with an ever increasing number of folks urging them to contact their reps and all of the Blue Dogs...
The reason we are in this position in the first place is we went to sleep at the switch. We have forgotten that the price of freedom is eternal vigilance. We are on the very cusp of losing it all. I believe that it will take a lot of time and effort before it is secure again.
I owe a debt of honor to my children and grandchildren to do everything I can to pass to them the liberty and freedom that I have enjoyed all my life.
If this generation lets liberties light go out we will have justly earned the scorn of all eternity.
Grzmlyk| 7.22.09 @ 8:25PM
I like this Bob a whole lot better than the troll Bob.
I totally agree that the price of freedom is eternal vigilance.
I pray we don't earn the scorn of future generations, but I fear we are too far around the bend. This administration is hell-bent for leather to control every aspect of our lives. And for what? For the state.
And then what is a human life? Are we born to serve the state? That's what Obama thinks. We need to reverse that, but, as I say, I think we're too far gone.
Sue| 7.22.09 @ 10:06PM
I don't really want to address what TK had to say. I want to address the fact that the Medicare and Medicaid systems will go bankrupt if not reformed. This is singularly due to the massive numbers of baby boomers coming online within the next 10-20 years.
It has the politicians running scared. The reason they are running scared is: 1) They know they can't deliver what LBJ promised in 1965; 2)They know they can't possibly tax the next generations enough to sustain it; 3) They can't face the voting public and admit that FDR's and LBJ's socialist engineering programs are a complete scam and failure.
With the two programs net expense taking upwards of 50% of the National budget by the year 2030-2040, they can't stand the thought that there will no longer be a pot of gold to purchase the votes of constituents to keep themselves in power - whether it be the current members or new incestuous members of their party's choosing.
Now I say this. Why not let these social programs play out and become the second largest expenditure of the budget or even the greatest largest expenditure. What do we have to lose? They will be forced to make the difficult choices of reducing their wasteful, pork spending and the two budget items left on the revenue/expense ledger will be defense, and social security and healthcare combined. We all know that social security is a ponzi scheme and with inflation and the devaluing of the dollar, essentially worthless and will not even purchase the medi-gap policy needed to go with Medicare by the time the 50 year olds get to drawing it.
Maybe, just maybe, they will open their eyes up to the Constitution and realize that our Framers designed it with limited government to prevent the politicians from destroying the Country by doing things they are not authorized to do.
By overstepping their boundaries and trying to provide every possible need from "free food," "free housing," free healthcare," "free money in the forms of rebates from other taxpayers," and on and on, they are now put into the horrible position of not being able to defend the Country from its foreign enemies and refuse to try to protect our borders to insure protection from domestic enemies as well.
I say let her ride!!!!!!! It's the only way we have to making them pay for the errors of their ways. Let's force them to pull back all spending - foreign and domestic - State Department to Education Dept. to the silly Surgeon General/National Institutes of Health, EPA, and others.
It's the health of our Nation's citizens. It should take priority. That's what LBJ and FDR wanted. Let's give it to them!
Demand it from our Representatives! We want the cadillac plan! Not the Volkswagen! We want the technology! No excuses, no rationing, no increased taxes to pay for it. It's what FDR and LBJ wanted us to have. The Democrats have promised it for well over 100 years. Well, the time has come. It's time for them to give it to us!
Michael L. Hauschild| 7.23.09 @ 6:47AM
Dear "I used to post as Bob",
You and our brethren are being much too critical of "currently resides as poster Bob" (crap Bob). After all he is a Harvard Educated statistician, and therefore enjoys the liberty of ALWAYS being correct, and is duty bound to proclaim why EVERYONE else is NEVER right. (declaring the ABSOLUTE stupidity of others does not seem to require a [+] or [-] calculation) Residing in the Ivory Tower of intellectual superiority means that you never have to include reality in your "representative sample."
ACarroll| 7.24.09 @ 5:27PM
Mr. Goldberg:
It's hard to believe all of these "dittoheads" who don't care if there is any evidence to back up your extremist statements. Until you can provide the sources for your "facts", which are only opinions (based on what parts of the WWW you troll nobody knows) until you do, none of what you write has any credibility beyond the people who already share your opinions (and mentioning "National Cancer Institute estimates" doesn't count as a citation). To paraphrase you: "A health policy analyst you ain't."
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