Here’s Washington Post columnist Steven Pearlstein
calling on Obama and Democrats “to stand tall” on healthcare
and come up with “succinct legislation that guarantees that every
American will have a basic health insurance policy and sets
reasonable caps on the growth of government health-care spending.
The details should be left to the regional exchanges and a new
board of independent health experts to oversee Medicare and
Medicaid.”
Is Pearlstein psychic or wildly influential? The President will
(has?) push(ed) for a public plan, fully funded. And even if
Congress ditches it in favor of some renamed version (Government
capitalized, regulated cooperatives that are really just Medicaid
managed care programs with no income limits), there will be
plenty of government regulation of the dumb doctors, greedy
special interests and thuggish patients who just want to spend
health care money for the hell of it. (Can I have seconds on that
colonoscopy, please?) Pearlstein asserts: “fundamental policy
goals of universal coverage and cost containment are inconsistent
with the political instincts to assure Americans who already have
health insurance that they will be able to keep everything they
already have.” In other words, stupid doctors and patients should
follow government orders of what to use, how much and when.
Pearlstein provides us with a cognitive map of the social
engineers in the Obama White House and elsewhere who truly
believe — in the face of contrary evidence (namely faster rising
health care costs in Canada and the UK even as new technologies
are rationed) — that government should assert control over the
introduction and use of medical services and new technology. Any
deviation from that goal would “sacrifice first principles,
embrace bad policy in the name of compromise and capitulate to
political thuggery.”
Yet Pearlstein is quite willing to toss the public plan
overboard. He, like many Democrats, understands that it is a
growing ideological distraction. Defining it down would still
leave in place all the worst features of government involvement
in healthcare.
Which leave us with the Baucus “Framework for Comprehensive
Health Reform.”
It is being pitched as the middle ground or the compromise
proposal compared to the House health bill or the Senate Health,
Education, Labor and Pension bill because it has no “real” hard
public plan.
In fact, behind the generalities of the memo loom most of the
government agencies, entities, actions that the other bills would
require to both reduce Medicare spending and force doctors to
practice medicine according to government guidelines — or else.
The Baucus memo “saves” money by shoving more single individuals
into Medicaid. A doubling of Medicaid enrollment will be linked
to penalizing doctors for “using more resources than their
peers.” Which is on top of proposed freezes in physician
reimbursement or cuts designed to achieved productivity gains
(meaning using fewer resources than your peers without regard to
the complexity of illness).
That is the Baucus definition of quality, which is also applied
en masse to all doctors participating in Medicare. This process
will be accelerated by the creation of a health quality “czar”
who will have power to define what quality care is (determining
what resources should be utilized before punishing doctors for
using more of them or different ones) for doctors and patients in
health exchanges, the Medicaid plans posing as non-profit health
coops, real and vastly expanded Medicaid and Medicare.
Woe unto the Medicare consumer who is readmitted to the hospital
for a “high cost condition” such as cancer, Alzheimer’s, heart
failure above a certain one-size fits all (in order to save
dough) thresholds. Think of the Baucus memo as the kinder,
gentler version of healthcare reform? Who needs rationing and
death panels when Medicare (and other plans) denies coverage
based on a “lack of compelling comparative effectiveness
evidence” that … newer technologies or more resources don’t
benefit people.
Hence, the Agency for Health Care Research and Quality, which now
spends more each year on reviewing old studies a high school
student can download from Google Scholar than the Food and Drug
Administration devotes to reviewing new medicines ($600 million
to $500 million), produced a study “concluding” that a single
statin drug is just as effective in reducing deaths from heart
disease than combinations of drugs. Ditto a study about the
comparative effectiveness of screening for breast and prostate
cancer. Neither study took into account any of the variations in
response that new technologies can identify or treat. You can’t
pay for what can’t measure.
Sometime before the NFL playoffs, most Americans will laugh this
media-assisted retooling of this government intrusion into
individual choice out of existence. Pearlstein is already
seething that the health care debate was “hijacked by ranters and
ravers of all stripes and members of Congress who don’t know
their own minds and cower before their own constituents.”
Can’t wait till Pearlstein tells us how he feels after
“comprehensive” reform tanks. That will be another barometer of
how arrogant and isolated from reality the liberal policy
establishment has become. And how profound their punishment will
be come next election.
