A Further Perspective

The Government Plan

With or without the public option, the idea is to assert government control over individual choice. Good luck with that.

By 9.10.09

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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.

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About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.