PrintNovember 27, 2007
When Politicians Decide Healthcare
If you need a good idea of what government-run healthcare would mean to you and your family, look no further than Medicare, or the wrangling taking place in Washington surrounding Medicare funding.
With much of the media focused on the Democrats' efforts to expand eligibility and funding for the State Children's Health Insurance Program (SCHIP), much less publicity has been given to Congressional deliberations on Medicare. While SCHIP is a backdoor effort to grow government-run healthcare, the Medicare funding process is a good example of what happens once politicians get to decide how much and what sort of healthcare participants receive from the federal budget.
The Democratic-controlled Congress has been working all year to determine how to allocate an estimated $390 billion dollars to cover more than 40 million seniors and other recipients. The process is byzantine, as the legislative process tends to be. It involves everything from possible changes to Medicare Advantage to physician fees to reimbursements for a host of treatments and therapies housed in this mammoth program.
What the process isn't principally about is the best healthcare for Medicare recipients. Foremost, this is a political process with political ends in mind. And therein is a cautionary note for voters who are flirting with the idea of socialized or universal healthcare, or some lesser proposal that is a Trojan horse in all but name.
Senator John D. Rockefeller (D-WV) and Representative Charles Rangel (D-NY), key committee chairs who are playing major roles in the outcome of Medicare funding, may, in their ways, be conscientious public servants, but they are politicians, meaning that along with 533 colleagues, they are making rather complicated calculations as to how to curry favor with, entice, placate or punish special interests. The same goes for their constituents, less the punishment.
More specifically, it's about protecting home state businesses that count on Medicare revenue for the products they manufacture or keeping jobs at local hospitals. It's about keeping older voters and other important voting blocs happy or quiet, or about trying to offload the pain of funding cuts on other members' districts or states (preferably, the opposition's). It's about allocating money away from Medicare to fund other, non-healthcare programs, or taking money away from Medicare to help pay for SCHIP expansion. And, finally, it's about campaign contributions, favorable publicity, votes and re-election, among other parochial considerations.
More specifically, it's about protecting home state businesses that count on Medicare revenue for the products they manufacture or keeping jobs at local hospitals. It's about keeping older voters and other important voting blocs happy or quiet, or about trying to offload the pain of funding cuts on other members' districts or states (preferably, the opposition's). It's about allocating money away from Medicare to fund other, non-healthcare programs, or taking money away from Medicare to help pay for SCHIP expansion. And, finally, it's about campaign contributions, favorable publicity, votes and re-election, among other parochial considerations.
Two examples illustrate well what it means when politicians, and not patients and healthcare providers, decide what the scope of treatment or therapy will be. One is inpatient rehabilitation and the other is home oxygen therapy. Both are under consideration now as part of the Medicare funding battle.
The debate over inpatient rehabilitation centers on a rule concocted by Medicare bureaucrats. Not long ago, bureaucrats decided that, to qualify for Medicare certification and reimbursements, a rehabilitation hospital had to dedicate a majority of its beds to just thirteen ailment categories. It began with sixty percent of beds, though the rule contains an escalator. The list of ailments excluded for Medicare reimbursement includes knee or hip problems, multiple fractures and osteoarthritis or rheumatoid arthritis. This year the rule mandated that the percentage of beds to be set aside at sixty-five percent. In 2008, the number of beds will rise to seventy-five percent.
The rule is essentially a cost-control measure. But the leap from sixty to seventy-five percent for the set-aside has significant economic implications for rehabilitation hospitals and important ramifications for patients. Beyond restricting the number of ailment categories, the more beds allotted to comply with the rule, the fewer available to treat excluded ailments, and the fewer for non-Medicare patients. The hospital industry, rehabilitation physicians, therapists, and some patient and senior groups have mobilized in an attempt to cap the percentage at sixty, which is likely the best that can be accomplished, given the broader political realities. Congress will decide.
The rule is essentially a cost-control measure. But the leap from sixty to seventy-five percent for the set-aside has significant economic implications for rehabilitation hospitals and important ramifications for patients. Beyond restricting the number of ailment categories, the more beds allotted to comply with the rule, the fewer available to treat excluded ailments, and the fewer for non-Medicare patients. The hospital industry, rehabilitation physicians, therapists, and some patient and senior groups have mobilized in an attempt to cap the percentage at sixty, which is likely the best that can be accomplished, given the broader political realities. Congress will decide.
The second example is funding for home oxygen therapy. Home oxygen is provided to recipients that suffer everything from asthma to Chronic Obstructive Pulmonary Disease (COPD). House action in late summer proposed cutting funding for home oxygen therapy by twenty percent and halving the benefit from the current thirty-six months to eighteen. Some of the thinking behind the proposed changes is to shift money to the Children's Health and Medicare Protection Act (CHAMP Act, aka, H.R. 3162). Shifting priorities, it seems, trump the needs of respiratory sufferers. Once again, affected groups are trying to persuade Congress to reverse course. The Senate has yet to act. Whether or not funding or benefit levels are restored is problematic at best.
Whatever the outcome of these issues, the larger point is that the healthcare of millions of Americans hinges on what Washington politicians, federal bureaucrats and the experts at the Medicare Payment Advisory Commission (MedPAC) decide. And you can bet that the politicians aren't making decisions based solely on the merits of either program. None of this is in the hands of Medicare recipients and their physicians or healthcare providers, who can chart the best courses for treatments. It reduces healthcare to a political process, whereby various interests and constituencies vie for as big a chunk of the Medicare budget as they can persuade or pressure Congress into giving. Lobbyists are afforded very good livings, while Medicare recipients in need of more comprehensive inpatient rehabilitation or home oxygen therapy are reduced to calling or writing their Members of Congress to plead for benefits.
Some may call this democracy in action; others would ask how much democracy do you want as part of your family's healthcare?
In a recent New York Times opinion-editorial, columnist Paul Krugman made an attempt to brand critics of politician-driven, government-run healthcare as defenders of the status quo, when, in fact, most critics of universal or socialized healthcare are fervent reformers, seeking free market solutions to what ails the healthcare system. Concentrating power in the hands of consumers and ridding the system of distortions chiefly created by government interference are primary aims.
Krugman ended his column by arguing that a sure way to counter the scare talk about socialized medicine is to ask Americans if they're satisfied with Medicare. A top-line reading of survey research undoubtedly bolsters his case, but if he bothered to dig deeper, he might have found the senior suffering from COPD who, relying on home oxygen therapy, is in fear of what happens once her eighteen months of benefits expires. Or another senior who requires inpatient rehabilitation to treat rheumatoid arthritis, only to learn to his dismay that Medicare doesn't cover his ailment.
For liberals like Paul Krugman, perhaps these are small prices to pay for healthcare decided by Washington politicians. For the rest of us, these prices are just too high.
