PrintAugust 13, 2009
Connect the Dots on ObamaCare
The use of logical corollary, a fancier way of saying connect the dots, has eluded the defenders of ObamaCare. Critics of those who have exposed ObamCare's contradictions and incoherencies are either unwilling to connect the dots or too stubborn (dare I say stupid) to acknowledge what the dots really mean. Connecting the dots in this case doesn't require unusual skills, much less a background in symbolic logic, merely perseverance in reading the text of HR 3200.
Let's start with Sec 123, the formation of the Health Benefits Advisory Committee, and Sec 124, the creation of the Health Choices Administration and Health Choices Commissioner. Why have this committee, administration and commissioner? Simple, to run the public health care -- read single payer -- option, determine what benefits are to be covered and what the reimbursement rates will be. Running the single payer system would not be trivial, covering at least an additional 100 million people initially, managing claims of a trillion dollars per year, not counting the costs to run the system.
The new Health Choices Commissioner would be a cabinet level position. Remember how other modern era cabinet level jobs -- EPA and Department of Energy -- were rather modest when first established, but have mushroomed in 30 years to consume nearly $40 billion every year from the federal budget and now control everything from septic tank standards to light bulbs.
If Obama and the Democrat-controlled Congress only intended to improve health care access to the chronically uninsured, around 15 million people, it would have been easy enough to fold them under Medicare and Health and Human Services. But of course, a single payer system eventually covering 300 million Americans would be impossible to run under any current government agency, thus necessitating a new stand alone bureaucracy on a scale rivaling the Pentagon. So when ObamaCare defenders try to tell you a single payer outcome isn't in the works, then why the need for an enormous separate cabinet level bureaucracy? Connect the dots.
Let's now turn to Sec 111, Prohibiting Pre-existing Conditions Exclusions, Sec 113 Insurance Rating Rules, Sec 116 Ensuring Value and Lower Premiums and Sec 121 Coverage of Essential Benefits. These and other mandates such as cost sharing limitations and bans on lifetime maximum out-of-pocket deductibles or co-pays have the apparent design to improve accessibility and availability of private insurance plans. But we already know these types of mandates will render private plans economically non-viable, as insurance premiums would be priced off the charts so no one individual or company could afford to buy coverage or underwrite a group plan. Of course the real story is that no company would choose to voluntarily subscribe to such extraordinary plan provisions and the costs they entail. Many company sponsored comprehensive plans today carry costs as a percent to payroll of around 10 to 20%. These new mandates and coverage rules would double those costs, easily convincing the vast majority of company CFOs to abandon health care plans altogether, opting for the penalty box which is only 8% of payroll. How to get 100 million Americans into a single payer plan within three years if not sooner? Connect the dots.
By the way, mandates driving out private health care are precisely why Obama's comment about UPS, FedEx and the Post Office in Portsmouth NH was so asinine. Apart from the multi-billion dollar bleeding annually of the Postal Service, once more proving the federal government can't run a business, UPS and FedEx are free from the government mandates that are suffocating the Postal Service. How long would UPS and FedEx survive if they had to maintain staffing for thousands of small town and rural post offices and guaranteed delivery six days a week to every residence anywhere charging rates that are a fraction of the cost?
Let's turn to Title IV Subtitle A Comparative Effectiveness Research, "CER", Sec 1401. In its purest form, evaluating and ranking the most effective clinical remedies for diseases and illnesses is innocent enough and widely endorsed, as an initiative independent from government carried out by the medical profession. Dennis Cortez MD, CEO of the Mayo Clinic writes in the National Journal:
"In the case of comparative effectiveness, we can say it is a fundamental component to providing the highest quality, most effective, safest health care for individual patients."
Darrell Kirch MD, President and CEO of the Association of American Medical Colleges says there four criteria to judge CER:
"1) diseases and disabilities that impose the heaviest personal burden on patients and financial burden on society; 2) conditions for which there is a high degree of uncertainty in the medical community about the "right" thing to do (given the range of approaches and interventions available) ; 3) decisions that have especially significant consequences for patients (e.g., high-risk interventions); and 4) questions for which the data we need are largely available and can be quickly gathered and analyzed"
Notice that neither Drs Cortez nor Kirch mention cost of remedies, economic value, productivity, nor a government agency to collect the data and rank effectiveness priorities. They only discuss CER in the context of the best and most effective patient outcomes from a clinical perspective.
But cost is clearly linked to CER in Obama's mind when he says Medicare costs must come down 20%. And the House bill in Sec 1401 amending the Social Security Act establishes the CER Commission and a CER Center to "determine the national priorities in consultation with a broad array of stakeholders...including payers" and to "Make recommendations that enable...payers to make more informed health care decisions that improve quality and value". Now, who's the number one payer under the HR 3200 public plan option? And isn't value a cost measurement? Connect the dots.
And if mandated CER to be reported to "payers" isn't enough to drive down cost by introducing CER ratios that factor cost and quality of life, Sec 1233 under Medicare, Advance Care Planning Consultation requires health care providers to have end-of-life discussions with patients and report to the HHS Secretary "quality measures on end-of-life care and advanced care planning that have been adopted by a consensus based organization." Why devote over 100 paragraphs and some 500 lines of text to end-of-life consultations, living wills, health care proxies and reporting? To reduce costly end-of-life interventions that extend the life of the elderly. Cost reduction derived from denying medical interventions in favor of more aggressive hospice is the only reason for such a preoccupation in the House bill. There is no other reason for such proposed legislation. None. Connect the dots.
Obama must assume we are fools when he tries to persuade us that this plan is anything but a complete federal takeover of health care coupled with medical treatment rationing to contain costs. It is impossible to come to any other conclusion. George Orwell said it best, "One has to belong to the intelligentsia to believe things like that: No ordinary man could be such a fool."
The town hall uprisings and dramatic polling results of likely voters by Rasmussen showing that an overwhelming number of self-described Independents are opposed to ObamaCare proves the American electorate are not fools. Ordinary people can read the text and connect the dots. Since we're not fools, Obama must be one himself or simply lying to the nation. Connect the dots.
