Tuesday, July 28, 2009

ObamaCare’s Pig In A Poke

Before she began to comment upon what is now called ObamaCare, Betsy McCaughey, a former lieutenant governor of New York and presently an adjunct senior fellow at the Hudson Institute, took the precaution of reading both the voluminous stimulus bill as well as the health care bill, a path not followed by the majority of legislators who either voted or are due to vote on both measures.

McCaughey’s findings ought to disturb everyone who will be affected by either bill – which is to say, everyone in the United States.

Her recent commentary in Bloomberg News begins: “Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

“Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.”

That’s right: Health care provisions have been slipped past watchful eyes because they have been included not where one would expect them, in the health care bill, but in the stimulus package that, some Sherlock Holmes’ are beginning to discover, is costly to taxpayers while simulating little else but an insatiable legislative appetite for “free” dollars from Washington.

U.S. Senators, yet to vote on the health care bill, should read the provisions in the stimulus package before voting on ObamaCare.

Few will object a provision requiring a federal system to electronically track medical treatments, because such a provision will facilitate the sharing of medical records and avoid repetitive tests and errors associated with record duplication.

But some provisions that enforce uniformity are reckless and harmful to health care as we know it.

The bill establishes a new bureaucracy, the National Coordinator of Health Information Technology, that will monitor doctors to assure they are doing, McCaughey writes, “what the federal government deems appropriate and cost effective. The goal is to reduce costs and ‘guide’ your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, ‘Critical: What We Can Do About the Health-Care Crisis.’ According to Daschle, doctors have to give up autonomy and ‘learn to operate less like solo practitioners.’”

Penalties in the stimulus bill are attached to doctors and hospitals that do not measure up, so called “non-meaningful users,” an expression the definition of which is left to the Health and Human Services secretary empowered to apply “more stringent measures of meaningful use over time”

The obvious question – What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? – is left purposely vague. In his book, former Sen. Tom Daschle proposed an appointed body to decide “tough” questions politicians are loathed to answer. The stimulus bill follows his cue by establishing the Federal Coordinating Council for Comparative Effectiveness Research.

McCaughey writes that Daschle in his book recommends slowing the development of costly new medications and technology that are driving up costs: “He praises Europeans for being more willing to accept ‘hopeless diagnoses’ and ‘forgo experimental treatments,’ and he chastises Americans for expecting too much from the health-care system.”

The stimulus bill would change current protocol and apply a cost-effectiveness standard set by the Federal Council. Under the current standard of care, Medicare pays for treatments that are thought to be safe and effective. “The Federal Council,” McCaughey writes, “is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit.”

The provisions in the stimulus bill respecting health care enforce rationed care according to a model common in Europe, where in 2006 the U.K. health board determined that elderly patients with macular degeneration must wait until they had gone blind in one eye before being eligible to receive a drug to save the other eye. Three years of energetic public protest reversed the decision – a picture perfect shot of the dangers involved when legislators do not sufficiently examine hidden pigs in hidden pokes.

Has Connecticut Sen. Chris Dodd, now carrying the health care spear for an ailing Sen. Edward Kennedy, read these provisions in the stimulus bill? Have any of the members of Connecticut’s universally Democratic U.S. congressional delegation read these provisions?
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