Medicine Archives

What Works and What Doesn’t: Health Care

(This is part of the script for the latest episode of my podcast, "Consider This!". You can listen to it on the website, or subscribe to it in iTunes, Stitcher Radio, Blubrry, Player.fm, or the podcast app of your choice.)

Liberal columnist Ezra Klein, writing in the Washington Post, June of 2009:

If you ordered America’s different health systems worst-functioning to best, it would look like this: individual insurance market, employer-based insurance market, Medicare, Veterans Health Administration.

Yeah, he really said that, and it was obviously untrue back then. But that didn’t stop his love of socialized medicine. Here he is again in 2011:

The thing about the Veteran’s Administration’s health-care system? It’s socialized. Not single payer. Not heavily centralized. Socialized. As in, it employs the doctors and nurses. Owns the hospitals. And though I think there’s some good reason to believe its spending growth is somewhat understated — it benefits heavily from medical trainees, for instance — accounting for that difference still means a remarkable recent performance.

He also called the VA system, “the program is one of the most remarkable success stories in American public policy.” Of course now everyone’s saying that the system has been awful for decades, so you can’t blame Obama for it. While that’s certainly true, you can blame liberal pundits who have been trying to suggest for years that the performance of the VA means that ObamaCare ought to work. It seems like they’ll say anything to get their policies enacted. Never mind reality.

And they’re making the same claim as a certain presidential candidate did 6 years or so ago. So in a sense, you can blame the President for foisting on us a system based on one that was, and is, a money pit and an abject failure, and which is utterly dishonest about those failures. They can, or should, be able to see what works and what doesn’t, but I guess Obama is going with the idea that this time, it’s gonna’ work.

    More Money for Medicare?

    One of the alternatives to ObamaCare that the Left suggested is that Medicare should just be expanded to cover everyone. It “worked”, so they said, and thus that would be a simpler way to get health care coverage expanded.

    But an investigation by the inspector general of the Department of Health and Human Services said that the program spent $6.7 billion (with a “b”) too much for office visits and other services. And that’s just in 2010; just one year’s worth of fraud, abuse and/or incompetence.

    We keep hearing about how this politician or another wants to save the government and the taxpayer money by eliminating this kind of waste, but it never happens. Here’s one reason why. The Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn’t plan to review the excess billing payments that account for this because it isn’t cost-effective to do so. Essentially what they’re saying is that it would cost more than $6.7 billion to save that $6.7 billion. Really? Is…is that job opening available? Because if it is, I think I could do it for half that cash. Or, at least I’d like to try.

    See, this is a prime example of the problems of big government. It can waste billions – billions – and then claim that it’s not cost effective to deal with the waste. And then the recipients of that fraud have nothing to worry about. Their scam is safe within the walls of a massive bureaucracy. Oh sure, it’s helping the poor and elderly, but really, is there no way at all for that to happen without flushing away billions every year? Really?

    This is also a prime example of what happens to centralized government programs. They become bigger and costlier, and, as Ronald Reagan observed, they wind up being the closest thing to eternal life we’ll see this side of heaven. They are a power unto themselves, and any attempt to rein them in has to deal with that inertia, not to mention that, as I said earlier, any attempt to curb such waste gets those attempting it the injustice of being considered hateful, racist, and whatever else the Left can come up with today.

    There’s a trend here on the issue of big government programs, both in the money they cost, and the way they’re defended in spite of their results. And yet, we just keep adding to their numbers. If one definition of insanity is doing the same thing over and over but expecting different results, it’s time to have the government committed.

    It has been a tenet of the Left that government can be a force for good, and no one’s really denying that. It’s just that there are places for it, and places where it shouldn’t be, and if you overextend government’s reach, prepare for these very consequences. The Constitution was written to keep those kinds of folks in check. Unfortunately, there’s not been enough pushback, and now too many Americans expect this sort of overreach, but they want others to pay for it.

      More Money for the VA?

      (This is part of the transcript of my latest podcast episode, "Consider This!")

      In an opinion piece at the Huffington Post by H. A. Goodman, he argues that Republicans have been complaining about how bad the VA is, but hypocritically voted against a bill for various funding for the VA back in January.

      Here’s a problem with that, and it’s not something you’ll hear on most newscasts. For the last 5 years, the VA has not spent its full health care budget; as much as $1.163 billion extra to as “little” as $450 million in medical-care funding from this past fiscal year. And still vets have been waiting too long for care, some paying with their lives. Clearly, clearly, throwing more money at the problem has done nothing whatsoever to fix it.

      The Republicans, back in January, said that if the huge catch-all bill were split up into separate bills, there were plenty of items they would vote for. The issue was fiscal responsibility. Democrats, on the other hand, really do have the mindset that enough greenbacks will solve any problem, especially if the problem is one that makes liberalism look bad. And the single-payer VA medical system absolutely fits that particular bill. Creating a single source of a particular product or service (in this case, health care) inevitably leads to scarcity (in this case, waiting lines). If vets could choose any hospital they wanted, and if the government still picked up the tab, would we have this problem? No. But this would be an indictment of a system that Democrats want to see implemented all over, and so it cannot be seen to fail.

      Remember this when Democrats like Mr. Goodman accuse Republicans of “hating the poor” or of being “racist” because they don’t want to throw more money at programs that are similarly flawed. Since the mid 60s, when the “War on Poverty” began, the poverty rate has been bouncing around between 10 and 15% of the population. Nothing has changed. Prior to that, the poverty rate had been steadily decreasing, from 30% in 1950 to 15% when we went to war on it. We were gaining ground, but since “going to war”, it’s been nothing but a stalemate, even though the programs have been costlier every year. But just look askance at the programs, just try to reign in some of that continue rise in cost, and you get accused of all manner of hate and villainy. For nearly half a century we’ve been pouring more and more money into it, just like the VA. And, just like the VA, it is not doing what it is supposed to be doing, or doing it incredibly inefficiently.

      But if you want to change the flat tire and try to get things done better, you’re accused of hating the car. The flat’s got us this far, it can go further, right?

        The Real Issue With the VA

        (This is part of the script for the latest episode of my podcast, "Consider This!". You can listen to it on the website, or subscribe to it in iTunes, Stitcher Radio, Blubrry, Player.fm, or the podcast app of your choice.)

        Presidential candidate Barack Obama, back in 2007, gave a speech titled “A Sacred Trust”. It was a speech about the military; his plans for it, and for the veterans who came home from it. Here is one thing he said in it, “No veteran should have to fill out a 23-page claim to get care, or wait months – even years – to get an appointment at the VA.”

        How was he going to fulfill that goal? Here was his promise, “It’s time for comprehensive reform. When I am President, building a 21st century VA to serve our veterans will be an equal priority to building a 21st century military to fight our wars. My Secretary of Veteran’s Affairs will be just as important as my Secretary of Defense.” He followed that with specific changes he was going to make. But, whether he made those changes or not, whether or not vets are means-tested for care, whether or not VA budgets were passed on time every year, the result is still the same; long waits, and deaths due to them.

        Obama knew of the problems in the VA before he became President. At least 5 years ago, he was warned about the specific wait time issue. What has changed? Nothing. And now he claiming he was shocked to hear about it; not from his advisors, but from the media. Let’s not forget that he was shocked about the IRS targeting conservatives, up until the point where he claimed that there was “not a smidgen of corruption”. I guess his views on that “evolved”.

        There is another line from that speech that I think bears considering. His plans for the VA were a blueprint for something else. “The VA will also be at the cutting edge of my plan for universal health care, with better preventive care, more research and specialty treatment, and more Vet Centers, particularly in rural areas.” That’s right. ObamaCare was the next step, and what’s happening now with the VA is the future of what’s going to be happening with you. Centralized health care, or passing laws to create facilities and doctors out of thin air, doesn’t work.

        And honestly, this has been the issue for decades. It didn’t start when Obama was elected. Presidents from both parties have presided over this long-running debacle, some say as far back as the Kennedy administration, because the fundamental problems are always there. On MSNBC, one of their military analysts, Army Col. Jack Jacobs, spoke on The Reid Report about how Veterans Affairs Sec. Eric Shinseki was a good guy and was doing a good job, but in the end, the VA’s system of health care itself cannot give us what we need from it, regardless of how much money you throw at it.

        Yeah, that really aired on MSNBC. But if the VA is the blueprint for ObamaCare, then the question is this: If we can’t take care of those we are the most indebted to, how is it going to work for all of us? Centralization like this – one of the pillars of the liberal view of government – is a failure. It has been shown not to work, specifically with regards to health care, and yet we just keep doing it bigger and costlier. Vets are dying in service to this social and political experiment. That’s certainly not the war they signed up for.

        And in the meantime, Army Private and convicted felon Bradley Manning has been on the fast-track to get his sex change. Got to have your priorities.

        The White House vowed to withdraw all U.S. troops from Afghanistan by year’s end. That’s if they agree to leave. Comedian Argus Hamilton says, if given the choice between surviving Taliban attacks in the Afghan mountains and surviving VA care when they get home, they like their chances in the mountains.

          Unique Lawsuit Against ObamaCare

          George Will, writing in the Washington Post, highlights a very novel lawsuit working its way through the courts. Essentially, the thought process of the suit goes like this:

          1. The Constitution says explicitly that, “All bills for raising reveornue [that’s the 1700s spelling of “revenue”] shall originate in the House of Representatives”.
          2. The ObamaCare bill originated in the Senate. No problem there, but…
          3. The Supreme Court, in what Will calls a “creative” reading of the law, called the bill a “tax” on certain activity (or, in the case of ObamaCare, inactivity).
          4. As a tax, it is therefore a revenue bill, but it did not originate in the House, and is therefore unconstitutional.

          Ya’ gotta’ wonder if Chief Justice John Roberts played rope-a-dope with the liberals on the bench in creating this particular interpretation, and was hoping someone out there would notice.

          There are some other issues with how the bill was created, and reading this short piece, from a link in the show notes, is incredibly enlightening. Keep an eye on Matt Sissel and the Pacific Legal Foundation’s lawsuit. We may be hearing about it more prominently in the months to come.

            From the "Now They Tell Us" Department

            The Associated Press is breaking news that those of us who were paying attention knew about at least 6 months ago.

            The first thing Michelle Pool did before picking a plan under President Barack Obama’s health insurance law was check whether her longtime primary care doctor was covered. Pool, a 60-year-old diabetic who has had back surgery and a hip replacement, purchased the plan only to find that the insurer was mistaken.

            Pool’s $352 a month gold plan through Covered California’s exchange was cheaper than what she’d paid under her husband’s insurance and seemed like a good deal because of her numerous pre-existing conditions. But after her insurance card came in the mail, the Vista, California resident learned her doctor wasn’t taking her new insurance.

            "It’s not fun when you’ve had a doctor for years and years that you can confide in and he knows you," Pool said. "I’m extremely discouraged. I’m stuck."

            Stories like Pool’s are emerging as more consumers realize they bought plans with limited doctor and hospital networks, some after websites that mistakenly said their doctors were included.

            Now we know why her policy’s cheaper. You get what you pay for.

              Health Care Coverage vs. Health Care

              There’s a difference between getting heath care coverage, and actually getting health care. In the US, you could always get health care. Emergency rooms had to see you whether or not you could pay them. And there were various free clinics, like one in Mountain View, California.

              The Rotacare clinic was happy to help out their patients in getting ObamaCare coverage so they’d no longer need the free clinic. Months later, however, the same people are coming back. Why? They can’t find a doctor taking more patients or who are accepting the plans.

              Conservatives warned that exactly this thing would happen, years ago. It was handwaved away as scare tactics. But it’s Californians who are scared now, about having to pay premiums, subsidized though they may be, and not be able to actually use what they paid for.

              Millions of Californians have been added to the ranks of the insured, but 1/3 of California primary care physicians are set to retire. What are we going to do now? We passed a law that said insurance should be magically cheaper. That didn’t work. So then let’s pass a law to make doctors magically appear!

                Piecemeal vs. Overhaul

                Part of ObamaCare was the PCIP, the Pre-Existing Condition Insurance Plan. John Lott notes that, at its height, at the beginning of 2013, there were 115,000 enrolled in it. So one big selling point seems to be working.

                Except that dealing with something like this on its own would have been cheaper and less disruptive of the entire health insurance industry. Clayton Cramer did the math, and if you gave those people $20,000 per year to subsidize their insurance premiums, it would cost $2.3 billion. Now, that’s a lot of money anyway, but doing it that way would also allow millions of people to keep their plan if they liked their plan; just one example of the disruption that was caused instead.

                Again I note that Republicans did have their own solutions to the health care problems, but Democrats insisted that the whole industry had to be upended in order to fix it. We’re finding out just how wrong that was. We are. Seems they aren’t.

                  ObamaCare “Savings”

                  In spite of all its rollout issues, the glitches, the delays and the special privileges, the promise of ObamaCare was that, in getting more people, mostly the young and the poor, insured, that would spread out the risk and make insurance cheaper overall, even with those subsidies. By how much? Well, there were promises made, over and over.

                  Now, in some of those cases he did say “up to” $2500 dollars. And since 0 is technically on the way up to 2500, if you didn’t save anything, he can count you as a promise kept, just like anyone else trying to sell you something on TV. However, what about these folks?

                  A recent survey of 148 insurance brokers shows that ObamaCare is sending premiums rising at the fastest clip in decades.

                  “For the last, about, five years they’ve been doing this survey, so this was the largest percentage increase in any quarter since they’ve been doing (it),” said Scott Gottlieb of the American Enterprise Institute.

                  “But at 12 percent, 11 percent increase on average across all the states — that puts it at the upper end of any increase we’ve seen for decades.”

                  I don’t think that “truth in advertising” laws would allow you to claim that saving negative dollars is somewhere “up to” $2500. Now, are some people saving that much? I’ll stipulate to that, but in general, on average, this is costing the American people more, not less.

                  And for some states, it’s really bad. Premiums in Pennsylvania went up 28 percent. In Florida, up 37%. In California, up 53%. And those in Delaware have had to deal with a 100% increase in premiums.

                  Oh, and this isn’t considering the higher deductibles. That’s just as much a cost as the premium. And the Congressional Budget Office projects that the premiums of the ObamaCare plans are going to continue to rise.

                  Of course, those paying the penalty are saving loads of cash. That defeats the purpose, but hey, savings are savings, right?

                    Defending ObamaCare With Anecdotes

                    You’ve no doubt heard them yourself. I’ve heard them quite a bit; on social media, on blogs, and even in TV commercials. I’m talking about people with their own personal stories about how the Patient Protection and Affordable Care Act, aka ObamaCare, has helped them personally.

                    It’s great to hear that people are able to get coverage for things that they either couldn’t get covered for before, or for less money. Who wouldn’t be in favor of that, and be glad for these people? It feels good hearing how people have benefited from this government program.

                    And that’s what those, especially on social media, are trying to say with their success story; this is a good thing, because it worked for me. Then I have to ask, what do we make of this story?

                    William Rivers Pitt, is the senior editor and lead columnist at the leftwing web site TruthOut. He has his own story which he posted at the Democratic Underground website, a forum for the far Left. (Have we figured out where this guy’s politics lie on the spectrum?) He first extolled the wonders of Obamacare, writing about his experience in getting signed up. System goes down in the middle of the session. No problem. Call the 800 number and finish the process there. “No. Big. Deal. Thanks, Obama.” That’s how he signs off that post.

                    And then reality set in. In another post later on, he relates his experience, not with signing up for Obamacare, but actually trying to use it.

                    What I’ve learned after a three-month war with these fiends: the ACA says the insurance companies cannot deny coverage to those with pre-existing conditions, which is true as far as it goes. But they can deny coverage for the life-saving medications necessary to treat those conditions. The insurance company I signed up with through the ACA exchange just denied coverage of my wife’s multiple sclerosis medication. We’re "covered," to the tune of $700 a month…just not for what she really needs.

                    He signs off that post quite a bit differently. Later he said he feels like a dupe, and wishes he had a time machine to undo what he’d done. His criticisms get to the point that the DU folks stopped allowing him to comment on his own post.

                    So then let’s consider this. Does this prove that Obamacare is an abject failure? No. Additionally, good experiences with it don’t prove that it is a success, either. If you contend that one is true, then you have to accept the other, and they come to opposite conclusions. Well then, what does any of this prove, other than that some people are doing better and others doing worse?

                    The answer is, it proves nothing.

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