( - promoted by kindler)
For reasons unknown to me, I am on Dick Morris's e-mail list. You may remember Morris as the Republican strategist who wound up working for Bill Clinton in the 1990's.
Well, in yesterday's e-mail to Morris's minions, we learn that the Obama health care bill will mean the end of Medicare as we know it. Cue the scary music.
There are two parts to the Morris rationale. Obama's health care proposal is, in effect, the repeal of the Medicare program as we know it. The elderly will go from being the group with the most access to free medical care to the one with the least access. Indeed, the principal impact of the Obama health care program will be to reduce sharply the medical services the elderly can use. No longer will their every medical need be met, their every medication prescribed, their every need to improve their quality of life answered.
In other words, at the moment the elderly are in a relatively privileged position, in that their bills are covered by Medicare; if we give other Americans a similar guarantee, the elderly no longer have a comparative advantage over the rest of us. This piece of the argument does not argue that the elderly will suffer any diminution in their own health care -- only that they will lose the psychic benefit that they supposedly now derive from knowing that the rest of us have to struggle to pay our health care bills in ways that they do not. This is stupid for so many reasons, but what I find most offensive is the suggestion that the elderly are in fact chortling all the way to the doctor's office as they look back with glee on their children who can't get in the door. |
The second reason that the elderly should be scared of the Obama plan (there isn't one yet, but let's not let facts get in the way here) is that if the rest of us have more access to medical care, the elderly will get crowded out and will not be able to see doctors when they need to. Today, 800,000 doctors struggle to treat adequately the 250 million Americans who have insurance. Obama will add 50 million more to their caseload with no expansion in the number of doctors or nurses. Indeed, his plan will likely reduce their number by lowering reimbursement rates and imposing bureaucrats above them who will force medical decisions down their throats. Fewer doctors will have to treat more patients. The inevitable result will be rationing.
There actually is a germ of an argument in what Morris says, but not for the reason that he offers. He raises a specter for the elderly of what "rationing of health care" would mean, ...it is the elderly who rationing will most effect. Who should get a knee replacement a 40 year old or a 70 year old? Who should get a new hip, a young person or an old person? Who should have priority in the operating room a seventy year old diabetic who needs bypass surgery or a younger person? Obviously, it is the elderly who will get short shrift under his proposal. Here Morris raises a problem for the health care system as a whole, but he both misstates the issue and misstates the reason for the debate.
Talk to health-care administrators and planners, and one thing that they agree on is that we end up spending doctors' time and insurance company money on things that, from a societal point of view, seem like luxuries. Do you do expensive orthopedic surgery on someone who is terminally ill? Is elective surgery being done to improve someone's quality of life -- the $20,000 hip replacement, for example -- a waste of money if it is being done on someone dying of cancer?
We spend inordinate amounts of money on health care for people in the last year of life. If the medical profession could figure out principled bases for making better decisions about how to manage the terminally ill patient, the Medicare system would save a lot of money. But this begins to sound like "rationing."
To Morris, "rationing" means that a government health care administrator looks at 20 people who need surgery and says, "We only have money for 10 surgeries; we'll pay for the surgery for the ten youngest people, and the rest of you are screwed." And he offers up the Canadian experience as proof of the problem.
Comparing Canadian statistics to American statistics, he writes:
Limited colonoscopies have led to a 25% higher rate of colon cancer and a ban on the use of the two best chemotherapies are part of the reason why 42% of Canadians with colon cancer die while 31% of Americans, who have access to these two medications, survive the disease. This is an awful distortion of the statistics.
The National Center for Policy Analysis -- a group of heavily Republican business leaders who are opposed to government action in health care -- includes some interesting statistics on their website. Fact No. 2: Americans have lower cancer mortality rates than Canadians. ... colon cancer mortality among men is about 10 percent higher than in the United States.
. . .
Fact No. 4: Americans have better access to preventive cancer screening than Canadians.
. . .
* Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent). We have many more colonoscopies in this country BECAUSE of government action -- because many states, including Virginia, passed laws requiring health insurers to cover the cost of a colonoscopy for someone over the age of 50. Before those legislative changes, brought about in large part by the efforts of Katie Couric after her husband died of colon cancer, the statistics were comparable.
If you have more colonoscopies, you catch more cancers earlier. If you catch them earlier, you can cure them. Colon cancer death rates are almost entirely a function of the number of colonoscopies. If the government-run health-care plan provides that colonoscopies will be covered, they will be performed and lives will be saved.
So Morris shows the Republican talking points -- the elderly will lose because the rest of us will get better health care, the elderly will lose because health-care administrators will conclude that the elderly aren't as deserving of good care, and we will all die before our time of preventable disease if we let government pay for our care. |
