Consumer Centered Healthcare

Anonymous, Used by Permission
Written June, 2009

Introduction

The government already has promised more than it can deliver to those on Medicare. If it now makes more promises that it cannot keep, the system could collapse for everyone. Certainly the Obama health care plan will require scaling back medical care for those on Medicare — by rationing services.

If press reports are at all correct about what will be in the Administration bill (still being kept a secret from the American people), it has become the author’s view that Seniors are among the groups which will be most disadvantaged by the Administration bill.

Top Ten Reasons

1. The Obama proposal is based upon the faulty premise or hypothesis that there are 46 million Americans without health care. This statement has been repeated so often that it has become almost a “mantra,” but it is not true.

• First, it is said that the 46 million are “uninsured.” Casually, that’s interpreted or reported as they are “uncovered.” The first statement might be true; the latter is not.
• A very large number of the 46 million are covered or are eligible for Medicaid, the VA, medical care for military dependents and retirees, the Indian Health Service, student and university health services, and county hospital systems. The safety net does seem to provide safety to these folks.
• Moreover, it is believed that the alleged 46 million includes a significant number of illegal aliens.
• The public has been led to believe, by politicians that are ambitious and reckless with the facts, that there are 46 million Americans, in effect, bleeding in the streets. That’s one out of six Americans. THIS CAN’T BE THE CASE but, like moths around a candle, virtually everyone — with characteristic American sympathy and concern — believes the original shibboleth.

2. The Obama Approach would massively increase the cost of providing health care to the federal government, bankrupting the system for current beneficiaries.

• It has been estimated that the Obama proposals for nationalizing health care will cost $1.5 trillion in added federal health care spending over the next 10 years.
• This new debt would come at a time when the national debt has already QUADRUPLED in the first five months of the Obama Administration.
• This, also at a time when the runaway costs of the current Medicare and Medicaid entitlement programs are spiraling out of sight, with huge unfunded liabilities. Medicare’s trust fund is scheduled to go negative in eight years, and Medicaid is bankrupting not only the federal government, but also the states (which must pay a significant share of the cost).
• It was recently reported by the Congressional Budget Office (CBO) that, simply with the current trend lines of Medicare and Medicaid spending, absent any corrective action, the federal personal income tax rate will have to go to 66 percent by 2050 and to 88 percent by 2082.  These numbers do not include the recent dramatically enlarged SCHIP program, a new entitlement for children that covers families far above the poverty line.

3. Severely diminished quality of care. Turning to a system like Canada and Great Britain would be a major mistake.

David Gratzer, M.D., senior fellow at the Manhattan Institute, and born and raised in Canada, says that government health care there is neither compassionate nor equitable. Canadians, he says, wait for practically any procedure or diagnostic test or specialist consultation. One patient, with difficulty walking and in chronic pain, was referred to a neurologist; he was told that an MRI would have to be done, and that possibly there should be a referral to another specialist. The wait for these would be roughly a year. If surgery were needed, the wait would be months more. Instead, he went to the Mayo Clinic in the United States and paid for it himself. An Ontario woman had a 40-pound fluid-filled tumor removed from her abdomen by an American surgeon in 2006. Her Michigan doctor estimated that she was within weeks of dying. She was still on a wait list for a Canadian specialist. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery (with broken backs, burst aneurysms, and other types of bleeding in or around the brain). Only half of Canadian ER patients, Dr. Gratzer asserts, are treated in a timely manner according to national and international standards. Finally, he reports that the physician shortage in Canada is so severe that some towns hold lotteries, with the winners gaining access to the local physician. Prior authorization turns into bureaucratic delays which turn into formal waits and denials . . . almost inevitably jeopardizing the patient’s health and often causing premature and preventable death. Cancer survival rates in Canada and the United Kingdom significantly are lower than in the United States. Where will the patients Dr. Gratzer describes (and those in the United States!) go if the U.S. adopts the same system as Canada’s?

4. Dictates by bureaucrats on physicians and patients as to what kind of care they may receive.

• Inevitably, when resources are strained, physicians (and other providers) are told what kind of care to provide — or, of course, what care will be paid for.  This is often done by a high school or community college graduate, who is not medically trained, but merely following “guidelines.”
• Total health care costs are the product of four variables:  eligibility, benefits, provider reimbursement, and utilization.  When the federal government pumps up eligibility (to be politically popular; spend and spend, elect and elect), the other three must be arbitrarily restricted.  Thus, the federal government dictates what benefits will be provided, what the federal reimbursement limits will be, and how often the patient may visit the provider.

5. “Guidelines” become hard and fast, and have already surreptitiously been authorized in federal law.

• Neatly tucked into the second stimulus bill enacted in a great rush in February of this year were a substantial number of provisions on a somewhat different, but related, subject:  Health Information Technology (HIT), which never received any committee attention, hearings, testimony, let alone debate (or even awareness on the part of most Members) and which can (and no doubt will) substantially alter the provision of health care in this country. Centralized, federal control of health care data is now required. In addition, there is created for the first time a Federal Coordinating Council for Comparative Effectiveness Research, which will determine what health care is “appropriate and cost effective.”
• “Appropriate and cost effective” can easily be converted into “guidelines,” then into hard and fast rules . . . and, as resources are stretched thin, this — under the President’s approach — no doubt will lead to health care rationing.

6. Health care rationing will become the norm, and who is hit hardest and soonest by health care rationing? Senior citizens.

• When health care rationing begins to show its ugly head, it is a very real probability that the first victims will be senior citizens. “You are too old to have that treatment; you are going to die of something else anyway.”
• An example in England: Senior citizens with macular degeneration in one eye were told that they could receive no treatment for it until it developed in the second eye. (The outcry because of this government fiat reportedly was such that the socialized health care officials had to rescind the policy. But how many must suffer before the policy gets changed? Could it be you, or someone you love?)
• Kidney dialysis, organ transplants, and use of any expensive new technology — even though the patient’s life might be saved — would be in jeopardy.

7. To pay for the overwhelming costs of the new program, the Congress is considering repealing many tax features and deductions that benefit senior citizens.

• Legislators presently are considering repealing or modifying present tax provisions that now benefit seniors:
• Repeal or modify the present tax exclusion of Medicare benefits.  The tax exclusion of Medicare benefits from income has been reported to be worth $40.6 billion in revenue.
• Employer-provided health insurance — presently treated as excludable income — would now be taxed (a very large number of seniors — perhaps as many as one-third to one-half of Medicare beneficiaries — receive their Medicare supplemental benefits through former employers).  This also includes retired military, TRICARE, and retired federal government workers.
• Repeal or modify the itemized deduction for medical expenses (worth $10.7 billion). Either raising the threshold or eliminating the deduction altogether would affect senior citizens disproportionately for two reasons: (i) Their income tends to be lower, and thus it would be more difficult to qualify for the deduction; and (ii) seniors tend to have more medical expenses than younger taxpayers.
• In addition, as a consequence of counting the value of health insurance as taxable income, and raising or repealing the medical expense deduction, would be subject a greater portion of seniors’ Social Security benefits to taxation. A senior’s marginal tax rate thus would be much higher than other taxpayers’.

8. As governmental review and payment dictates become more onerous, an increasing number of health care providers will choose to leave the system.

• Already, as the requirements and poor payment rates of Medicare and Medicaid impact providers, they choose to leave the system altogether.
• This means a fewer number of providers will be available to treat patients — meaning longer delays in getting appointments and perhaps even restrictions on your choice of physician. As the federal government becomes the equivalent of a giant HMO, you very well may be told whom to see, eliminating freedom of choice altogether.
• Worse yet, all medical care providers conceivably might be required to become federal employees.

9. As federal medical costs spiral upward, look for Medicare (and any new program) premiums (especially Parts B and D), co-payments, and deductibles to go up. Benefits to Seniors will be reduced to help pay for benefits being newly-extended to others.

10. Promised offsetting savings — often cited by the President as in the range of $300 to $400 billion — as a result of “efficiencies” or “modernized systems” will prove to be ephemeral, illusory, or non-existent. The entire history of Medicare and Medicaid proves this. The system is not self-funding. Increasingly, the tax burden will be placed on Americans, including Seniors.

Conclusion

There will be those who will try to convince Seniors that “health reform” is vital and that the changes made will not be as drastic as those outlined above. They are, in effect, quietly repeating:  “Come into my parlor, said the spider to the fly.”

Tags: health care reform, Medicare, seniors

This entry was posted on Tuesday, August 18th, 2009 at 11:38 am and is filed under The Coalition Presents. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.