The Doctor Is In

I’ve been incommunicado for a while, in no small part for reasons shortly forthcoming. But lest you be left completely high and dry, here’s a little nugget for you.

The WSJ has a book review of Son of Hamas which will definitely be on my reading list when it comes out:

Mosab Yousef is the son of Sheikh Hassan Yousef, a founder and leader of the Palestinian terrorist group Hamas. Throughout the last decade, from the second Intifada to the current stalemate, he worked alongside his father in the West Bank. During that time the younger Mr. Yousef also secretly embraced Christianity. And as he reveals in his book “Son of Hamas,” out this week, he became one of the top spies for Israel’s internal security arm, the Shin Bet.

Matt Kaminski describes the book as follows:

The book, a Le Carréesque thriller wrapped in a spiritual coming-of-age story, is an attempt to answer what he says “is impossible to imagine”—”how I ended up working for my enemies who hurt me, who hurt my dad, who hurt my people.”

“There is a logical explanation,” he continues in fairly fluent English. “Simply my enemies of yesterday became my friends. And the friends of yesterday became really my enemies.”

Just to whet your appetite — back soon.

As the Democrats in Congress press forward in blind determination to pass their health care reform legislation come hell or high water, the pernicious effects of the legislation are increasingly becoming evident to anyone who takes the time to dig into its details. Though our Congressional representatives cannot seem to find the time to read these gargantuan, 2000-page bills, busy as they are padding their pockets with filthy lucre from lobbyists and interest groups, those at the state level who are will be responsible for picking up the credit card bills from this monomaniacal spending spree are starting to sweat. Even the Blue states — no strangers to fantasy spending budgets, punitive taxes, and political giveaways — can see the handwriting on the wall.

Out here in scenic Washington — where Patty Murray is considered an astute statesman and Jim McDermott is considered sane — the details of Obamacare are becoming frighteningly clear:

Washington has a 13.2% uninsured rate and one half of these people are in the age range of 18-34. Because of the bill’s individual mandate that would require every adult to buy health insurance, 432,000 young healthy people in the state would be forced to make this purchase … The bill also requires a community rating price control on all policies which would cause these young Washingtonians to pay a higher price for coverage, while older, sicker individuals would pay less for their insurance.

There is something of a sweet irony here: those who voted overwhelmingly for Obama and who much prefer spending money on grunge music, Hempfests, and gas masks are about to wake up and find themselves paying hefty premiums to greedy insurance corporations, or facing big fines or jail time for refusing to do so — proving there truly is Karma in the world.

The Avatar-blue seasoned citizens will likewise find themselves unpleasantly surprised:

On the other end of the age spectrum, 890,000 seniors have Medicare coverage in Washington. Congress plans to finance the Senate bill in part by cutting Medicare by $471 billion. Physician reimbursement would be reduced by 21%, while Medicare Advantage would essentially be eliminated, forcing 205,000 Washington seniors out of the program and back into traditional Medicare. Access to doctors is already a problem for Washington seniors because of low Medicare payments compared to private insurance. Further cuts in how much Medicare pays doctors will only make this access problem worse for seniors.

In fairness here, the 21% cut in physician reimbursements is by no means certain: Congress has consistently blocked these “budget neutrality” cuts in the past (to prevent a mass exodus of physicians willing to see Medicare patients), even though they use the imaginary $250 billion “savings” as part of the budgetary chicanery to make Obamacare look affordable.

But Medicare Advantage plans are squarely in the sights of the Congressional cost-cutting guns. These plans provide benefits to Medicare patients using private health insurance, typically providing much better benefits than Medicare alone while costing less than expensive supplemental plans which merely cover Medicare’s substantial co-pays and deductibles. MAs are very popular — 30-40% of Medicare-eligible patients use Advantage plans, and the percentage has been growing rapidly. The drastic slash in funding for MA plans will result in benefit cuts and stiff premium hikes, driving many patients back to traditional Medicare, drastically ratcheting up out-of-pocket expenses for the elderly and cutting many of their benefits.

And it should be stressed that physician access problems in Medicare patients (it is extremely difficult in Washington to find primary care physicians who accept new Medicare patients, and the specialists are fast bringing up the rear given Medicare’s drastic cuts in fees to specialists) are not simply about low payments, and greedy doctors wanting more money; it is about reimbursing physicians to provide care at levels substantially lower than their overhead costs.

Quite simply, when you see a Medicare patient, you lose money.

Of course, you don’t have to be young or on Medicare to reap the benefits of health care reform:

Almost 130,000 Washington residents have health savings accounts (HSAs) and high deductible insurance plans. The Senate bill reduces the HSA contribution amount by one half and doubles the penalty for non-medical withdrawals. New government limitations will probably eliminate high deductible policies and consequently eliminate HSAs. All HSA holders would lose their personal coverage and be forced to buy traditional insurance.

The Seattle area has growing industries in biotech and medical device manufacturing. The Senate bill would add a 10% to 20% tax on these businesses. The cost would either be passed on to consumers or, more likely, would cause a reduction in medical research and development.

Almost 2.7 million workers and their family members in Washington receive health insurance through their employers’ self-insured programs. These people would be allowed to keep their insurance for five years. The plans must then comply with strict government benefit plans which would cause many employers to drop their coverage and force many workers to join a government plan. In addition, generous employer-sponsored insurance will be subject to a new 40% tax. In three years, 20% of all workers will be paying this tax and in six years, 20% of all households making more than $50,000 a year will have to pay this tax.

And then there’s Medicaid — coverage for the poor co-funded by federal and state governments. Obamacare extends health insurance to the uninsured poor by greatly expanding Medicaid, which is already well on its way to bankrupting the states:

Under the Senate-passed bill the number of Medicaid recipients in Washington would immediately increase by over 280,000 people. The federal taxpayers would initially pay for these new enrollees, but within five years state taxpayers would be forced to pay at least $6.8 billion more over the following ten years. The total cost of Medicaid to Washington taxpayers would then be nearly $36 billion for that ten year period. Access to doctors for Medicaid patients is even worse than for Medicare patients because of lower doctor reimbursement rates. Adding hundreds of thousands of people to Medicaid, when these patients are already being turned away by doctors, makes no sense for either patients or taxpayers.

This is fiscal insanity, akin to buying a ticket for passage on the Titanic after it has hit the iceberg.

Washington State is hardly alone in its terror about the coming health care regime. California, whose credit rating is shakier than a welfare queen on crack, is looking at financial and medical Armageddon as well. From the New York Times:

The [California Medicaid] program, known as Medi-Cal, currently serves roughly 6.5 million poor Californians. And that number could increase by 2 million under the pending legislation. Congress wants to use the Medicaid program as a way to cover more of the uninsured poor, reasoning that it’s a relatively cheap way to go by relying on existing programs.

But doctors say only a third of the state’s 60,000 practicing physicians are participating in the program because of low reimbursement rates, and they fear that more physicians will opt out.

“Increasing eligibility for Medi-Cal without increasing reimbursement rates would be catastrophic,” said Brennan Cassidy, president of the 35,000-member California Medical Association. “There’s no place for those patients to go for primary care because doctors aren’t accepting them.”

Again, the problem is not merely “low reimbursements” — it is Medicaid payment rates which cover less than half a physician’s costs to see the patient.

It is difficult to overstate how disastrous the pending Congressional legislation will be for health care and our nation’s financial stability. Are we really getting ready to jump off this precipice?

Sadly, it appears so.

The blogs have been abuzz about the big news from Arizona: The Mayo Clinic in Arizona will no longer be accepting Medicare patients for primary care.

The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians…

I’m surprised it took this long.

Mayo Clinic has long had a well-earned reputation for providing high-quality care at lower cost than much of the health care economy, due in large part to their successful formula (closed panel, salaried clinic physicians, and the resulting tight peer review) which is difficult or impossible to reproduce throughout the highly-diversified delivery systems in U.S. healthcare.

But Mayo Clinic is now coming to terms with the hard economic realities of seeing Medicare patients: it costs more to see them than you are paid:

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older…

For years, physicians and clinics have simply absorbed this cost, effectively using their cash flow from better-paying private insurers to cover their Medicare losses. And we have reached the point where this calculus is no longer viable — a line crossed some years ago with Medicaid, the federal health program for the poor, whose reimbursements are only 60% or less of what Medicare currently pays.

What we have here is an unsustainable business model.

Typically, the folks at CMS downplay this reality, using the accounting chicanery so prevalent among our government bureaucrats, who love to piss on your leg and tell you it’s raining:

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

Yes, the gap may have remained stable — but Medicare payment rates have declined significantly over the past decade. In 1997 the Medicare conversion factor per relative value unit (RVU) was $40.97; in 2007, it was $37.89 — a nearly 10 percent decline, without factoring in inflation — and not including significant reductions in relative value units themselves (which are purportedly a hard measure of the costs and value of the service provided, but in reality are frequently “recalculated” to reduce Medicare expenditures), and a marked increase in bundling (wrapping several services together and paying for only one). What has happened is that private insurers have followed Medicare’s lead and also significantly reduced their fees, which are commonly calculated based on Medicare’s rules and formulas, but at a slightly higher conversion factor.

So while the ratio may appear stable, the reality is that both Medicare and private carriers have been dropping their fees, while medical expenses (salaries, benefits, supplies, malpractice premiums, etc.) have risen significantly faster than inflation. So the income vs. expense curves are now crossing for many, if not most, medical practices, and Medicare patients are beginning to generate significant losses, while private reimbursements can no long cover the difference. The only economically sane decision to remain solvent is to cut back or eliminate Medicare patients. The result? Reduced access to care. Of course the politicians will take credit for reducing health care costs — caring for fewer patients will certainly cost less.

Who needs death panels?

This is simple economics, really — but far too difficult for our politicians and liberal policy wonks to understand:

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.

“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

No, Medicare doesn’t just look like a poor payer — it is a poor payer, and doesn’t cover the expenses involved in providing the medical care it pays for — even for a highly efficient organization like Mayo Clinic. This idiot’s theory is that simply by increasing the number of primary care providers, competition will be greater, and more MDs will be willing to take less to provide care. Law of supply and demand and all that.

So if you’re selling TVs which cost you $500 to purchase wholesale at a retail price of $350 (and that’s the price the government mandates), opening new dealerships will make this arrangement more economically viable, through competition.

Where do they find these morons?

Not unexpectedly, Mayo Clinic’s jilted Medicare patients are none to happy, as they are being asked to pay cash (gasp!) to keep their physicians:

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic’s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare.

“We’ve had many patients call us and express their unhappiness,” he said. “It’s not been a pleasant experience.”

Mayo’s decision may herald similar moves by other Phoenix-area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association.

“We’ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

So Mayo’s trying to offload their Medicare patients onto other primary care physicians in the community, who no doubt will be more than happy to pick up these new financial albatrosses.

Best of luck with that plan.

The solution to this imminent disaster in access is not merely an increase in Medicare payment rates — Medicare and Medicaid are hell-bound for bankruptcy, and a few band-aids won’t stem the hemorrhage, but only make it worse. The imminent passage of “health care reform” legislation now bubbling in the witches’ cauldron of Congress will not only worsen Medicare’s situation — half a billion dollars are being cut from Medicare under the new legislation — but will instead bring this access disaster to private insurers as well. As their loss ratios are fixed by law at unsustainable levels, and community ratings forces them to accept high-cost patients without financial compensation for their increase risk and cost exposure, they will be forced to raise premiums to untenable levels — or drastically cut reimbursements to hospitals and physicians.

The system is a disastrous maze, and needs to be completely dismantled, and rebuilt from scratch. And the chances of that happening are zilch, zip, zero.

Welcome to the future of health care in America. Better stay healthy.

Here’s wishing you all a very blessed a Merry Christmas!

Enjoy your family, the great food, and the time off.

And be mindful of its meaning:

Now in those days a decree went out from Caesar Augustus, that a census be taken of all the inhabited earth. This was the first census taken while Quirinius was governor of Syria. And everyone was on his way to register for the census, each to his own city. Joseph also went up from Galilee, from the city of Nazareth, to Judea, to the city of David which is called Bethlehem, because he was of the house and family of David, in order to register along with Mary, who was engaged to him, and was with child. While they were there, the days were completed for her to give birth. And she gave birth to her firstborn son; and she wrapped Him in cloths, and laid Him in a manger, because there was no room for them in the inn.

In the same region there were some shepherds staying out in the fields and keeping watch over their flock by night. And an angel of the Lord suddenly stood before them, and the glory of the Lord shone around them; and they were terribly frightened. But the angel said to them, “Do not be afraid; for behold, I bring you good news of great joy which will be for all the people; for today in the city of David there has been born for you a Savior, who is Christ the Lord. “This will be a sign for you: you will find a baby wrapped in cloths and lying in a manger.” And suddenly there appeared with the angel a multitude of the heavenly host praising God and saying, “Glory to God in the highest, And on earth peace among men with whom He is pleased.”

The madman is not the man who has lost his reason. The madman is the man who has lost everything but his reason.
 
       – G.K. Chesterton –

We have become a nation of experts.

They are everywhere: on TV, advising us about raising our children or improving our sex life; in magazines and newspapers, lending a measure of weight to opinion pieces disguised as news; in business, promising to improve productivity and bolster profits through higher productivity, or slicker marketing, or yet another reorganization or “team-building” project. They are ubiquitous in government and politics, lending credence to the implausible and certainty to the unpredictable. Armed with statistics, and studies, and the ethereal proclamations of other unnamed experts like unto themselves, they saturate our psyche with innumerable “facts” and figures, that we may live perfect lives in an imperfect world. The chaos which swirls around us need not engender fear and hopelessness — there will always be an expert to hold your hand, lest you become lost and wander from life’s perfect path.

Intimidated by their credentials and self-assured certainty, we slowly relinquish the uneasy feeling that their advice and conclusions invariably run counter to our experience, and common sense, and the simple wisdom of life acquired through parents and parish, logic and lore. Theirs is a relentless battering of our natural defenses, made ever more potent by lives lived without margin, frantically running to and fro, pursuing the very goals our experts have set forth, while quietly dying to the insight gained by simplicity and satisfaction with life’s precious but fragile treasures. Their strident advocacy drowns out the the quiet wisdom whispered to the soul in contemplation and prayer, found only in reflection and the fertile soil of rich relationships.

The fecklessness of our experts is often utterly dispensable, if annoying, as our guilded guides waffle from truth to contradictory truth: “Take estrogen!” “Don’t take estrogen!” “All fats are bad!” “These fats are good!” “Sun causes cancer!” “Sun prevents cancer!” What is true today will be foolishness tomorrow — and nary a hint of humility will be heard from those who hustled us mere months before.

As our increasingly secular and superficial culture abandons the transcendent truths of faith and the tested wisdom of tradition, we search desperately for a lodestone upon which to ground our lives, and so trade trust and belief in transcendent and transformational absolutes for fear and the desperate desire to control the world which has become our enemy. We frantically cling to every proffered proof, no matter how foolish or feckless, seeking something upon which to ground and anchor our lives. As these sands shift dangerously beneath our feet, we lurch and stumble from fragile branch to broken rail, as we stagger along a path which leads ever downward.

Yet the allure of the experts can prove far more destructive than mere personal angst in a turbulent, fast-moving world: how many listened to the professionals who told us we could not lose in real estate? Leverage to the max, it can only go up! The consequences across the economy have been devastating — except for those who sold us this sage advice. These “experts” understood the game far better than the market, and walked away unscathed and wealthy, leaving only our wreckage in their wake.

Our dependence on the guidance of scientists, economists, educators, and technocrats proves especially toxic when their expertise becomes wedded to money and political influence. Under the guise of shielding us from the complexity of their disciplines, they evolve into closed guilds, guardians of a secret knowledge which we, in our harrowed and hectic lives, have no time and little interest in understanding. As our educational system — itself run by a closed guild — produces generations of students tutored in woman’s studies, postmodern deconstructionism, and the evils of the West, yet ignorant of logic, philosophy, and the rigors of the hard sciences, the problem is compounded. We increasingly are left with little recourse but to trust those who guard and disperse the hidden knowledge we no longer comprehend. Our gnostic masters dispense their wisdom; ours is but to nod, and obey.

Nowhere can this process better be seen than the unfolding drama surrounding the East Anglia email scandal. Centered on one of the three major centers for climate research and data in the world, the hacked emails and software code have ripped open the veil to show us the inner sanctum of science utterly corrupted and politicized. At issue is anthropogenic global warming (AGW) — the theory that recent warming trends in global temperatures are caused by rising levels of carbon dioxide from human activity, fostered by industrialization. It has long been a theory which struggled to pass the sniff test, placing undo weight on a trivial component of so-called greenhouse gases, while ignoring the enormous (and obvious) impact of solar activity, water vapor, and cloud cover. Yet for years we have been told — in increasing shrill and strident tones — that this theory is “settled science,” and there is an imminent crisis at hand.

It has been fascinating to watch this ball of yarn unravel. In what may prove to be the greatest hoax mankind has ever witnessed — most certainly the one with almost unimaginable financial impact globally — we are watching the “settled science” of AGW disintegrate. We read how data was manipulated to hide declining global temperatures and make them appear to be rising sharply (”Mikes nature trick“). The peer review process made sure no contrary or skeptical opinions were published, and efforts were made to delegitimize journals which published such articles. Proxy data such as tree-rings were cherry-picked to ensure that the data conformed to the AGW philosophy. FOIA requests for data were met with stonewalling and destruction of raw data. The homogenization of temperature station data — making adjustments to the temperatures to reflect changes in the surrounding environment, such as urbanization — showed shows striking and arbitrary adjustments to demonstrate a sharp rise in temperatures when no such changes existed in the raw data. Other major climate research centers are similarly stonewalling raw data requests. The data problems just scratch the surface; the software used to generate reports and alarmist graphs was incompetently written by amateur programmers — and could not even reproduce the graphs from the original data without massive software hacks and fudge factors — by the programmer’s own admission.

The response of climate scientists to these devastating revelations? Denial and attack. The response of the UN Climate gurus and American and Western policy makers? Denial and attack. The response of the media to this massive global meltdown of AGW “settled science? Silence.

Amazing.

Whatever the role of human activity in global warning, one thing is abundantly evident: the current “science” of AGW is not really science at all, but more closely resembles a pernicious, cultic religion. Its priesthood holds the secret knowledge about “climate change,” and we the fools who question or challenge them engender naught but condemnation, ridicule, hatred and disdain. For the priesthood and the true believers who bow to them, the payoff for guarding their secrets are huge: for our scientist priests, millions in research grants, often at taxpayer expense; for the evangelists (Al Gore comes to mind), the ability to engender hysteria with wild, apocalyptic climate claims while raking in millions on carbon trading and investments in “green” technology; for the politicians, the opportunity to further extend the control and power of government into every aspect of its citizens lives while pocketing huge political contributions from environmental groups and green industries.

We have been lectured endlessly by our postmodern mentors that religion is naught but ignorance and superstition, while scientific “facts” are Truth. But “knowledge is power,” as the saying goes — especially when the knowledge can be hidden behind a veil of secrecy, manipulated at will to conform to unchallengeable presuppositions and philosophies, then relentlessly drilled into our collective consciences through compliant and complicit channels of media, education, and politics.

The climate scientists are hardly alone in such gnostic gambits; evolutionary biology — whose “scientists” seem to spend most of their efforts proving that God doesn’t exist rather than demonstrating that their tattered and threadbare theories of evolution have an actual basis in reproducible science and genetics, and a demonstrable and reliable predictive value (which all solid science must have) beyond the the pure speculation and projection that comprises most evolutionary science. Think I’m being a crazy fundamentalist creationist? Try, as a scientist, to demand that evolutionists satisfactorily answer any host of devastating challenges to their theories: the irreducible complexity of biological subsystems such as the eye, the cellular mitochondria and intracellular protein factories; the entropy problem (complex systems tend naturally to disorder and chaos, not more complexity); the Cambrian explosion; the impossibly long odds that all physical constants stood at precisely the correct values at the instant of the Big Bang; the enormous problem of free will, higher intellect, and purpose in the human animal which has no precursors in lesser beasts. Challenge these — even with understated, respectful, and serious questions — and watch how quickly the ad hominem attacks begin, how quickly you will be excluded from “peer reviewed” literature, ridiculed and ostracized, and labeled as an ignorant creationist fundamentalist, an enemy of science — or worse.

In our repudiation of a world based on absolutes and transcendency, our free fall into secularization has ironically left us clinging to science as our sole absolute, our foundation in a world which no longer makes sense, in which there are no true absolutes. Yet science cannot bear such weight alone, detached as it has become from notions of absolute truth and the true nature of the creation that is man and his universe. It has become instead a tool of power, and manipulation, and deception. The ship of knowledge no longer has an anchor, and drifts aimlessly toward the rocks of self-righteous deception and the shoals of arrogance.

G.K. Chesterton, writing nearly a century ago, mused that “this is the age in which thin and theoretic minorities can cover and conquer unconscious and untheoretic majorities.” What was true then is ever more true today, as we relinquish our own convictions and the truths which come by faith and tradition for the perilous tyranny of rule by experts. True freedom requires absolute truth, with its liberating transparency and the humility of knowing we are not gods. Science detached from absolutes will not bring progress but peril, not truth but tyranny. In our quest for the Utopia which technology enticingly promises, to forget our foundational truths is to invite disaster and slavery.

Sadly, we are already well on our way.

In the dark of night, appropriately, the Senate last night voted to end debate on its health care reform bill, bringing it to a floor vote. From Commentary magazine comes the following assessment of what will be voted on:

The non-reform health-care bill does, to the disgust of liberals, make insurance companies very happy. The government is coercing customers to buy the companies’ products under penalty of prosecution and fine. The non-reform health-care bill does, to the horror of seniors, slash $500B out of Medicare with no conceivable alternative other than rationing to meet its new budget. The non-reform health-care bill does, to the delight of trial lawyers, do nothing to reform the tort system or the problem of defensive medicine. And the non-reform health-care bill does, to the chagrin of deficit hawks, do nothing to bend the cost-curve or cut the deficit. (James Capretta explains: “For starters, as CBO notes, the bill presumes that Medicare fees for physician services will get cut by more than 20 percent in 2011, and then stay at the reduced level indefinitely. There is strong bipartisan opposition to such cuts. Fixing that problem alone will cost more than $200 billion over a decade, pushing the Reid plan from the black and into a deep red.”) Finally, the non-reform health-care bill will, to the embarrassment of good-government types, in all likelihood get passed through a combination of bribery and secrecy, with virtually no time for thoughtful consideration.

On every level it’s a policy train wreck.

Not to mention that it pushes many of the uninsured into Medicaid, in a massive expansion of a program which is bankrupting the states, and which very few physicians can afford to take due to abysmal reimbursement rates which do not come close to covering expenses. The 22% Medicare fee cuts to physicians — one of the many accounting gimmicks thrown in to make this bill appear to be financially viable — will, if enacted, lead to a mass exodus of physicians from Medicare as well. Universal insurance coverage (which this bill does not even achieve) does not equal universal access, as we are about to discover to our horror and dismay.

I am doing my best to be sanguine about things over which I have no control, but it is difficult to watch the death of a profession and a superb health care system, to advance the partisan agenda of the power-hungry crooks and cronies who make up our current government. Revulsion is not too strong a word.

We will live to rue the day this disaster passes into law.

UPDATE: From the WSJ:

The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that “reform” has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later.

***

• Health costs. From the outset, the White House’s core claim was that reform would reduce health costs for individuals and businesses, and they’re sticking to that story. “Anyone who says otherwise simply hasn’t read the bills,” Mr. Obama said over the weekend. This is so utterly disingenuous that we doubt the President really believes it.

The best and most rigorous cost analysis was recently released by the insurer WellPoint, which mined its actuarial data in various regional markets to model the Senate bill. WellPoint found that a healthy 25-year-old in Milwaukee buying coverage on the individual market will see his costs rise by 178%. A small business based in Richmond with eight employees in average health will see a 23% increase. Insurance costs for a 40-year-old family with two kids living in Indianapolis will pay 106% more. And on and on.

These increases are solely the result of ObamaCare—above and far beyond the status quo—because its strict restrictions on underwriting and risk-pooling would distort insurance markets. All but a handful of states have rejected regulations like “community rating” because they encourage younger and healthier buyers to wait until they need expensive care, increasing costs for everyone. Benefits and pricing will now be determined by politics.

As for the White House’s line about cutting costs by eliminating supposed “waste,” even Victor Fuchs, an eminent economist generally supportive of ObamaCare, warned last week that these political theories are overly simplistic. “The oft-heard promise ‘we will find out what works and what does not’ scarcely does justice to the complexity of medical practice,” the Stanford professor wrote.

• Steep declines in choice and quality. This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.

This centralized system means above all fewer choices; what works for the political class must work for everyone. With formerly private insurers converted into public utilities, for instance, they’ll inevitably be banned from selling products like health savings accounts that encourage more cost-conscious decisions.

Unnoticed by the press corps, the Congressional Budget Office argued recently that the Senate bill would so “substantially reduce flexibility in terms of the types, prices, and number of private sellers of health insurance” that companies like WellPoint might need to “be considered part of the federal budget.”

With so large a chunk of the economy and medical practice itself in Washington’s hands, quality will decline. Ultimately, “our capacity to innovate and develop new therapies would suffer most of all,” as Harvard Medical School Dean Jeffrey Flier recently wrote in our pages. Take the $2 billion annual tax—rising to $3 billion in 2018—that will be leveled against medical device makers, among the most innovative U.S. industries. Democrats believe that more advanced health technologies like MRI machines and drug-coated stents are driving costs too high, though patients and their physicians might disagree.

“The Senate isn’t hearing those of us who are closest to the patient and work in the system every day,” Brent Eastman, the chairman of the American College of Surgeons, said in a statement for his organization and 18 other speciality societies opposing ObamaCare. For no other reason than ideological animus, doctor-owned hospitals will face harsh new limits on their growth and who they’re allowed to treat. Physician Hospitals of America says that ObamaCare will “destroy over 200 of America’s best and safest hospitals.”

• Blowing up the federal fisc. Even though Medicare’s unfunded liabilities are already about 2.6 times larger than the entire U.S. economy in 2008, Democrats are crowing that ObamaCare will cost “only” $871 billion over the next decade while fantastically reducing the deficit by $132 billion, according to CBO.

Yet some 98% of the total cost comes after 2014—remind us why there must absolutely be a vote this week—and most of the taxes start in 2010. That includes the payroll tax increase for individuals earning more than $200,000 that rose to 0.9 from 0.5 percentage points in Mr. Reid’s final machinations. Job creation, here we come.

Other deceptions include a new entitlement for long-term care that starts collecting premiums tomorrow but doesn’t start paying benefits until late in the decade. But the worst is not accounting for a formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that. Everyone knows the payment cuts won’t happen but they remain in the bill to make the cost look lower. The American Medical Association’s priority was eliminating this “sustainable growth rate” but all they got in return for their year of ObamaCare cheerleading was a two-month patch snuck into the defense bill that passed over the weekend.

The truth is that no one really knows how much ObamaCare will cost because its assumptions on paper are so unrealistic. To hide the cost increases created by other parts of the bill and transfer them onto the federal balance sheet, the Senate sets up government-run “exchanges” that will subsidize insurance for those earning up to 400% of the poverty level, or $96,000 for a family of four in 2016. Supposedly they would only be offered to those whose employers don’t provide insurance or work for small businesses.

As Eugene Steuerle of the left-leaning Urban Institute points out, this system would treat two workers with the same total compensation—whatever the mix of cash wages and benefits—very differently. Under the Senate bill, someone who earned $42,000 would get $5,749 from the current tax exclusion for employer-sponsored coverage but $12,750 in the exchange. A worker making $60,000 would get $8,310 in the exchanges but only $3,758 in the current system.

For this reason Mr. Steuerle concludes that the Senate bill is not just a new health system but also “a new welfare and tax system” that will warp the labor market. Given the incentives of these two-tier subsidies, employers with large numbers of lower-wage workers like Wal-Mart may well convert them into “contractors” or do more outsourcing. As more and more people flood into “free” health care, taxpayer costs will explode.

• Political intimidation. The experts who have pointed out such complications have been ignored or dismissed as “ideologues” by the White House. Those parts of the health-care industry that couldn’t be bribed outright, like Big Pharma, were coerced into acceding to this agenda. The White House was able to, er, persuade the likes of the AMA and the hospital lobbies because the federal government will control 55% of total U.S. health spending under ObamaCare, according to the Administration’s own Medicare actuaries.

Others got hush money, namely Nebraska’s Ben Nelson. Even liberal Governors have been howling for months about ObamaCare’s unfunded spending mandates: Other budget priorities like education will be crowded out when about 21% of the U.S. population is on Medicaid, the joint state-federal program intended for the poor. Nebraska Governor Dave Heineman calculates that ObamaCare will result in $2.5 billion in new costs for his state that “will be passed on to citizens through direct or indirect taxes and fees,” as he put it in a letter to his state’s junior Senator.

So in addition to abortion restrictions, Mr. Nelson won the concession that Congress will pay for 100% of Nebraska Medicaid expansions into perpetuity. His capitulation ought to cost him his political career, but more to the point, what about the other states that don’t have a Senator who’s the 60th vote for ObamaCare?

UPDATE 2: from Robert Samuelson, WaPo:

These fears are well-grounded. The various health-care proposals represent atrocious legislation. … So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.

Samuelson argues that the uninsured will receive better care because more of them are covered. Of course, that is only true if they can actually get to see a physician who accepts their Medicaid coverage, which is already an enormous problem, and will certainly grow worse. I suspect they may actually receive better care now, uninsured, than they will covered under Medicaid.

 
Here’s a collection of archival photographs from Pearl Harbor, Dec 7th 1941.

Most were obtained from the naval archives.

Continue reading: Remember Pearl Harbor  →

Over at Big Government, we get a glimpse of where ObamaCare will take us: Health Care’s Coming Heart Attack – A Pre-Obama Care Death Panel?

I am writing of the Obama Administration’s – regulatory decision – to go ahead with a massive cut in Medicare payments to cardiologists. I emphasize that this is a regulatory decision because it was not made by the Congress legislatively (not that that would be ok) but, instead, it was made by the massive Health and Human Services Department of the US Government. Given the limited resources of the Medicare budget, in order to increase payments to general practitioners (in an effort to attract more such doctors – a good idea), bureaucrats needed to gore somebody’s ox and cardiologists were chosen (a horrible idea).

The decision to do so is astonishing.

Keep in mind that the very purpose of health care is to improve the health and therefore the lives of Americans. The cardiologist community has been wildly successful in that endeavor. Although heart disease remains the #1 killer of Americans, the mortality rate for heart attacks has plummeted. For instance, the post-heart attack, 30-day mortality rate decreased from 18.9 percent in 1995 to 16.1 percent in 2006 and the in-hospital mortality rate decreased from 14.6 percent to 10.1 percent.

Further, between 1994 and 2006, the mortality rate among women 55 and under who suffered a heart attack dropped an incredible 52.9%. For men in that same age group the drop was 33.3%. According to the author of the mortality study that determined those latter figures: “It appears that risk factors, which may be controlled through prevention efforts, are very important in driving these mortality reductions.”

Given those figures, it is hard to argue with the success of cardiologists who sit on the forefront of heart care and heart disease prevention – unless, of course, you are a government bureaucrat.

Rather than pouring more dollars into an obviously successful branch of medicine that is saving lives (the ultimate purpose of health care?), the Obama Administration is going ahead with a plan to cut nearly $1.5 billion from Medicare payment to cardiologists. Obama is doing so by such devices as literally eliminating reimbursement for certain services and/or reducing the amount they will pay for others. Case in point, cardiologists have been able to bill for an extended first visit with Medicare patients to get their history and to recommend a course of treatment. As of January 1, 2009 [2010 - ed.] – no longer.

What is being referred to here is Medicare’s decision to eliminate consultation service codes as of Jan 1 2010. These codes are almost exclusively used by specialists, and pay substantially better than standard visit codes, reflecting the higher complexity of care typically involved in specialty care. It is not just the cardiologists who are affected by this administrative change in Medicare payment — it is all specialists: oncology (cancer treatment), infectious disease, pulmonary, surgical specialties such as orthopedics, urology, ENT, neurosurgery, cardiac surgery, etc. etc. They are betting on a premise already proven false: that preventive medicine through primary care will reduce costs.

Specialty care is more expensive because specialists care for the sickest and most complex patients. When you are having your acute MI, you need a cardiologist, not a family practice physician. Specialty care is where the vast number of advances in American medicine have taken place — the advances which give us the best results in the world in cancer treatment, heart disease, and surgical advances such as laparoscopy and other minimally invasive procedures.

The inevitable outcome of these changes are that Medicare patients will have reduced access to specialists, as specialists increasingly are unable to afford taking a loss on every Medicare patient they see due to reimbursements which fall below their costs of providing care. They will by necessity reduce the number of Medicare patients specialists see, or force them to stop seeing Medicare patients altogether, resulting in longer waits to see a specialist and regional shortages of care in these areas. One does not need “death panels” to make policy changes which restrict care to the elderly and disabled; quiet bureaucracy works every bit as well, with the added advantage of plausible deniability.

Welcome to the new millennium in health care. Hope you enjoy your government-run universal health care.