Harvard Professor and former Reagan economic adviser Martin Feldstein writes today in the Wall Street Journal that Obamacare is “all about rationing. From the column:
The president has emphasized the importance of limiting services to “health care that works.” To identify such care, he provided more than $1 billion in the fiscal stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. That could morph over time into a cost-control mechanism of the sort proposed by former Sen. Tom Daschle, Mr. Obama’s original choice for White House health czar. Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost.
In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as “too expensive.”
Exactly. Over time the cost control boards would ration not only “what, ” but also “who,” based on invidious categories such as age, disability, and quality of life judgmentalism.
Feldstein also pushes taxing Cadillac health insurance policies to prevent over consumption. He mentions a 20% copay is excessive. I am not sure about that. A lot of us have HMOs with very low copays, and they are hardly Cadillac. Still, if “too much” private consumption of health care is bad–isn’t it stimulative?–there is no question that government-imposed rationing is worse. Moreover, why shouldn’t consumers be allowed to have high deductible coverages to reduce insurance expenses? We do for auto insurance.
These are the things we need the time to ponder and debate. A lot is at stake. The last thing we need is a mad rush to force Obamacare down our collective throats.
August 24th, 2009 | 2:36 pm
Wesley: Don’t let your dislike of the Obama carry you away. If you’re really concerned about health care rationing tell it to the American health insurance industry, which is notorious for denying coverage of procedures they feel are “unnecessary” or “experimental.”
August 24th, 2009 | 2:38 pm
— CORRECTION —
Wesley: Don’t let your dislike of the Obama administration carry you away. If you’re really concerned about health care rationing tell it to the American health insurance industry, which is notorious for denying coverage of procedures they feel are “unnecessary” or “experimental.”
August 24th, 2009 | 2:45 pm
Exactly: President Obama shouldn’t be surprised to be judged by the company he keeps.
However, I suggest viewing high health insurance deductibles in light of their own merits rather than comparing to car insurance. The two things are just different enough that a direct comparison (often used by Obamacare supporters to justify coercive means of achieving universal coverage) can be misleading.
August 24th, 2009 | 3:55 pm
[...] Building on the Aquinas idea, I link you to Wesley J. Smith says of O-care, it’s “all about rationing”. He also presents evidence that end-of-life counseling could be directed toward death. You think? [...]
August 24th, 2009 | 5:10 pm
All insurance is about rationing. Our current system is about rationing supplemented by outright denial. Obama’s system aims to provide health care to the uninsured while maintaining the choices of the currently insured.
This is what you’re panicking about?
August 24th, 2009 | 9:55 pm
Maintaining choices of the currently insured? Right now my options seem to be: a) drop my policy and get slammed with a $1,000 fine, or b) continue and possibly have a “minimum benefits package” imposed on me. So padraig, if you have hard evidence to the contrary then please cough it up.
August 25th, 2009 | 11:41 am
CG,where is your hard evidence that you’d have to drop your current policy? Please respond with references to the actual bill.
August 25th, 2009 | 3:49 pm
…while maintaining the choices of the currently insured…
This is a terribly disingenuous claim. While the current plan allows for existing policies to be grandfathered in – so that people who currently have individual health insurance policies will not lose coverage – only a small number of existing plans would be grandfathered in, and health insurance companies cannot enroll new people into these existing plans. All new private health insurance will have to be bought through an exchange, where the government, through an unelected health choices commissioner, will set premiums, dictate benefits, determine deductibles and establish coverage. Exchange participants will be required to insure anyone who asks to be covered and to accept all renewals.
The eventual, and quite inevitable, result of such a system will be a gradual disappearance of private insurance companies:
Since the premiums for these new plans will be federally set, how will these companies absorb the cost of restricted premiums for higher risk policies? They must either a) steadily raise the premiums on the grandfathered-in plans, which will gradually force the extinction of these plans, b) reduce their approval and paying of benefits (making them less competitive and less likely to survive), or c) go out of business.
So, yes, you can keep your plan, provided that it is one of the plans the government allows to be grandfathered-in. That is, you’ll be allowed to keep it until the proposed public plan and government exchange force that plan (and/or the entire company) out of business, which it most certainly will, sooner or later, do.
I really wish those pushing the public option would drop the charade and admit that their ultimate goal is a single-payer system.
August 25th, 2009 | 4:30 pm
Even if you’re right, GR, and I think a lot of what you say is highly speculative, why would it be such a bad thing for the private insurers to go away? They’re a bloody scourge as far as I’m concerned, and I say that having both worked for one and having been covered by one. Like I’ve said before, if you want death panels and health care rationing, we already have those in the form of the private insurers.
Even without them, you’re not necessarily in single-payer land. I for instance am in a large HMO, paid for in full by my employer. That HMO offers several levels of care based on the payer, ranging from extremely basic to comprehensive. If the govt picks up the base for some additional insureds, the insureds and/or their employers can still pay the difference and move up to 1st class, as it were. Plenty of room for competition among the health care providers there.
August 25th, 2009 | 6:53 pm
why would it be such a bad thing for the private insurers to go away?
Your child-like faith in government to meet the health care needs of 300 million people better than the private sector is truly mesmerizing.
Even funnier is the little dance Obamacare defenders are doing: “No, we won’t take your private insurance away, and anyone who says we will is spreading disinformation!….OK, it will go away…but that’s a good thing!” “There won’t be health care rationing! That’s a scare tactic!….OK, there will be rationing, but it’ll be done by the wise and benevolent government instead of those greedy insurance companies…”
And no, there is not “plenty of room for competition” when the government is setting the premiums at below-market value (they’ve already boasted that the private plans allowed will be less expensive while covering more) while requiring that the private insurance companies cover anyone who asks (i.e. regardless of preconditions). The “public option” can get away with this because the government can deficit-spend and extract its own revenue (i.e. taxes) from folks whether they use the public option or not. Private businesses cannot do either of these things and stay in business. This is not “speculative”, it is simply a reality that those with any economic background can recognize.
So, please, Obambots, please, just do one thing: stop lying about how we’re going to get to keep our private coverage if we want to. It’s neither true nor even possible, and you damn well know it.
Furthermore, your “we have rationing now” is bit like saying that McDonald’s currently rations Big Macs. No, they give them to those who pay for them; they don’t give them away for free but decide who gets them. Most people can’t afford the truly expensive health care, and rely on insurance. However, again, how much coverage you get is based on how much you pay. I would rather have the care I get be based on my ability to pay, by what insurance company and what plan I was able to afford through work and planning, than to have the government – who I already pay more than my fair share of taxes to, thank you very much – decide that my time is up.
Good luck with your child-like faith in government. I’m sure it’ll turn out just peachy for you.
August 25th, 2009 | 10:11 pm
I have no child-like faith in government. Your saying it repeatedly doesn’t make it true. If I ever did, eight years of W cured it. And I don’t see Democrats as necessarily being any wiser.
No room for competition? How about all the Medicare supplemental insurance providers? And you think the government wants to kill you? This is your reasoning?
You use insults because it’s easier than having a reasonable discussion, or possibly because you suspect you’d lose such a debate. Everybody’s entitled to their opinion, but don’t expect to have yours respected when you resort to name calling.
August 26th, 2009 | 10:32 am
What bothers me, Padraig, is all of the head-patting talk from Obamacare supporters that “Of *course* you’ll be allowed to keep your doctor and your insurance!” when the House bill under consideration will effectively force plans to compete in the exchange on the government’s terms against a government-owned plan. Many, many insurers will leave the business or be driven out.
Also, Wesley has done an excellent job documenting the way in which the UK’s NHS has been implementing cost-cutting measures at the expense of its patients – as in the refusal of treatment based on “Quality-Adjusted Life Years” in this very article. There is every reason to expect the “public option” insurance will do this in short order, particularly because the cost estimates for Obamacare are so vast – and they may possibly be overly optimistic.
August 26th, 2009 | 1:19 pm
It’s impossible, padraig, to have a reasonable discussion when you refuse to engage any points that I make. And contrary to your charge of name-calling, I merely responded to your own words:
- You wrote: Obama’s system aims to provide health care to the uninsured while maintaining the choices of the currently insured.
I responded that Obama’s plan will eventually put private insurers out of business. You responded that this was a good thing – our private coverage would go away, but that was a good thing! No more greedy insurance companies! Never mind that you had vitiated your original claim that those who liked their coverage could keep it.
You then wrote that fears of rationing are baseless because we have rationing now by insurance companies. I responded to both this and the above argument by pointing out the rhetorical game you were playing: “No, we won’t take your private insurance away, and anyone who says we will is spreading disinformation!….OK, it will go away…but that’s a good thing!” “There won’t be health care rationing! That’s a scare tactic!….OK, there will be rationing, but it’ll be done by the wise and benevolent government instead of those greedy insurance companies…” I also pointed out that you were displaying a remarkable amount of faith in government (through an unelected board) by allowing it to do the “rationing” instead of private companies (who are accountable to their stockholders and the marketplace). This you call name-calling.
You proceeded to ignore my point that with the proposed government “exchange” through which all new health plans must gain approval is to be set up in such a way that the government is setting the premiums at below-market value (they’ve already boasted that the private plans allowed will be less expensive while covering more) while requiring that the private insurance companies cover anyone who asks (i.e. regardless of preconditions).You also ignored my point that health care “rationing” is actually not the present state of affairs in US health care (but most certainly would be under Obama’s plan).
The only argument you’ve made is that supplemental insurance providers will still provide a private market for health care plans. However, here’s the kind of “competition” available in Obama’s plan:
*The exchange will require health insurers to issue a policy to everyone who walks in the door, no questions asked, and to guarantee that coverage for life.
*The exchange will bar insurers from screening prospective customers for any “pre-existing” and potentially costly medical conditions.
*The exchange will require insurers to charge all consumers the same premium for their coverage, regardless of relevant factors such as age, gender, occupation, and, of course, health status.
Combined with other items on the White House insurance-reform wish list, such as a ban on “excessive” out-of-pocket expenses and on yearly or lifetime limits on benefits paid, these mandates would effectively socialize the market for health insurance. Everyone could get insurance whenever he decided to sign up for it, and at one guaranteed price. Insurers would become regulated utilities, answering to government-appointed boards and rate commissions. This is neither “competition” nor a business model that will allow for a healthy enough profit to provide anywhere near the coverage widely available now through private insurance.
So, after offering one refutable argument (twice), failing to address my rebuttals, and ignoring my other points, you claim that I am afraid of debate because I’m afraid I would lose. Thank you for providing me with the hearty laugh.
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