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Posts tagged with: health care reform

It has been over a year since the passing of the Affordable Care Act, and we are still discovering problems with it. Supporters claimed passing the bill will help everyone, especially the vulnerable. However, the Affordable Care Act ironically does just the opposite by placing the elderly in a very dangerous position. Dr. Don Condit, author of the Acton monograph a Prescription for Health Care Reform, explains how the Affordable Care Act negatively impacts the elderly and its violation of subsidiarity in this week’s Acton Commentary. Get Acton News & Commentary in you email inbox every Wednesday. Sign up here.

A Sugar Coating for the Bitter Pill of ObamaCare

By Dr. Don Condit

Remember Mary Poppins singing, “A spoonful of sugar helps the medicine go down in the most delightful way”?

If so, be concerned, because you or your parents are probably on Medicare – or will be soon — and last week the Department of Health and Human Services (HHS) proposed regulations for Accountable Care Organizations (ACOs).

The sugar-coated rhetoric in this announcement from HHS cannot disguise the bad medicine in this part of this part of the Affordable Care Act, which intends to bureaucratically cut as much as $960 million in Medicare spending over three years. This ObamaCare prescription  threatens patients, the physicians who care for them, and the common good. The only clear winners are the consultants and lawyers busy trying to decipher this 429-page tome of acronyms and encrypted methodology that will compromise the doctor-patient relationship and is contrary to the principle of subsidiarity.

Medicare beneficiaries will be “assigned” to 5,000 patient-minimum organizations to coordinate their care. While HHS Secretary Kathleen Sebelius talks about improvement in care, the politically poisonous truth is that Medicare is going broke and ACOs are designed to save money. The words “rationing” or “treatment denial” or “withholding care” are not part of her press release, but reading the regulations reveals intentions to “share savings” with those who fulfill, or “penalize” others who fall short of, the administration’s objectives. The administration’s talking points include politically palatable words which emphasize quality improvement and care enhancement when the real objective is cost control by a utilitarian calculus.

Physicians and other health care providers will find themselves in conflict with the traditional ethos of duty to patient within ACOs. Ever increasing numbers of doctors are leaving private practice and becoming employed by hospitals, due to a variety of challenges inherent in these uncertain times. The hospitals are the most likely recipient of bundled payments for caring for Medicare patients. Doctors will face agency conflicts between the time honored primary duty to patient, which may conflict with hospital administration, and ACO goals of fiscal savings. Medical care providers will receive incentives for controlling spending, and penalties if they do not. “No one can serve two masters” (Matthew 6:24). Not even physicians.

The physician’s ACO conundrum is illustrated in the language where these regulations proclaim that, “Providers should be accountable for the cost of care, and be rewarded for reducing unnecessary expenditures and be responsible for excess expenditures.” Yet the very next sentence stipulates that, “In reducing excess expenditures, providers should continually improve the quality of care they deliver and must honor their commitment to do no harm to beneficiaries.” (page 14)

The principle of subsidiarity guides policy makers to empower decision making and scarce health care resource allocation at the doctor-patient level. However, the Affordable Care Act moves in the opposite direction. It increases bureaucratic power and responsibility. This is not the antidote needed to reform health care in the United States. The complexity, cost, and confusion of implementing these ACO regulations defy comprehension. We can only hope ACOs will follow “just say no” HMOs into the historical ash heap of misguided health policy.

There is no question that significant – and scarce — health care resources are consumed in the Medicare population toward the end of life. ACOs intend to limit this spending — the government way. The Ethical and Religious Directives by the United States Conference of Catholic Bishops suggest a better path forward:

While every person is obliged to use ordinary means to preserve his or her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a reasonable hope of benefit without imposing excessive risks and burdens on the patient or excessive expense to family or community. (32)”

The patient must be the focal point of concern. They, or their surrogate, with the help of their physician, need to become informed. They must also participate in the expense of their care, which will better allocate resources for the community than would more distant bureaucratic panels or regulation.

Furthermore:

A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (57).

Enabling all patients, with and without means, to “proportionally” participate in the cost of their care will better allocate scarce health care resources than further sugar-coated, and non-delightful, misguided administrative policies.

By the way, if you didn’t recognize the Mary Poppins song, that’s OK. Worry instead about your grandparents for now, and consider how your generation will counter-reform ObamaCare in the future.

Dr. Donald P. Condit, MD, MBA is an orthopaedic surgeon specializing in hand surgery in Grand Rapids, Michigan. After graduating with a BS in Preprofessional studies at the University of Notre Dame he attended the University of Michigan Medical School. At the Seidman School of Business of Grand Valley State University his emphasis of study was economics and the ethical allocation of scarce health care resources. With his family, he serves annually with Helping Hands Medical Missions in El Salvador. He also volunteers at Clinica Santa Maria and for Project Access, for the uninsured, in Kent County. He is the author of A Prescription for Health Care Reform and is a Clinical Professor of Surgery at Michigan State University.

 

Despite a promise of “complete and fair coverage of health care for everyone for free,” the Greek state-controlled system is broken and corrupt, the Athens daily ekathimerini.com reports. Predictably, Greeks have taken it upon themselves to build a private health care sector:

Despite hikes in Greece’s health spending between 2000 to 2008 being among the highest of all OECD countries, this has not been matched by growing life expectancy rates, the report added. Turning to the hospital system, corruption has grown due to poorly run operations and an improper organisation structure with about one in five Greeks admitting to having paid a bribe in order to receive medical treatment at a state hospital. These problems have contributed to growth in the private healthcare industry which provides crucial services but also enjoys the benefit of not having any competition, the report added.

In the UK, the National Health Service has been using hospital beds as housing for senior care, to the detriment of people who actually need hospital beds. From the Telegraph:

If current trends continue, almost 100,000 of 170,000 NHS beds will end up being filled by elderly people who are well enough to be in residential care. This will cost the health service millions of pounds and throw its day-to-day operations into chaos, says the report by Bupa, the health insurance and care provider. It blames the looming crisis on a “17-year legacy of under-funding in the care home sector”. The next few years will see the problem getting progressively worse, the report’s authors predict, despite a Coalition pledge that local authorities will have an extra £2 billion to spend on adult social care over the next four years.

For more on this issue, see Acton’s Health Care resource page.

On May 21, 2010, the United States Conference of Catholic Bishops released a media statement which sought to identify the way forward for Catholic engagement in the healthcare debate in light of the passage of healthcare legislation. The USCCB stresses that at the core of the bishops’ advocacy throughout the debate was a concern for three principles: (1) the protection of innocent life from the use of lethal force from conception to natural death; (2) the maintenance of conscience protections; and (3) the realization of universal access to healthcare for all, especially the poor and migrants. These, the USCCB stresses, will remain at the forefront of its contributions to the healthcare discussion. The USCCB consequently asks America’s “Catholic community to come together in defense of human life, rights of conscience and fairness to immigrants so we will have a health care system that truly respects the life, dignity, health and consciences of all.”

All this is well and good. Unfortunately, there is no mention in this text of a concern voiced by a good number of Catholic bishops throughout the debate: an assessment of whether the recent healthcare legislation can truly be said to reflect adherence to the principle of subsidiarity. For anyone who needs a reminder of what this principle means, here’s what the Catechism of the Catholic Church says (CCC 1883):

Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which ‘a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good’.

It’s important to note that subsidiarity is not an “anti-government” or “anti-state” principle. Indeed it affirms that there is a role for government because (1) there are some things that only governments can and should do and (2) sometimes the state does need to intervene when other communities are unable to cope temporarily with their particular responsibilities. Nor, it should be added, does subsidiarity always translate into the very same policy-positions, precisely because some elements of the common good are in a constant state of flux.

That said, it’s puzzling to say the least that the USCCB, both during and after the healthcare debate, is not in the habit of referencing subsidiarity as a vital principle for Catholics to reflect upon as they consider the implications of what few now question amounts to the massive expansion of Federal government control over healthcare in the United States. Contrary to what some Catholics imagine (especially the professional social justice activists who dissent from fundamental church dogmas and doctrines while casting anathemas against anyone who disagrees with their own prudential judgments on any number of economic issues), striving to widen access to healthcare need not automatically translate into the state assuming a dominant role.

In their important joint pastoral letter of August 22, 2009, Archbishop Joseph F. Naumann of Kansas City, Kansas, and Bishop Robert W. Finn of Kansas City-St. Joseph listed subsidiarity as a vital principle upon which Catholics should reflect when thinking about health care reform. They even described subsidiarity as “the preamble to the Work of Reform”. Elsewhere in the document the bishops spelt out what this means for healthcare reform:

The right of every individual to access health care does not necessarily suppose an obligation on the part of the government to provide it. Yet in our American culture, Catholic teaching about the ‘right’ to healthcare is sometimes confused with the structures of ‘entitlement.’ The teaching of the Universal Church has never been to suggest a government socialization of medical services. Rather, the Church has asserted the rights of every individual to have access to those things most necessary for sustaining and caring for human life, while at the same time insisting on the personal responsibility of each individual to care properly for his or her own health.

During the healthcare debate, a considerable number of Catholic bishops expressed similar views. Bishops Walker Nickless of Sioux City, for example, was very specific:

… the Catholic Church does not teach that ‘health care’ as such, without distinction, is a natural right. The ‘natural right’ of health care is the divine bounty of food, water, and air without which all of us quickly die. This bounty comes from God directly. None of us own it, and none of us can morally withhold it from others. The remainder of health care is a political, not a natural, right, because it comes from our human efforts, creativity, and compassion. As a political right, health care should be apportioned according to need, not ability to pay or to benefit from the care. We reject the rationing of care. Those who are sickest should get the most care, regardless of age, status, or wealth. But how to do this is not self-evident. The decisions that we must collectively make about how to administer health care therefore fall under ‘prudential judgment.’ [I]n that category of prudential judgment, the Catholic Church does not teach that government should directly provide health care. Unlike a prudential concern like national defense, for which government monopolization is objectively good – it both limits violence overall and prevents the obvious abuses to which private armies are susceptible – health care should not be subject to federal monopolization.

Preserving patient choice (through a flourishing private sector) is the only way to prevent a health care monopoly from denying care arbitrarily, as we learned from HMOs in the recent past. While a government monopoly would not be motivated by profit, it would be motivated by such bureaucratic standards as quotas and defined ‘best procedures,’ which are equally beyond the influence of most citizens. The proper role of the government is to regulate the private sector, in order to foster healthy competition and to curtail abuses. Therefore any legislation that undermines the viability of the private sector is suspect. Private, religious hospitals and nursing homes, in particular, should be protected, because these are the ones most vigorously offering actual health care to the poorest of the poor.

These and similar views expressed by many bishops were dismissed as “libertarian” by whatever’s left these days of the Catholic left – as if only libertarians could possibly believe that limiting government power and encouraging private sector and civil society solutions to genuine social and economic problems are good things.

The truth, however, is that the USCCB’s professional social justice bureaucrats have a long history of playing down or even ignoring the implications of the principle of subsidiarity. Subsidiarity isn’t, for example, even listed as one of the “Themes of Catholic Teaching” on the Justice, Peace and Development section of the USCCB’s website. It is long past the time for that to change.

From the movie Fight Club (1999):

Narrator: Tyler, you are by far the most interesting single-serving friend I’ve ever met… see I have this thing: everything on a plane is single-serving…
Tyler Durden: Oh I get it, it’s very clever.
Narrator: Thank you.
Tyler Durden: How’s that working out for you?
Narrator: What?
Tyler Durden: Being clever.

The Hill reports that Dems feel healthcare fatigue.

Blue Dog Earl Pomeroy (D-N.D.), who voted for the health overhaul, said the debate has shifted to the Obama administration, which must now implement the bill. “The healthcare bill is done,” Pomeroy said. “The action on healthcare is now in the executive branch as they implement the bill. It’s critically important that they implement it in a sound way, and I believe the attention of Congress is best spent on overseeing the sound implementation of this bill.”

Clever. Vote to nationalize the U.S. health care system even though you didn’t bother to read the 2,400-page bill. Then walk away because you’re “tired” and want to leave the heavy lifting to the White House. Plus, more photo-ops and press releases about health care from Rep. Pomeroy’s office would only serve to keep this on the mind of North Dakota voters.

Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) agreed with the premise that “members would be wary of major health legislation after we’ve spent so much time — we do have other priorities.” … “I could see that people would be exhausted if we were doing something major and controversial,” Waxman told The Hill. “So I think that we’ll probably limit ourselves right away in terms of what we’ll be pursuing.”

Paul Howard at City Journal looks at Obamacare’s Hidden Costs, a phenomenon certain to increase the fatigue factor among Obamacare supporters in the months and years ahead:

While the full cost of President Obama’s health-care legislation won’t be apparent until federal subsidies to the uninsured start flowing in 2014, Americans are getting an early glimpse of some of the unintended—but very costly—consequences of rushing through a 2,400-page bill affecting 17 percent of the economy. Since the president signed the bill into law on March 23, dozens of companies have reported to the Securities and Exchange Commission the losses that they expect to take as a result of the legislation. (Companies that offer drug benefits to their retirees will now be taxed for the partial federal subsidy that they receive for each retiree.) The U.S. Chamber of Commerce estimates that as many as 40 major companies will take a hit, for a total of $3.4 billion; other cost estimates run even higher.

Greece, once again, provides a warning. Investor’s Business Daily asks, Guess What Greece Has To Jettison?:

Greece was told that if it wanted a bailout, it needed to consider privatizing its government health care system. So tell us again why the U.S. is following Europe’s welfare state model.

The requirement, part of a deal arranged by the IMF, the European Union and the European Central bank, is a tacit admission that national health care programs are unsustainable. Along with transportation and energy, the bailout group, according to the New York Times, wants the Greek government to remove “the state from the marketplace in crucial sectors.”

This is not some cranky or politically motivated demand. It is a condition based on the ugly reality of government medicine. The Times reports that economists – not right-wingers opposed to health care who want to blow up Times Square – say liberalizing “the health care industry would help bring down prices in these areas, which are among the highest in Europe.”

Of course most of the media have been largely silent about the health care privatization measure for Greece, as it conflicts with their universal, single-payer health care narrative.

In the Rapids City (S.D.) Journal, columnist Rick Kahler quotes an anecdote from an fellow financial planner:

“I have some good friends (dual Greek and U.S. citizens) who live in Athens. They tell me corruption is rampant and every tax increase is met by an exponential increase in the underground, noncompliant economy. There is no sense of duty to pay taxes. There is no sense of dishonor asking someone to transact business outside of the system.

“Greece’s health care system just about collapsed when it became socialized. First, long lines led to treatments being scheduled so far in the future that costs were reduced because patients routinely died before the treatment date. Citizens responded by taking paper bags filled with paper currency to doctors in exchange for prompt treatment.

“When this practice became common, the government eventually began arresting doctors.

Did this make the system function properly? Nope. The doctors simply used their nice European Union passports to leave the country and seek work elsewhere.

“Nurses were then expected to provide medical care they hadn’t been trained to do. This at least made costs go down—nurses started fleeing, too, so that salary expense declined. My friends in Athens report many Greek hospitals are ‘just walls—no doctors, no nurses, not even anyone worth bribing. When we need care, we buy a ticket to the U.S.”

Check out the Acton Institute resource page on Health Care.

I’m a little slow getting to this–some readers have doubtless already seen media reports–but if you weren’t yet aware of the Obama Administration’s actuaries’ study of the probable effects of Obamacare (released last Thursday), you should be. Our friend, Grace-Marie Turner of the Galen Institute presents the lowlights at NRO. Among the predictions:

Tens of billions of dollars in new fees and excise taxes will be “passed through to health consumers in the form of higher drug and devices prices and higher premiums.”

Under the new law, national health spending will increase by $311 billion over the coming decade. And instead of bending the federal spending curve down, it will move it upward “by a net total of $251 billion” over the next decade.

Mounting evidence that the majority of our nation’s lawmakers, who thought this was a good idea, were, to put it kindly, mistaken.

A good back-and-forth at in character on health care reform between Karen Davenport and Heather R. Higgins. Question: Will the implementation of the health-care bill passed by Congress improve the character of our country?

Davenport says “yes”:

While we cede some rights, we also assume new responsibilities. First, we assume the responsibility to obtain and maintain coverage for ourselves, and acknowledge that we cannot wait to purchase health insurance until we are sick. We also take on greater responsibility for others, particularly by helping individuals and families purchase coverage if they cannot afford to do so on their own.

Higgins says “no”:

In contrast, the health bill is premised on the idea that people should expect to be taken care of. This law is more aligned with the sentiments of a European social democracy where hard work is devalued and income inequalities condemned. In the health bill, personal freedom and individual choice are replaced with bureaucratic dictates, one-size-fits-all parameters, and the removal of responsibility and consequence from individuals. Citizens are infantilized as wards of the state. But that’s only the beginning of the adverse consequence that this travesty will have on our national character.

CBN News interviews Acton Research Fellow Anthony Bradley on “Theology, Politics & the African-American Community.” His new book, Liberating Black Theology — The Bible and the Black Experience in America, is now available from the Acton Book Shoppe.