Tag: government rationing

‘Why Indiana Shouldn’t Fall for Obamacare’s Medicaid Expansion’

My latest oped, in the Indy Star:

Meanwhile, many [Medicaid] enrollees can’t even find a doctor. One-third of primary care physicians won’t take new Medicaid patients. Only 20 percent of dentists accept Medicaid. In 2007, 12-year-old Deamonte Driver died — yes, died — because his mother couldn’t find one of those dentists.

For more on why states should reject ObamaCare’s Medicaid expansion, read my latest Cato white paper, “50 Vetoes: How States Can Stop the Obama Health Law.”

Shades of Nixon

Reason magazine has a characteristically excellent video about the gas shortages in New York and New Jersey. Which is to say, the video is really about the insane responses of officials in those states to the scarcity of gas. Reason’s Jim Epstein writes: “Govs. Chris Christie and Andrew Cuomo…threatened to prosecute any station owners caught raising prices, thus removing any incentive to truck more gas in from other parts of the country.” Here’s the video:

The Washington Post reports Christie responded with an age-old government-rationing scheme:

New Jersey Gov. Chris Christie ordered…drivers with even-numbered license plates being allowed to fill up on even-numbered dates and odd-numbered cars on the other days. But several motorists said they hadn’t heard the news because they had no power at home, and gas station managers said they didn’t bother to look at the plates.

“I don’t have any time to check plates,” David Singh said as he pumped gas into a car at the Delta station he manages on McCarter Highway in Newark.

So not everyone heard about the government’s rationing scheme, and even fewer people cared. You know what conveys information a lot better than tired government edicts? Market prices.

Fortunately, market prices are still breaking through:

Shauron Sears, 37, a waitress, said she spent 12 hours vainly waiting for gas on Friday and another hour waiting Saturday at a Sunoco station on McCarter Highway. Just as she got to the front of the line, a manager started waving his arms and shouting, “No more gas!”

Sears said…since her house flooded she and her family have been camping at her sister’s house in Orange, N.J. Nine people are in the house, including a baby, and Sears is eager to return to her own home. But her first priority is to get gas.

“There are people who are buying gas and selling it for $8 a gallon,” she said. “Maybe I can buy some from them.”

The entrepreneurs selling gas at illegal mark-ups might affect Sears in a manner the government’s price controls won’t. By helping her.

The Decision Is Whether We Will Reform Health Care with Our Eyes Open

Donald Berwick may have mastered the science of health care management and delivery. (I for one would jump at the chance to enroll my family in the Berwick Health Plan.) But his recent oped in the Washington Post shows he has yet to absorb the lessons that economics teaches about government planning of the economy, such as through ObamaCare.

Berwick, whom President Obama recess-appointed to be administrator of the Centers for Medicare & Medicaid Services (CMS), sets out to defend ObamaCare from a fairly devastating critique by Robert Samuelson a few days earlier. Berwick responds, in essence, nuh-uh:

I saw how this law is helping tens of millions of families and is finally putting our health-care system on the right track…I have seen how improving care can reduce costs dramatically.

Berwick fails to see the world of difference between those two statements. Yes, in his private-sector work, Berwick has helped hospitals save more lives, kill fewer people, and save money in the process. I’m pretty sure he has saved more lives than I ever will.

But all he saw from his perch at Medicare’s helm was people happy to receive checks from the government, and a bunch of well-meaning bureaucrats setting goals. He did not see the costs imposed by those subsidies. As for goal-setting, this one sentence captures it all:

The CMS, for example, has set ambitious goals to reduce complications that, if met, would save 60,000 lives and $35 billion in just three years.

If. Met. A recent Congressional Budget Office review of Medicare pilot programs showed that Medicare bureaucrats set goals all the time. They never achieve them.

Berwick’s claim that ObamaCare “cracks down hard on waste and fraud” because “Last year the government recaptured a record $4 billion” is even more ridiculous. The official (read: low-ball) estimates are that CMS loses $70 billion per year to fraud and improper payments. The best evidence suggests that wasteful spending approaches $200 billion per year in Medicare alone. All that money that comes from you, John Q. Taxpayer. Berwick knows all these things. Yet he thinks you should be impressed that recovering a measly $4 billion is the best the government has ever done.

Berwick would never tolerate such willful blindness, shoddy reasoning, and (surprise!) poor results if it were his own money on the line. Which is exactly the point. In a free market, people spend their own money. At Medicare, Berwick spent, and ObamaCare continues to spend, other people’s money.

That is the main reason why markets are smart and government is stupid. And why otherwise smart people like Berwick can afford to keep their eyes shut.

‘The Moment It Produces Useful CER, PCORI Is Toast.’

An excerpt from a Politico Pro article (paywall) on the “Patient-Centered Outcomes Research Institute,” President Obama’s comparative-effectiveness research agency:

The point of comparative effectiveness research is to compare two or more different ways of treating the same condition to see which one works best. The idea is that if definitive best practices can be established, they will be widely adopted by providers and may be preferentially reimbursed by payers. Cheaper treatments that are effective would be favored.

It may sound harmless — like common sense, even, to the uninitiated — but it’s a menacing prospect to some pharmaceutical companies and medical device-makers who are concerned that their products may wind up on the wrong side of the ledger.

For this reason, Michael Cannon, director of health care studies at the Cato Institute, says good comparative effectiveness research is almost suicidal.

“The whole point of [comparative effectiveness research] is to find out what doesn’t work,” Cannon said in an email. “Every time the government has tried to do CER, the guys who provide the stuff found not to work successfully lobby to have the offending agency defunded. I see no reason to think this time will be any different. The moment it produces useful CER, PCORI is toast.”

And that’s just one source of opposition.

Other sources of opposition include patients who don’t like restrictions on their health care subsidies, thank you very much.

(The “suicidal” bit is confusing, and wasn’t my language. So to clear up any misunderstandings: comparative-effectiveness research is good. Markets both produce and employ it. Government is so incompetent that it cannot reliably produce CER, much less make use of it. Markets are smart. Government is stupid.)

On ObamaCare, David Frum Just Doesn’t Get It

David Frum knows that ObamaCare can’t be repealed.  But don’t worry, he also knows how to make it palatable to Republicans:

  1. Move up the start date of ObamaCare’s state waiver program from 2017 to 2014.  As I explain here, that program will only produce alternatives to ObamaCare that are equally or more anti-market, such as a single-payer system.  Frum wants that to happen sooner.
  2. Raise taxes, on everybody.  I swear I am not making that up.
  3. Replace ObamaCare’s individual mandate with an equally coercive tax credit that accomplishes the same thing, but which the courts would probably uphold.  Bra-vo.  Frum implies it is necessary to “work around” the fact that Republicans are not “entirely rational” when it comes to the individual mandate.  (True, but they’re getting more rational all the time.)
  4. Republicans should embrace government rationing of health care.  Frum counsels Republicans to “unleash the cost controllers” and become the “green eyeshade party willing to do the disagreeable work of squeezing waste from the system.”  How?  Well, he doesn’t call for Medicare vouchers, under which enrollees would ration their own care.  In fact, he has thrown cold water on that idea.  But the only alternative is to have the government ration care.  And Frum makes no distinctions between the elderly and non-elderly, which leads me to believe he wants Republicans to ration care to the under-65 crowd too.  Slap that on a bumper sticker!

In sum, Frum’s GOP-palatable alternative to ObamaCare is … ObamaCare.  But maybe more coercive.  And implemented sooner.  With higher taxes.  And less vulnerable to legal challenges.  And with Republicans playing the bad guy.

Frum laments that Republicans mistakenly threw away the opportunity to work with Democrats to implement these brilliant ideas in 2009 and 2010.  But Republicans did so because these brilliant ideas hurt people.  They were wrapped into a bill called ObamaCare, and Republicans rejected it.  They were right to do so.  And they are right that ObamaCare can’t be fixed.

(Related: Ramesh Ponnuru previously took down Ross Douthat’s ideas for fixing ObamaCare.)

(Also related: CNN has signed Frum to provide conservative commentary during the 2012 election.)

Provenge Controversy Argues for Medicare Vouchers

The new prostate-cancer vaccine Provenge (manufacturer: Dendreon) appears to extend life by an average of four months at the relatively high cost of $93,000 per patient.  This week, Medicare bureaucrats will conduct a national coverage analysis before deciding whether Medicare will cover the vaccine.  This “unusual“ step has sparked charges that government bureaucrats are rationing medical care to save money.

Today’s Washington Post includes letters from two cancer survivors that neatly illustrate why the government should not be in the business of providing health insurance or purchasing medical care at all.  Cancer Survivor #1 argues that Medicare should cover Provenge:

“Expensive” treatments have given me many extra years with my family. I witnessed my older daughters graduate from high school, start college and celebrate events doctors told me I would never see…Time is precious, life is priceless and every breath is a gift.

Cancer Survivor #2 says no way:

As a 63-year-old cancer survivor, would I forgo just four more months of life if it would cost $93,000? Yes, in a heartbeat…Let’s quit trying to live forever and put those millions of dollars into educating the next generation.

If the government stayed out of health care, or just subsidized Medicare enrollees with a voucher, then both cancer survivors would get their wish.  Cancer Survivor #1 could purchase coverage for expensive cancer treatments.  Cancer Survivor #2, and millions like her, could buy lower-cost insurance and donate the savings to scholarships.

Yet politicians and government bureaucrats dictate what type of insurance Medicare enrollees get, which means they also decide what enrollees will not get.  And no matter where they draw the line, someone loses.  Either Cancer Survivor #1 won’t get her expensive medical treatment, or Cancer Survivor #2 won’t be able to fund scholarships for kids.

The only way out is Medicare vouchers.  In addition to being the most plausible way to reduce Medicare spending, vouchers are the only way to protect Medicare enrollees from government rationing.