Government Health Care Trade-Offs: Death or Treatment?

Uwe Reinhardt has made the argument that health care rationing is health care rationing.  It’s inevitable, so there’s no big deal about the government exerting more control.  I argued earlier that this ignores the question 0f who is doing the rationing, us or the government?  Since resources are finite but desires are infinite, we all engage in “rationing” in most every aspect of our lives.  But we do so based on our needs, wants, wishes, and dreams, not those of politicians or bureaucrats.

Who makes the decision especially matters when the issue is life and death.  There was a recent report on that a Democratic congressional aide was overheard suggesting that expanded Hospice care would help solve the cost problem for health care: 

And, for the crowning glory, the aide feels that “probably the best part of the bill is the increase in Hospice care which will solve the prolonging of life issue.” 

One has to be careful dealing with second-hand reports of overheard conversations.  Nevertheless, RedState’s Erick Erickson pointed to Oregon’s health program, which seems to trend the same way.  As Fox News detailed:

Some terminally ill patients in Oregon who turned to their state for health care were denied treatment and offered doctor-assisted suicide instead, a proposal some experts have called a “chilling” corruption of medical ethics.

Since the spread of his prostate cancer, 53-year-old Randy Stroup of Dexter, Ore., has been in a fight for his life. Uninsured and unable to pay for expensive chemotherapy, he applied to Oregon’s state-run health plan for help.

Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup’s request with a letter saying the state would not cover Stroup’s pricey treatment, but would pay for the cost of physician-assisted suicide.

“It dropped my chin to the floor,” Stroup told FOX News. “[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?”

The letter, which has been sent to other terminal patients throughout Oregon, follows guidelines established by the state legislature.

Oregon doesn’t cover life-prolonging treatment unless there is better than a 5 percent chance it will help the patients live for five more years — but it covers doctor-assisted suicide, defining it as a means of providing comfort, no different from hospice care or pain medication.

“It’s chilling when you think about it,” said Dr. William Toffler, a professor of family medicine at Oregon Health & Science University. “It absolutely conveys to the patient that continued living isn’t worthwhile.”

Where government picks up the tab, it obviously has to decide what services it is willing to cover.  In the case of Oregon, the juxtaposition of refusing to pay for medical treatment while underwriting euthanasia should cause significant discomfort at the least.  Of course, drawing the line will never be easy.  But surely we don’t want government to decide where to draw the line for the rest of us who are not — presently, at least — dependent on Uncle Sam for their health care.

Which brings us back to the problem of rationing.  We should not be able to count on someone else paying so we can receive every last medical treatment and procedure that is available, irrespective of how miniscule the likelihood of success.  But we should be able to spend our money, either directly, on treatment, or indirectly, on a generous insurance policy, if that’s what we desire.  Government’s responsibility is to help ensure access for those unable to help themselves, not make medical decisions for the rest of us, no matter how “rational” they might seem to someone else.

The Attempted Murder of HSAs

There may be nothing that more scares advocates of government-controlled health care than giving patients control over their medical treatment.  Thus, it should come as no surprise that the current versions of health care “reform” would kill off Health Savings Accounts (HSAs).

Explains John Fund in the Wall Street Journal:

Eight million Americans, according to the Treasury Department, are covered by plans with low-cost premiums and high deductibles that are designed for large, unexpected medical costs. Money is also set aside in a savings account to cover the deductibles, and whatever isn’t spent in one year can build up tax-free. Nearly a third of new HSA users, according to Treasury figures, previously had no insurance or bought coverage on their own.

These policies will be severely limited. The Senate plan says a policy deemed “acceptable” must have insurance (rather than the individual) pay out at least 76% of the benefits. The House plan is pegged at 70%. That’s not the way these plans are set up to work. Roy Ramthun, who implemented the HSA regulations at the Treasury Department in 2003, says the regulations are crippling. “Companies tell me they could be forced to take products off the market,” he said in an interview.

This level of micro-management is a good argument in principle against the sort of “reform” currently being promoted on Capitol Hill.  But the proposed rules likely were drafted in order to eliminate HSAs as an option.  Explains Ryan Ellis of American Shareholders:

If an insurance plan must pay for 70 or 76 percent of all health care costs, it would be next to impossible for it to qualify as a high-deductible health plan.  No HDHP, no HSA contribution.

The only hope a plan would have would be to do the following:

  • Have a deductible no higher than the HDHP minimum ($1150 single, $2300 family in 2009)
  • The out of pocket limit would have to be an identical amount
  • The plan would have to cover all allowable preventive care on a first-dollar basis (annual physical, prenatal and well-child, immunizations, smoking cessation, weight loss programs, and early screening services)

Any HDHP which is this generous would have very little premium savings relative to a tradtional health insurance plan.  If the typical HDHP today shaves about 33 percent off your premium, a plan like this might only shave off about 10 percent.  There would be very little incentive to get an HSA-qualified insurance plan.

HSAs are an imperfect vehicle, an attempt to deal with the perverse incentives created by Washington’s favorable tax treatment of employer-provided health care.  But the limitations inherent to HSAs should impel us to expand, not eliminate vehicles to enhance consumer choice.  The more we find out about health care “reform,” the more obvious it is that patients would be the biggest losers.

Brainstorming for (Your) Dollars

The Wall Street Journal reports [$]:

President Barack Obama’s health-care plan is in jeopardy because of serious concerns that costs will spin out of control. As much as anyone, it’s White House budget director Peter Orszag’s job to save it…

After his TV appearances, he went straight to the Senate Finance Committee, where he spent three hours with committee aides brainstorming about how to pay for the trillion-dollar legislation. At one point, they flipped through the tax code, looking for ideas.

Note, of course, that finding new sources of tax revenue doesn’t do anything about cost concerns. But for those “fiscal conservatives” who worry more about the deficit than about the government ending up with all our money, new revenue to match new spending may alleviate their concerns. (By the way, this WSJ article also has interesting vignettes about Orszag’s encounters with libertarian writer Virginia Postrel and my former colleague Andrew Biggs.)

For a review of some of the ideas Orszag and his friends have found as they flipped through the tax code — such a charming metaphor for the reality of the ruling class looking for opportunities to extract more of the money we earn — click here.

Race to the Takeover

With the federal takeover of health care stalled, President Obama was able to enjoy a little feeling of success today at an event celebrating the “Race to the Top Fund,” a $4.35 billion kitty of education money created under the economic “stimulus” law. Not much actually happened today — the draft state application for fund dollars was released — but that was enough to produce a full-on, Department of Education dog-and-pony show topped off with a speech by the president. The administration even had a bit of a media blitz leading up to the show, with numerous articles appearing in major papers, a Washington Post op-ed by Secretary Duncan, and the president participating in a lengthy Post interview.

Unfortunately, there’s nothing about the Race to the Top Fund actually worth celebrating. Despite rhetoric by the president about “evidence-based policymaking” and promises that “politics won’t come into play” with fund money, this is just another escalation of politicized, destructive, federal education interference. It pours more taxpayer ducats into the edu-abyss, and with new data-collection requirements and money for national (read: federal) standards and tests, further tightens Washington’s grip on our schools. And don’t expect any of this to translate into better outcomes: The people employed by government schools, who have the greatest incentive and ability to control education policy, will still be calling the shots in a soon-to-be even tighter monopoly. Heck, just ask American Federation of Teachers president Randi Weingarten and National Education Association president Dennis Van Roekel. Both were in attendance at today’s big event, and both were singled out for praise by Secretary Duncan and President Obama.

The race to the federal takeover just keeps getting faster.

55% Duties on Chinese Tires Would Be Plain Stupid in Every Respect

Last month, I posted about the upcoming decision confronting President Obama on the question of whether or not he should impose trade restrictions (55% duties) on passenger tires from China, as recommended by the U.S. International Trade Commission.

I am in the process of finishing a short paper on the issue, explaining why doing so would be disastrous for the economy and foreign relations, but am taking a break to share this brilliant op-ed that appeared in today’s Detroit News. Ross Kogel, Jr., president of Tire Wholesalers, really hits the nail on the head, articulately and succinctly, explaining that there is no upside, only misery, in the proposed tariffs.

Michigan could sure use several more Ross Kogel and far fewer of the business-as-usual pols and union leaders who have run the state into the abyss.


The Price of Universal Coverage Just Went Up

Since at least February, President Obama and other elders of the Church of Universal Coverage have labored to create the impression that universal coverage is inevitable, because a sense of inevitability reduces its cost.  If interest groups think this train is leaving the station, they are less likely to stand in its way.  Lobbyists are more likely to cut whatever deal they can if their clients believe, “It could have been much worse.”  That’s why Obama has demanded haste: the longer the process, the harder it is to maintain a sense of inevitability.

Here’s a sampling of today’s health care headlines from the non-partisan Bulletin News, which summarizes news media coverage:

  • Senate, Obama Back Off Healthcare Reform August Deadline.
  • Obama Rakes In Cash For DNC, Criticizes Media Coverage Of Healthcare Debate.
  • Obama’s Performance At Wednesday’s Press Conference Comes Under Fire.
  • President’s Media Strategy Raises Eyebrows.
  • House Democrats Consider Sidestepping Committee.
  • Democratic Caucus Holds “Contentious” Meeting.
  • Black Caucus Blasts Blue Dogs; AARP, Unions Also Criticize Group.
  • Freshmen Senators Ask Baucus To Hold Costs Down, Praise His Efforts.
  • More Criticism Of Obama.

Now that reform seems less inevitable, interest groups will be less likely to settle for a bad deal.  Instead, they will be more likely to demand higher payoffs than before, because their clients believe the expected cost of alienating Church elders has moved away from “getting punished” and toward “the status quo ante.”

So, good luck paying for this thing.