President Barack Obama intends to remake society mainly by shifting American wealth from one group of people to another and from one priority to another. The most devastating shift will happen stealthily and steadily so that the priorities can’t shift back because too much government dependence will forbid it. That dependence will happen in the form of government-run health care.
What will be traded in this bargain will be national defense. Defense spending will diminish. Missile shields in Europe will be traded for a waiting list for appendix removal in America. Some view this as a good thing because they don’t see the value of defense spending anyway. However, America is building a European defense shield precisely because they have traded national security for social programs. Who will defend America once America does the same? Meanwhile, China ups defense spending by 15%.
The question for people today is whether government-run health care will be the panacea many hope for. Like anything run by the government, it’s doubtful. Thankfully, voters seem to recognize the potential problems. From the Wall Street Journal:
On health care, the poll flashed warning signs for the administration.
Forty-nine percent said they were willing to pay higher taxes so that everyone can have health insurance, compared with 66% who said the same in March 1993, when President Bill Clinton was embarking on his ultimately unsuccessful health-reform effort. That underscores why the administration is focused on cutting costs, not covering the uninsured.
People have reasons to be worried. A national database will invade health care consumer’s privacy:
The package says individuals are not required to get services from people who do electronic health records. But doesn’t that run counter to what the stated goal of everyone in by 2014? Why, you would think it does. But don’t worry yourself. You don’t have to send your information in. Nope. They won’t make you do it. They are going to make your doctor do it. The bill requires the doctors to. Doctors who don’t will receive less and less money for the patients they see.
It’s right there on page 680: “with respect to covered professional services furnished by an eligible professional during 2015 or any subsequent payment year, if the eligible professional is not a meaningful EHR user (as determined under subsection (o)(2)) for a reporting period for the year, the fee schedule amount for such services furnished by such professional during the year (including the fee schedule amount for purposes of determining a payment based on such amount) shall be equal to the applicable percent of the fee schedule amount that would otherwise apply to such services under this subsection.”
Further, what’s the penalty if, say, health records are stolen and/or hacked? Digital Soapbox is concerned:
This section is quite interesting:
“(c) BREACHES TREATED AS DISCOVERED. — For purposes of this section, a breach shall be treated as discovered by a covered entity or by a business associate as of the first day on which such breach is known to such entity or associate, respectively, (including any person, other than the individual committing the breach, that is an employee, officer, or other agent of such entity or associate, respectively) or should reasonably have been known to such entity or associate (or person) to have occurred.”
So … if a hacker reports the breach to authorities, after successfully stealing medical records, it isn’t considered “discovered” until someone at the entity acknowledges it!?
But while the writer hopes for more enforcement teeth should records be breached, he ignores the bigger problem. Doctors already worry about being out of compliance with HIPPA and other Medicare and Medicaid regulations. Fines for being in violation of the current regulations have made it so many doctors won’t participate in the program, this doctor included. What that means is that often the best doctors don’t participate in government-run health care now because they don’t have to. Further, there becomes a cost-benefit analysis. Just as men have left the teaching profession in droves because of the risks both personal and professional due to threats of sexual abuse charges, doctors will leave the profession because the personal risks aren’t worth it. What I find interesting is the nonchalance with which the technology writer talks about the fines — only $10,000? For a small business doctor, two of those fines could mean being put out of business. So there are privacy concerns but also economic concerns. Will America’s new health care system be staffed by imported doctors because smart young Americans will choose professions with a better upside and less personal risk just as has happened in Britain? That’s likely. It’s already happening.
And then there’s the expansion of the government economically. The stated goal is health care for all, but the costs seem to matter little. Medicare and Medicaid may be cheaper than private insurance, but limiting services and rationing care are the ways that’s achieved. With Baby Boomers aging, costs are rising and will peak in 2030.
The restrictions are important, too. Government-run health care cuts costs because tough decisions on care choices are made not by doctors and patients but by bureaucrats. Bloomberg’s Betsy McCaughey says:
What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.
The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.
Government-run health care will impose behavioral changes because people won’t change on their own. Recently, the New York Time’s Tara Parker-Pope wrote about patients and doctors using unhelpful treatments even though no evidence supports the treatment. This is a problem — antibiotic use and needless back surgeries come to mind. Still, the assumption is that this quirk of human nature can be modified:
“In American culture, prescriptions and procedures have become surrogates for real health care and real dialogue,” Dr. Newman said. “We need doctors and patients to conceive of medicine and health in a totally different way than they have been taught in the last 20 to 30 years.”
Well, yes. That’s true. Americans have become conditioned to externalize the cause of their health care issues, but one could argue that generous insurance has made the situation worse and not better. There are few economic consequences for misusing health care — people are either uninsured and don’t pay or insured well and don’t pay [well, they pay, they just don’t connect what they pay with what they receive]. That is, the consumer is separated from the consequences of his actions. President Bush’s attempts to increase health care savings accounts addressed this tangentially — when a person pays cash, he is connected to his decisions. When health care providers must compete in the marketplace, they have reasons to give better, more competitively priced care.
Health care reform will be a huge fight for the Obama administration. As Nancy Pelosi knows, “messaging” (i.e., deception) is the key to passing government-run health care. As Kevin Drum notes at Mother Jones:
Like it or not, universal health care will never get passed on the grounds that it will help the 48 million Americans who are currently uninsured. It will only pass if the other 250 million Americans are assured over and over and over again that the new plan will be at least as good for them as what they have now. The tactical shift Pelosi is talking about isn’t just wise, it’s absolutely indispensable.
But government run health care won’t be as good as they have now. Small sticking point.