“One of the biggest fears Americans have about Obamacare is who will ultimately control health care decisions: the government or patients and their doctors. New research by Heritage health policy analyst Kathryn Nix explains that while the law does not explicitly put those decisions in the hands of the government, it does allow government bureaucrats to unduly influence medical care. Enter comparative effectiveness research (CER), which compares different methods for preventing, diagnosing, or treating a specific disease or condition. In her paper, Nix explores the many ways CER might be used under Obamacare in ways that harm patients more than help them.
Obamacare creates the Patient-Centered Outcomes Research Institute (PCORI), which as Nix explains in previous research, is responsible for “comparing options for prevention, diagnosis, and treatment for specific health problems; improving health care systems; informing patients and other stakeholders; addressing disparities among patient populations and health outcomes; and designing research to be patient-centered.”
PCORI cannot use CER to issue coverage recommendations or make payment decisions. However, changes made by Obamacare to the Medicare bureaucracy will impact patients’ ability to make decisions. Obamacare also creates a value-based purchasing program for certain Medicare providers, which will financially reward some and punish others based on federal quality measures. These could eventually be influenced by CER produced by PCORI.
This new program, Nix writes, “could encourage physician behavior that does not put the patient first, meanwhile treating providers in ways that are unfair, inequitable, and unlikely to truly reflect better-value, high-quality care.” She describes some of the consequences:”
“A persistent health-care myth is that the U.S. system is uniquely wasteful versus the European countries that spend far less per patient as a result of tight government control. Only the establishment experts who spread this myth will be surprised, but new research shows American patients are often getting more value—better outcomes and longer lives—in return for those extra dollars. More remarkable still, the news arrives via the policy journal Health Affairs, in a symposium on the cost and quality of U.S. cancer care. This is like the Vatican saying go ahead, worship the raven images and false idols. Tomas Philipson of the University of Chicago and colleagues compare U.S. oncology spending over the period from 1983 to 1999 (the last year for which data are available) with that in 10 European Union countries. Costs were lower overall overseas and grew by 16%, while they grew by 49% in the U.S. Yet U.S. cancer mortality rates are lower, despite higher cancer rates, and “We found that the value of survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed ‘worth it,'” Mr. Philipson et al. write. Throughout the entire period, U.S. cancer survival gains were larger, reaching 11.1 years over 1995 to 1999 against 9.3 years in the EU. The researchers then compared the U.S. and EU gains using conservative, commonly accepted measures for the value of a statistical life, less the cost of the care. The U.S. comes out ahead by $598 billion. In other words, though the U.S. spends more, patients and society benefit far more.”
“The Obama Record: When Vladimir I. Lenin sought to remake Russian society into a “proletariats’ paradise,” he targeted three sectors for control: health care, banking and education. Sound familiar? Of these three, however, Lenin viewed socialized medicine as the “keystone” to building his socialist utopia. The Bolshevik leader told the Russian people everybody would be able to afford going to the doctor, not just the “greedy rich.” He also claimed centralized control of the medical industry would “reduce costs” and end the “waste” from “unnecessary duplication and parallelism” in a competitive market. In 1918, the USSR became the first nation to promise “free” universal health-care coverage. Fifteen years later, major flaws appeared in its grand social experiment, even to Western observers who for the most part romanticized it. “Monetary motives have almost entirely ceased to operate in medical practice in Soviet Russia,” observed a pair of sympathetic physicians from America and Britain who traveled to Russia in 1933. As a result, “there still exists a great shortage of physicians and hospitals,” they wrote in their report, “Red Medicine: Socialized Health in Soviet Russia.” “Drugs are almost fabulously dear and scarce.” “Overworked doctors” couldn’t handle the flood of new patients. A bloated new medical bureaucracy, led by the People’s Commissar of Public Health, only worsened delays in treatment. “The dissatisfied patients objected to the many formalities before they were allowed to see a doctor at the public clinic, and to the fact that the intervals before they saw him again were excessive,” the 1933 report said.”
“At the heart of the multi-headed abominable creature knownas Affordable Care Act aka ObamaCare, there resides a singular deceit. It is too easy for lawyers and even U.S. Supreme Court Justices to miss this deceit in the process of arguing abstractions, but I and other doctors experience this
reality every day our offices:
Insurance does not equal care. One patient’s needs can get in the way of another’s needs. My waiting room is like so many others in America, and when it is clogged with several patients with low-paying highly-regulated insurance, the waiting time goes up and the access to quality medical care goes down.
With all due respect to Supreme Court Justice Sonia Sotomayor, though it is true that everyone will get sick and need health care eventually, it is not true that health insurance automatically provides you with that care.
I can tell you as a practicing physician that the regulations and restrictions and red tape of health insurance (all increasing
under ObamaCare) hamstring my office staff and interfere with my ability to take care of you.”
“Beginning Monday, the Supreme Court will hear challenges to the law. The American people, by an astonishing two-thirds majority, want the law and/or the individual mandate tossed out by the court. In practice, however, questions this momentous are generally decided 5 to 4 — i.e., they depend on whatever side of the bed Justice Anthony Kennedy gets out of that morning. Ultimately, the question will hinge on whether the Commerce Clause has any limits. If the federal government can compel a private citizen, under threat of a federally imposed penalty, to engage in a private contract with a private entity (to buy health insurance), is there anything the federal government cannot compel the citizen to do? If Obamacare is upheld, it fundamentally changes the nature of the American social contract. It means the effective end of a government of enumerated powers — i.e., finite, delineated powers beyond which the government may not go, beyond which lies the free realm of the people and their voluntary institutions. The new post-Obamacare dispensation is a central government of unlimited power from which citizen and civil society struggle to carve out and maintain spheres of autonomy.
Figure becomes ground; ground becomes figure. The stakes could not be higher.”
“Our budget’s Medicare reforms make no changes for those in or near retirement. For those who will retire a decade from now, our plan provides guaranteed coverage options financed by a premium-support payment. And this year, our budget adds even more choices for seniors, including a traditional fee-for-service Medicare option. We also introduce a competitive-bidding process to determine the growth of government’s financial contribution to Medicare. Forcing health plans to compete against each other is the best way to achieve high-quality coverage at the lowest cost, and implementing these reforms in Medicare can have the effect of lowering health-care costs for everyone. This is the key to increasing access and affordability while preventing government debt from threatening the health security of seniors and the economic security of all Americans.
Our budget also spurs economic growth with bold tax reform—eliminating complexity for individuals and families and boosting competitiveness for American job creators. Led by House Ways and Means Committee Chairman Dave Camp, our budget consolidates the current six individual income tax brackets into just two brackets of 10% and 25%.
We propose to reduce the corporate tax rate of 35%, which will soon be the highest rate in the developed world, to a much more competitive 25%. Our budget also shifts to a “territorial” tax system to end the practice of hitting businesses with extra taxes when they invest profits earned abroad in jobs and factories here at home.”