While most of the media are fixated on Benghazi, the IRS abuses, and the DOJ’s interest in reporters’ phone calls, the biggest scandal of all may be Kathleen Sebelius’ shakedown of health care companies to pay for activities Congress has refused to fund.
Federal regulations do not allow department officials to fundraise in their professional capacity. They do, however, allow Cabinet members to solicit donations as private citizens “if you do not solicit funds from a subordinate or from someone who has or seeks business with the Department, and you do not use your official title,” according to Justice Department regulations.
…the U.S. Office of Special Counsel concluded that Sebelius violated the Hatch Act by campaigning for President Obama and other political candidates while traveling on official business, an offense for which other federal workers are fired.
Why has the topic of “inequality” been getting so much attention in recent years? I have a theory, which I’ll advance in a future piece. But first things first.
What do the writers who are obsessing about it mean by “inequality”? They basically mean inequality of income. That would make sense if we all agree that the most important way in which people are unequal is differences in income. But what if that isn’t the case? Almost all of the people who are doing the complaining have chosen professions that earn less income than they could have had. That is, all these professors and editorial writers could have gone to law school or gotten an MBA or done something else that would have earned them more money. Obviously, money isn’t the most important thing in their lives.
The list below shows some other ways in which people are unequal. These things basically can’t be purchased. But if we were really concerned about life’s unfairness, we could compensate those who have less of these attributes and tax those who have more.
Josh Barro is the latest in a long line of left-of-center critics who fault Republicans for not being real partners in the health care debate. He writes:
Liberals are tired of being lectured by conservatives about what’s wrong with their approach to health policy because conservatives haven’t been a productive partner in seeking a fix.
Josh is half right. Yes, the left gave us a “fix” in the form of ObamaCare. But I believe it’s fair to say that no serious effort was made to work with Republicans. Remember: ObamaCare didn’t get one Republican vote on final passage. That’s not surprising. A few years back, when the Republicans pushed through the Part D drug benefit under Medicare, I don’t think a single Democrat offered to help with the legislation.
I’ve been a close observer of health care politics for a quarter of a century and in all that time I have seen very little productive interchange between the left and the right on this subject. And this is not just true of Washington. It’s true generally across the country.
Why is that?
At the most fundamental level, the left and the right approach the subject from completely opposite directions. The left invariably focuses on benefits. The right invariably focuses on costs. The left is concerned about what people are going to get. The right is concerned about how we are going to pay for it. You can find left wing health reform plans that barely mention how the reform will be paid for — or who will pay what for anything. You can find right wing reform plans that don’t even mention what medical care anyone will actually receive.
This, of course, is part of a larger division. In general, the left focuses on spending. The right focuses on taxes. But in health care the division is more pronounced. In fact, in health care the two sides don’t appear to be talking about the same subject.
Middle income families are about to encounter some real surprises as a result of the Affordable Care Act (ObamaCare). For example, many workers will soon discover that when they earn more money, they end up with less take-home pay. Others will discover that they are worse off if their employer offers them “affordable coverage” than if there is no health insurance offer.
The results from the Oregon Experiment, published in the New England Journal of Medicine on May 2, show that extending Medicaid to low-income adults did not improve basic clinical measures of health. Given that, it is a bit hard to see how being uninsured can cause 45,000 premature deaths every year — a figure rivaling the number of Americans killed in the Vietnam War. That’s the number physicians for a National Health Program say die prematurely in America due to a lack of health insurance.
The Oregon study results probably did not surprise those who have been paying attention to the serious academic literature, however. In independent empirical papers, Richard Kronick and David Card and his colleagues find little evidence that health insurance coverage significantly reduces mortality. Former Director of the Congressional Budget Office June O’Neill and her husband Dave also conclude that lack of insurance has little or no impact on mortality. See the discussion at this blog here, here and here.
One person who ordinarily pays scrupulous attention to the quality of research is Austin Frakt. Yet in a surprisingly irate blog post he makes this claim: the fact that health insurance improves health and reduces “mortality risk” is “well established” and “as close to an incontrovertible truth as one can find in social science.”
In another post he asserts that Megan McArdle “distorts the scientific record” in an Atlantic article in which she concluded that there was little evidence to support the claim that people die because they do not have health insurance. He accused her of cherry picking, of “misrepresent[ing] a body of work in support of that conclusion and further mislead[ing] readers that such work does not exist.”
Within the White House, within the Democratic chambers in Congress and among the (overwhelmingly liberal) health policy community there was considerable anguish last week. The reason: a new study finds that (as far as physical health is concerned) there is no difference between being in Medicaid and being uninsured.
It’s hard to exaggerate what a blow this is to the people who gave us the Affordable Care Act (ObamaCare). Everything about ObamaCare ― from the money we are spending to the damage being done to the labor market to the hassles the whole nation is going through ― depends on one central idea: that enrolling people in Medicaid will give them access to better health. (Tens of thousands of lives will be saved every year, the president told us.)
It gets worse. Beginning next year, ObamaCare is expected to newly insure about 34 million people. About half of these will enroll in Medicaid. The other half are supposed to get their insurance in health insurance exchanges, where most will qualify for generous premium subsidies paid for by federal taxpayers. If the Massachusetts health reform is precedent, however, these people will be in health plans that pay doctors only about 10 percent more than what Medicaid pays. Think of these plans as Medicaid Plus.
Yet, if Medicaid doesn’t make people any healthier than they were when they were uninsured, that implies that the entire ObamaCare program could be one huge waste of money.
How much do you think Medicare will pay a doctor or a nurse for keeping a patient out of the hospital? Answer: zero.
That’s pretty amazing when you consider that Medicare’s hospitalization insurance (Part A) is spending about $250 billion every year. Yet it allocates not one thin dime for keeping-patients-out-of-the-hospital activities. If you go down the list of about 7,500 tasks that Medicare pays doctors to perform, you’ll discover that reducing hospitalization just isn’t there.
What brings this to mind is an Ezra Klein post describing a Medicare pilot program managed by Health Quality Partners in Doylestown, Pennsylvania:
Health Quality Partners’ results have been extraordinary. According to an independent analysis by the consulting firm Mathematica, HQP has reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent…
To put that in perspective, if HQP activities were replicated nationwide we would save about $122 billion a year. If we didn’t need the money to reduce the deficit, with that kind of savings the federal government could give your household and every other household in the country a $1,200 tax rebate every year.
So what is the Department of Health and Human Services doing about this fascinating experiment? It’s going to close it down.
A version of this Health Alert (co-authored by Pamela Villarreal) appeared at Townhall.
One of the worst features of the American health care system is the sorry state of medical malpractice law. Fewer than 2 percent of injured patients ever file a lawsuit. Of those that do, only one in 15 receives compensation. More than half of every dollar goes to cover the cost of litigation, rather than to the injured and their families.
Ironically, the medical malpractice system is inordinately focused on whether someone was at fault when an injury or accident occurs. Of the estimated 187,000 deaths (NCPA estimate based on NEJM and NCBI) and 6 million injuries that occur in hospitals each year, only an estimated one in four are considered negligent (malpractice) — and the actual number is probably much lower than that. Another 30 percent (such as certain types of infections) are judged to be “preventable,” even though no one is guilty of negligence. Almost half of adverse medical events are “acts of God” — no one was at fault and there is no obvious way of preventing them.
It is cruelly ironic, but the massive law that was enacted to solve the problem of the uninsured in America is more likely to worsen it. This would be true even if the program is perfectly implemented and all the provisions come online on time and within budget.
How could this be? It is a multistep process. Stay with me for a second.
The more things change, The more they stay the same.
When 21-year-old Mike Kelly (not his real name) set out on his bicycle one evening in Durango, Colorado, he had no intention of ending up in a hospital. A collision with an automobile changed those plans. Fortunately, Durango is a ski mecca where broken bones are almost a way of life. With all that practice, doctors there have evolved their practice into a sort of natural center of excellence for treating bone injuries.
In Mike’s case, however, another set of doctors came into play. Mike and his family are clients of PinnacleCare, a “health advisory” firm in Baltimore, Maryland. Within 30 minutes of Mike’s arrival at the emergency room, the staff of PinnacleCare was on the phone with the ER doctors in Durango — discussing treatment options and transferring Mike’s medical records.
Communication is a big problem for everyone in medical emergencies. The doctors want to know what drugs the patient has been taking; if there have been any recent surgeries; etc. The patient may be in no condition to tell them. The ER might have important information and the family naturally wants the ER doctor to tell them what is happening. But a federal law (HIPAA) prevents such communication unless the patient signs a waiver and even then ER doctors aren’t fond of talking to families when a patient needs attention. PinnacleCare solves this problem. They already have the waiver. They have the electronic medical records (EMRs). They can provide the kind of doctor-to-doctor communication that is most needed. And then they can talk to the family while the ER doctors do their work.
As Mike’s parent’s (who were at home in Virginia at the time of the accident) explained, “It’s like having a family doctor helping you instead of a strange doctor in a strange land.”
In Mike’s case, there was important information the ER team needed to know. One month earlier Mike had come down with mononucleosis and as a result his spleen almost burst. So the PinnacleCare doctors requested a FAST test (sonogram) on the spleen right out of the shoot. Then there was an option on treating Mike’s broken leg — he could have a rod or a cast. Either choice involves a tradeoff. PinnacleCare is in the business of providing second opinions, and these opinions come from doctors who have no financial interest in over-treating or under-treating or in any of the options under consideration.
After Mike was discharged, PinnacleCare found a physical therapist to attend him while his leg healed. When Mike was able to return to his home in Virginia, the agency found a therapist to continue the care and an orthopedic doctor to oversee his recovery. They emailed his Colorado medical records to the Virginia doctor and discussed Mike’s treatment plan with him.
Through it all, the Kelly family never had the difficulty so many other patients have — getting answers to questions. In fact, the Kellys have the cell phone numbers of the PinnacleCare staff!
Now let’s recap how many problems were solved in this one case.