Saturday, May 9, 2009

Obama: Making Health Care Worse

As part of my continuing series on Obama-care, his death-inducing proposals for health care, I previously quoted him on "democratic decisions" about whether patients should live or die. What essentially is Obama's plan for people with catastrophic care needs and those in conditions that appear to be terminal?

As one analyst on FOX News said Saturday morning, Obama essentially is proposing the "European solution," which is to tell very sick people to wait in long lines . . . until many of them die. At that point, they no longer will qualify as a "cost burden" on the health system. Ah, the joys of cost savings!

Am I exaggerating what Barack Obama said in his interview with the NY Times? Read his chilling words for yourself (at the very bottom of this piece).

Don't get me wrong: great as it is compared to other countries', our health system does have some serious flaws. In a capitalist society, efficiency and cost control depend greatly on the amount of information we have from businesses. In health care, alas, we have very little transparency.

Consider the following statement by health care expert Dr. David Gratzer (in his superb book The
Cure), speaking of the time a few years when he was a young Canadian-trained physician who'd moved with his wife to the US.

"In 2003, when my wife ruptured a disc in her spine, I set about to find her a neurosurgeon in western New York. Uninsured and uninformed, I resorted to cold-calling neurologists, asking for their opinions on reputable surgeons. Few were willing to speak to a stranger about a colleague's skills.

"Meanwhile, having a choice of two hospitals and on information on either, we selected one at random . . . and then spent a nervous night before the operation at a Hampton Inn, which I had chosen after reviewing detailed reports at I found myself musing darkly that for a mundane accommodation decision, we had a surplus of data, whereas for a critical medical decision, we had little or nothing to go on."

Gratzer continues, "The surgery itself required only an inch-long incision, took under half an hour, and resulted in an inscrutable bill for an extraordinary sum. When we called in to inquire, a hospital administrator hinted that the bill was 'negotiable.' Before we could negotiate, however, we started to receive threatening letters from a collection agency." (The Cure, p. 1)

In one sense. Gratzer's story is mind-boggling. At the same time, it's not atypical. It's a lot easier to get details and the quality and price of hotel accommodations than it is to get useful information about health care. There is no real or equivalent to

Unlike local grocery stores, pharmacies, and motels, health care operations do not advertise their comparative prices. They also don't provide any useful information about the kind of care patients might receive. If there are low-cost, high quality health alternatives available, you -- and hundreds of millions of other Americans -- have no way of finding out who or where they are.

How do your doctor's charges -- and skills -- compare with those in your area? If you know the answer to that, you qualify as a veritable fount of knowledge. Years ago, my mother had one of the most incompetent family care physicians imaginable. She loved him because as she said, "He's such a nice man." He was a nice man. He was also a health provider much more likely to read People magazine than a medical journal.

Apparently, local and national medical societies like it that way . . . and so apparently do state and federal governments. It allows doctors and hospitals to avoid competing on messy matters like price and quality of service.

Where there is no transparency -- basically, no advertising -- there is no incentive to compete on price. There's also no incentive to provide evidence that not all doctors and hospitals are created equal. What evidence does exist shows that some low-cost hospitals provide superior outcomes to their high-priced counterparts.

Yes, the US government's rules and regulations -- along with rapacious trial lawyers -- are responsible for most of American health care's problems of affordability and availability. But they're not the only culprits. Without transparency, health consumers -- even ones as knowledgeable as Dr. Gratzer -- can't make good decisions.

The end result is that health care in the US costs a great deal more than it should. Where there are no real informed choices, neither efficiency nor capitalism exists. It makes no sense for us to be fully informed about motel choices . . . and totally in the dark about health care options.

Note, the following are Obama's scary comments (in italics) I referred to earlier:

"There's always going to be an asymmetry of information between patient and provider," Obama said. "And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options." In other words, the federal government would be a middle-man, basically usurping a doctor's and patient's determination what treatment is appropriate.

In addition, Obama stated that "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here." (Note: it should not come as a surprise that people who are sick are big consumers of health care. People who are well don't need it.) The actual percentage cost of end-of-life care is about 30% (according to health expert Dr. John Donaldson).

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