Senators Seek Compromise on Public Option for Health Care Reform

By Douglass K. Daniel | July 7, 2009

  • July 7, 2009 at 9:27 am
    matt says:
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    From the Wash Post yesterday:

    –The nations largest insurers, hospitals, & medical groups hired over 350 former gov’t staffers and retired Congress critters to lobby against the government option. It says, “That tally does not include lobbyists who did not report their earlier government experience, such as PhRMA President W.J. “Billy” Tauzin”

    –The industry is spending $1,400,000 per day lobbying against the government option

    –PhRMA spent about $7,000,000 on lobbying in 1Q 2009, and Pfizer spent over $6,000,000

    –Overall healthcare lobby spending exceeded $126,000,000 in 1Q 2009

  • July 7, 2009 at 1:23 am
    David says:
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    A Public Option is unfair and dangerous to the private sector IF it ends up to be an overbearing and underpriced entity. Hopefully both sides can bend a little with the knowlege that the system is pretty darn good for those who have coverage. It’s true there are a lot of good people out thre in need of protection who are not simply looking for a hand-out. But, there are a number of rightfully concerned, good insurance companies out there who owe it to their stockholders and insureds to make sure a public option is not going to wreck their industry. So, they lobby. One idea would be to somehow make it possible for private insurers to administer benefits of a government program in the way private insurers administer to self-insured programs offered by large companies to their employees.

  • July 7, 2009 at 1:26 am
    An agent from Arizona says:
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    Agents this is a topic that we better get excited about and phone or write Congress. This is the first step towards National Health Care with the freedom of choice going out the window. Look to our neighbor to the North and across the Eastern Pond to Europe. Has national Health Care ever been effective? The Answer is NO. Why would we be any different?
    On another point I don’t need to tell many of you agents the important role the Independent Agents play in the delivery system, and the advice we give on health products.On a conceptual basis we do a very good job for our customers. Some of you P & C Agents are saying no big deal we don’t sell health products. Do you sell workers compensation? With a National Health Care where the medical will be taken care of what effect do you think the medical portion being taken out will have on the effect of the premium of a workers comp policy, or for that matter any other policy that has medical coverage?
    The plan that is on the table specifically prohibits insurance agents from assisting consumers in selecting coverage optionsor insurance programs.
    According to the bill their will be a group called Navigators. This group will be comprised of community workers and individuals, and they will not be licensed as insurance professionals. The Navigators will be compensated by the Federal Government, and not regulated by the Department of Insurance of your state. I cannot make this stuff up. Agents get involved before it is too late. Get on the horn with your representative. Many of your jobs are in jeopardy.

  • July 7, 2009 at 3:18 am
    Joe says:
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    Read these facts about the UK’s National Health care:

    Of NICE and Men
    Article Comments (111) more in Opinion ┬╗Email Printer
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    Speaking to the American Medical Association last month, President Obama waxed enthusiastic about countries that “spend less” than the U.S. on health care. He’s right that many countries do, but what he doesn’t want to explain is how they ration care to do it.

    Take the United Kingdom, which is often praised for spending as little as half as much per capita on health care as the U.S. Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE. Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you.

    * * *

    Associated Press

    President Barack Obama speaks about health care during a town hall meeting at Northern Virginia Community College last Wednesday.
    The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used “best practices” in medicine. As the Guardian reported in 1998: “Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere.”

    What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:

    In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs — including Sutent, which costs about $50,000 — that would help terminally ill kidney-cancer patients. After last year’s ruling, Peter Littlejohns, NICE’s clinical and public health director, noted that “there is a limited pot of money,” that the drugs were of “marginal benefit at quite often an extreme cost,” and the money might be better spent elsewhere.

    In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: “When treatments are very expensive, we have to use them where they give the most benefit to patients.”

    NICE has limited the use of Alzheimer’s drugs, including Aricept, for patients in the early stages of the disease. Doctors in the U.K. argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not “cost effective” in early stages.

    Other NICE rulings include the rejection of Kineret, a drug for rheumatoid arthritis; Avonex, which reduces the relapse rate in patients with multiple sclerosis; and lenalidomide, which fights multiple myeloma. Private U.S. insurers often cover all, or at least portions, of the cost of many of these NICE-denied drugs.

    NICE has also produced guidance that restrains certain surgical operations and treatments. NICE has restrictions on fertility treatments, as well as on procedures for back pain, including surgeries and steroid injections. The U.K. has recently been absorbed by the cases of several young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.

    We could go on. NICE is the target of frequent protests and lawsuits, and at times under political pressure has reversed or watered-down its rulings. But it has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.

    The NICE board even has a mathematical formula for doing so, based on a “quality adjusted life year.” While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn’t adjust for either overall or medical inflation.

    Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).

    The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price — the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000?

    One virtue of a private system is that competition allows choice and experimentation. To take an example from one of our recent editorials, Medicare today refuses to reimburse for the new, less invasive preventive treatment known as a virtual colonoscopy, but such private insurers as Cigna and United Healthcare do. As clinical evidence accumulates on the virtual colonoscopy, doctors and insurers will be able to adjust their practices accordingly. NICE merely issues orders, and patients have little recourse.

    This has medical consequences. The Concord study published in 2008 showed that cancer survival rates in Britain are among the worst in Europe. Five-year survival rates among U.S. cancer patients are also significantly higher than in Europe: 84% vs. 73% for breast cancer, 92% vs. 57% for prostate cancer. While there is more than one reason for this difference, surely one is medical innovation and the greater U.S. willingness to reimburse for it.

    * * *
    The NICE precedent also undercuts the Obama Administration’s argument that vast health savings can be gleaned simply by automating health records or squeezing out “waste.” Britain has tried all of that but ultimately has concluded that it can only rein in costs by limiting care. The logic of a health-care system dominated by government is that it always ends up with some version of a NICE board that makes these life-or-death treatment decisions. The Administration’s new Council for Comparative Effectiveness Research currently lacks the authority of NICE. But over time, if the Obama plan passes and taxpayer costs inevitably soar, it could quickly gain it.

    Mr. Obama and Democrats claim they can expand subsidies for tens of millions of Americans, while saving money and improving the quality of care. It can’t possibly be done. The inevitable result of their plan will be some version of a NICE board that will tell millions of Americans that they are too young, or too old, or too sick to be worth paying to care for.

    Printed in The Wall Street Journal, July 7, 2009, page A14

  • July 7, 2009 at 4:17 am
    David says:
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    It sounds remenicent of private insurer HMOs when they first came out. They put limits and controls in the system that
    P!ssed of doctors and patients alike. The difference with the Brit plan is that there are no physicians with their own practices. They are employees of the system. I am not sure what the answer is here. You have to agree that any system that administers health care, even the private sector, has to have some control or predictive element to it. If you have kids you know that maternity care is limited to 1 or 2 days by private insurers. I give Obama’s crew credit for undertaking this but it really is beyond most people’s comprehension (especially mine). I fear that those who have excellent coverage may see some of it go away or severely limited by private insurers to take over the heavy burden of those currently without coverage.

  • July 7, 2009 at 4:32 am
    Joe says:
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    Your fears are well founded. National health care (NHC) is rationed health care by the gov’t, not doctors or insurance companies. At least with insurance companies, one has the option to purchase various types of coverage. With NHC, the gov’t determines what may be purchased by anyone.

    The 43M uninsured is a myth. For the most part, people would rather spend their money on things other than health care. This shouldn’t require me or anyone else to fund their health care (be be subjected to rationed health care) so that they may buy a bigger house, new care, or take a cruise.

  • July 8, 2009 at 11:08 am
    Joe says:
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    The following is a succinct analysis of what’s wrong with the health care system and what might be done about it.

    Insurance Is No Answer John Stossel
    Wednesday, July 08, 2009
    Health care “reformers” keep talking about getting more health insurance. Then they talk about cutting costs. This is contradictory nonsense.
    Insurance, whether private or a government Ponzi scheme like Medicare, means third parties pay the bills. When someone else pays, costs always go up.
    Imagine if you had grocery insurance. You wouldn’t care how much food cost. Why shop around? If someone else were paying 80 percent, you’d buy the most expensive cuts of meat. Prices would skyrocket.
    That’s what health insurance does to medical care. Patients rarely even ask what anything costs. Doctors often don’t know. Often nobody even gives a damn. Patients rarely ask, “Is that MRI really necessary? Is there a cheaper place?” We consume without thinking.
    By contrast, in areas of medicine where most patients pay their own way, service gets better, while prices fall.
    Take plastic surgery and Lasik eye surgery: Because patients shop around and compare prices, doctors work hard to win their business. They often give customers their cell-phone numbers. Service keeps increasing, but prices don’t. “In every other field of medicine, the price is going up faster than consumer prices in general,” says John Goodman of the Center for Policy Analysis. “But the price of Lasik surgery, on average, has gone down by 30 percent.”
    This shouldn’t be a surprise. What holds costs down is patients acting like consumers, looking out for themselves in a competitive market. Providers fight to win business by keeping costs down and quality up.
    Yet politicians keep telling us the solution is more insurance. And they mean insurance not just for catastrophic diseases that could bankrupt us but also for routine treatments.
    The politicians are so oblivious to reality that they are on course to make things worse. Obama would force every business to either give workers health insurance or pay a fine into the public system. Why is that something we should want employers to do? Premiums come out of our salaries, but insurers are accountable to our bosses, not to us.
    Why not just have a free market where people can buy whatever kind of health insurance they want? Competition would then bring prices down.
    Obama and his Senate allies would limit competition by requiring insurers to cover everyone for the same “fair” price. No “cherry picking,” the president says. No charging healthy people less.
    They call this “community rating,” and it sounds fair. No more cruel “discrimination” against people who have a preexisting condition, obese people or smokers. But such simple-minded one-size-fits-all rules take from insurance companies their best price-dampening tool: Risk-based pricing encourages people to take better care of themselves, just as car-insurance companies reward good drivers. With one-size pricing your car-insurance company must give the town drunk the same deal it gives you.
    Insane, but the health-insurance industry is playing along. Insurers say that if government forces everyone to have insurance, they will accept all customers regardless of preexisting illnesses.
    They also offered to stop charging higher premiums to sick people. They’re even giving up on gender differences.
    Sen. John Kerry huffed, “The disparity between women and men in the individual insurance market is just plain wrong, and it has to change.” The president of the industry trade group, Karen M. Ignagni, agreed that disparities “should be eliminated.”
    Give me a break.
    Women pay more than men for health insurance for good reason. Despite being healthier than men, they incur higher costs because they go to doctors more often and take more medicine. Kerry is pandering. I don’t recall him demanding that men be protected from higher life-insurance and auto-insurance premiums.
    “Community rating” hides the cost of health care. It’s as destructive as ordering fire insurance companies to charge identical premiums for wood frame and stone houses. Universal health insurance with “no discrimination” pricing will make health care costs rise even faster.
    When politicians interfere with free markets, unintended consequences harm everyone, except the companies that lobby hard enough to protect themselves.
    Is it too much to expect our rulers to understand this?

  • July 8, 2009 at 3:05 am
    David says:
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    I get you on the first paragraph. But, you lost me on paragraph #2. My brother is out of work and has been for 6 months. He has a family. He is not taking any cruises nor is he looking for a bigger house. Even with the paired down coverage through COBRA he pays monthly, it is still a ton more $ than he can afford. Sooner or later he has to go bare. He is not looking for a handout or the shallow pursuit of materials. This is no myth. It must be nice to be you and blame “they” for the ills of the world.

  • July 9, 2009 at 10:19 am
    Joe says:
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    I’m not sure that I see where you find that I’m blaming anyone for anything; I’m not. All I’m saying is that I don’t owe to your brother, or anyone else for that matter, anything. Besides, if your brother has children, they’re eligible for health care under SCHIPS.

    The fact is, the world doesn’t produce enough well to provide the health care (“HC”) that everyone wants for themselves and their families. So, to make equal the HC available to all people of a nation, HC would have to rationed by the gov’t. Rationing HC is the whole idea behind NHC. This means more HC for some who couldn’t afford what is given to them by the taxpayors (it’s not given to them by the gov’t) and less HC for the taxpayors who subsidize those you can’t afford HC or won’t buy health insurance.

    While your brother has my sympathy, the fact is that I and other taxpayers would have to give up some of our standard of health care in order for others to have HC. Where does this stop? What about diet? An unemployed person can’t afford to buy some of the healthier foods. So, do the taxpayers have to give up some of their grocery money to buy healthier food for others?

    Where does it stop?

    Let’s face it, life has different outcomes for different people. I have multiple degrees and spent a ton of time and money to earn them, including serving in the USMC to earn the GI bill benefits. People make choices in life. We can’t support the other-path-taken choices for others if things don’t work out for them.

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