August 5, 2010

Let me introduce you to Dr. Donald Berwick.  He has been in the news because Barack Obama circumvented the Senate confirmation process and granted a recess appointment to Dr Berwick, who is now the director of the Centers for Medicare and Medicaid Services (CMS).  This federal agency runs Medicare and Medicaid; the same federal agencies that are slated to oversee the government run health care system.

Dr. Berwick is a professor at the Harvard Medical School and the President and CEO of the think tank, Institute for Healthcare Improvement (IHI).  He has openly expressed his disdain for free-market health care and opening expressed his support for Great Britain’s health care system. He is an advocate of health-care rationing and supports using the health-care system as a vehicle to redistribute wealth.

In April 2010, Obama sent Berwick’s name to the Senate for confirmation and it was assigned to the Senate Finance Committee for scheduling and approval.  The Senate Finance Committee is chaired by Sen. Max Baucus (D- MT), who had worked with the Obama Administration to develop the national health care program.  The directorship of the CMS normally requires a Senate confirmation, which Sen. Baucus had not yet scheduled when Obama made Berwick  a “recess appointment” on July 7, 2010.  It should be noted that every president uses recess appointments. But by a wide margin, the overwhelming majority of recess appointments come after hearings have been held and a nominee thoroughly vetted.  But, this was not the case with Berwick.

In May 2010, Dr Berwick was quoted in the Health Care News as saying; “You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker and that any health care funding plan that is just, equitable, civilized and humane must, MUST redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is, by definition, redistributional.” 

Berwick advocates cutting health costs by adopting some of the approaches of Great Britain’s National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS, as guidance for local authorities to decide what to cover.  Conservative American critics claimed in the June 4, 2010 issue of The Weekly Standard that, “NICE decides which healthcare people will get and which they won’t.”  Philip Klein in The American Spectator dubbed him “Obama’s Rationing Man.”  The chairman of NICE refuted these statements.  On May 14, 2010 in the Boston Globe, Sen. John Kerry (D- MA) defended Dr. Berwick against “phony assertions” and accused Republicans of using an “attack machine [to] make his nomination a distorted referendum on reform.”  

All of this debate over this “recess appointment” makes it very clear that the White House knew that Berwick may not survive the Senate confirmation hearings, which would have turned into a debate over health care reform.  White House Communications Director Dan Pfeiffer wrote on the White House blog; “There is no time to waste with Washington game playing.”

Senate Minority Leader Mitch McConnell (R-KY) and other Republicans contend that the White House wants to muzzle any debate over Berwick’s views. McConnell said in a statement that, “As if shoving a trillion dollar government takeover of health care down the throat of a disapproving American public wasn’t enough, apparently the Obama Administration intends to arrogantly circumvent the American people yet again by recess appointing one of the most prominent advocates of rationed health care to implement their national plan.  Democrats haven’t scheduled so much as a committee hearing for Donald Berwick, but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their healthcare is evidently reason enough for this Administration to sneak him through without public scrutiny.”

The reality of all of this is that, much like Obama, Berwick has little management experience and is about to head an agency that has more funds to “redistribute” then all but the top 15 economies in the world!  This “recess appointment” is a demonstration of this administrations unwillingness to have any debate about Berwick’s views as it pertains to health care.  It is a disgrace that thanks to the White House’s decision, the people of this country will not get the answers they deserve.  Where is the transparency in government that was promised…What happened to “No Back Room” deals? Remember, Berwick’s position as the head of the CMS gives him the ability to apply his views on Obamacare with reckless abandon.  He will not have to answer one question before he takes over a position where his socialistic and radical views will impact each and every American.

In brief:

Those who cite the WHO rankings typically present them as an objective measure of the relative performance of national health care systems. They are not. The WHO rankings depend crucially on a number of underlying assumptions— some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares.

The analysts behind the WHO rankings express the hope that their framework “will lay the basis for a shift from ideological discourse on health policy to a more empirical one.” Yet the WHO rankings themselves have a strong ideological component. They include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance. Even setting those concerns aside, the rankings are still highly sensitive to both measurement error and assumptions about the relative importance of the components. And finally, the WHO rankings reflect implicit value judgments and lifestyle preferences that differ among individuals and across countries.

WHOm Are They Kidding?

Original Cato policy paper on the WHO World Health Report 2000:

WHO’s Fooling Who?

I have recently attended two health care forums, both dominated by concerns over “ObamaCare” and the damage to our healthcare system should the government ever take control. When the discussion turned to what is really needed to improve our health care and reign in costs that increase premiums, there was a common theme at both events: the need to reform medical malpractice.

Medical malpractice law suits have had a devastating impact on the practice of medicine in Pennsylvania. Thanks to jury verdicts, expensive settlements to avoid trials, and increasing premiums for malpractice insurance, high risk specialists are in short supply across the state. Medical students educated in Pennsylvania schools leave to practice in other states with more reasonable liability systems. Obstetric units at hospitals have closed all across our region, and trauma care has suffered.

The expensive malpractice premiums paid by our doctors add to their overhead and the cost of their services. The fear of being sued causes doctors to practice “defensive medicine”, ordering more tests and procedures than might be necessary out of fear of being second-guessed by a trial lawyer should something go wrong. This drives up the utilization of medical services and virtually everyone is in agreement that such utilization is a major cost driver in our health care system.

Earlier in this decade, we in Pennsylvania had the opportunity to address and resolve this issue. Instead, legislative leaders literally snatched defeat from the jaws of victory. The high water mark of medical malpractice reform came with House passage of my amendment which was a complete package of medical malpractice solutions. My amendment allowed for a system to limit, or cap, so called non-economic damages (“pain and suffering”), reformed “joint and several” liability to prevent those with deep pockets but no liability from being sued, kept our county doctors out of the lottery-like Philadelphia court system as well as providing reforms to the way in which malpractice awards were paid out. It had all of the necessary ingredients to solve the problem once and for all.

What happened? The bill went to the Senate where it was eviscerated. When it came back to the House it was so watered down that it was no longer recognizable as the bold effort contained in the amendment. The only meaningful provision to survive was the limitation on “venue” to keep suburban doctors out of the Philadelphia court system.

Later we made a second attempt at capping malpractice damages.  This took the form of a constitutional amendment.  When it became obvious that House leadership was going to allow this effort to die, I took the extraordinary step of filing and bringing a discharge petition to the floor. This was a direct challenge to my own House Republican Leadership as I was bound and determined to bring caps on damages to a vote.  I did get the discharge resolution to the floor but we fell about 7 votes short of the numbers needed to pass it.

The current debate on health care makes it clear to me that we need to revive this effort to bring limits and common sense to our malpractice system and litigation in general.  Yet it seems no one in Washington is championing this reform that would help lower healthcare costs. It is time the President and Congress drop their single-payer, public option, government controlled, nationalized healthcare fantasies and take the steps necessary to reform our current system while maintaining the best aspects of our health care.

Medical malpractice reform is a good place to start. Providing competition among insurers by allowing the purchasing of insurance across state lines would also help. Greater transparency in pricing for services would allow the consumer to make informed health care decisions. Expanding the use of consumer driven healthcare through Health Savings Accounts (HSAs) will allow individuals to make cost/benefit decisions for their own healthcare as opposed to rationing by federal bureaucrats.

There are plenty of good ideas to reform our healthcare and promote affordability and access for everyone without government control.  Once we defeat “ObamaCare” perhaps these good ideas will be taken seriously. 

Curt Schroder is in his eighth term representing the 155th District of Pennsylvania. He is currently running for US Congress in the 6th District of Pennsylvania. More information can be found at www.vote4curt.com

Under Obama’s proposed health care plan, the government, not the individual or the insurance industry, will take over the role of defining our health care benefits. House Bill 3200, Section 123 defines a Health Care Advisory Committee of 27 persons, 18 directly appointed and 9 indirectly appointed by Obama. This committee will define the structure of our benefit plans, and believe it or not, only one of these 27 individuals needs to be a physician or health care professional! Our healthcare benefit plans will be defined by special interests, hand-picked by a President who is on record declaring his desire to develop a single-payor system within a ten or twenty year period. We have already seen the beginnings of a movement toward social engineering via proposed “sin-taxes” on sugary drinks, tobacco, and alcohol. What’s next? A tax on sleeping fewer than 8 hours a night, not riding your bike 5 miles a day, or eating pizza on Friday?
The Obama administration believes every individual is entitled to health care, and as of this writing approximately, 43% of Americans believe it is time to act on healthcare.* But is health care a basic human right, or is it a privilege and personal responsibility? And if it is a “right,” how much health care comes with this entitlement? Does the right to health care include all care possible to cure a condition, or only the care that is needed for pain relief? If you spend your life overeating, not exercising, and smoking, are you afforded the same care as a person who has eaten in moderation, exercised daily, and practiced healthy habits? Oh, what a tangled web we weave when we give up our individual liberties and responsibilities for the siren’s song of “health care for all.”

Are the American people really ready to take the lazy road to government-controlled health care versus maintaining personal responsibility to work, manage, and pay for our lifestyles, including financially managing the cost of our own health care decisions? We are not so unfeeling as to say that children, the disabled, and the elderly should not be cared for. But this can and should be accomplished without abandoning the free-market system.

Americans who are willing to be shepherded by big government are sure to be outraged when the seemingly caring shepherd throws off its cloak and bears the wolf’s teeth of higher taxes, increased wait times, and rationing to accommodate 45 million new patients. For those who say it is worth it to provide health care for all, I say, please step to the back of the health care line. And oh, on the way, I look forward to seeing you at the 6:15 A.M. aerobics class every Monday, Wednesday and Friday.

*Rasmussen poll

Conditioning people to a specific mindset is a major accomplishment of any movement in this country. Those who advocate that health care is something that should be provided by someone else, not purchased by the consumer, seem to have had success in pushing their views. As an employer, to remain competitive in the marketplace, I must offer a health care package to my employees. This, like all things, comes at a price, but we continue even with such costs of doing business.

Lately, I’ve been hearing that affordable health care for everyone in America is a right. One woman at a town hall meeting said it was a “right under the UN” – the United Nations. One has to wonder where she would get such an idea. I cannot understand why, in the greatest capitalist country in the world, these people do not apply free market principles to health insurance.

Why is it that people have such grand expectations from health insurance when other types of insurance policies aren’t designed to cover everything, every time? When you need an oil change in your car, do you call your auto insurance company? When you get a flat tire, do you call your auto insurance company? Some companies like AAA offer such a service, but it is usually purchased outside of your main insurer. When your timing belt breaks on your car, do you call your insurance company? Again, there are companies out there that offer aftermarket mechanical warranties, but these are not features of auto insurance policies. Should insurance cost the same for a Ferrari and a Prius? This would be laughable.

People choose different homeowners policies, based on their own needs and comfort levels. Most people in Pennsylvania don’t have earthquake insurance, because we don’t have earthquakes. Be certain, though, that if an earthquake hit our area, many people would expect someone else to pick up the tab to rebuild their home because they did not get adequate coverage. I choose to have earthquake insurance but offset it with a high deductible, which is the market’s way of assuring affordability of coverage.

We must also take into account that people have different standards of living. Some live lifestyles that afford them great health throughout their lives. Others don’t place that much emphasis on healthy living – which, for the time being, is a right as an American. Health insurance policies and premiums should reflect these choices just like your home or auto policies.
Turning our health care into a single-payer system, hence making costs “equal” for everyone, is a fantasy that defies basic principles of economics, and it will end in failure. If you disagree, just try asking your insurance agent to cover your next oil change or flat tire, and get back to me.

There have been several letters to the editor and many more comments from the elite media, mocking the health plan protesters’ use of the phrase “death squad.”  Brian Bernardini of Coatesville, in a recent letter asks the Daily Local to do a better job of fact checking on MSNBC this morning I listened as one elite after another mocked the “death squad” term and the town hall protests.

Brian, elite media – give us some credit please. We know that there is not a chapter or a page in any of the current bills titled “death squad.” But we also know that one of the president’s key advisers, Rahm Emanual’s physician brother, has talked about the need to “fact test” care options in the elderly. He believes that the money may be better spent on younger patients – or as he put it, on education or the arts.

So for those in the slow class let me elaborate – if grandma needs a new heart valve to live another eight years she may be considered a bad financial risk – that then becomes grandma’s death sentence.

Let’s look at another death squad possibility under the new plan. In the UK expensive drugs to treat women with advanced breast cancer were denied: why? Because they were too expensive for a country where socialized medicine has forced rationing. Being denied those life saving drugs is a death sentence to the women who need them. Because of all the publicity here in America and the protests in the UK, those women are now getting the drugs they need, but absent that protest and this debate – socialized medicine was their death sentence.

The other fact of life in this equation is that any plan that covers everyone, has no competition, and the only cost control is rationing care will lead many to die before treatment may be given. We have testimony and data from other socialized plans, in other countries that tell us that patients don’t get the care they need when they need it – another possible death sentence.

The other lie in Obama’s plan is that you will have a choice. That may be true for a short period of time, but make no mistake that choice will go away. As the government plan crowds out private plans they will not be able to compete financially with a taxpayer-funded public plan. Eventually they will become too expensive and employers will be forced to drop them – our only option will be the Obama plan. The president knows this full well as there is a YouTube video of him saying as much when he was a senator. There will be exceptions to this rule – Obama and all government workers will keep their generous plan and we will continue to pay for it.

And let me ask a rhetorical question: Do you think the teachers’ union or the UAW are going to give up their plans for a public plan? My guess is that they will not, so we will continue to pay for those generous plans as well.

Finally, I am amused at how outraged my liberal friends are at the very vocal town hall protests. Are your memories that short? Recently I saw liberals throw pies at Ann Coulter, force a conservative speaker at Columbia University off the stage with their taunts and wild screaming and who can forget the Vietnam protests – occupation of government buildings, bombing government buildings – riots in the streets and on college campuses.

If you are not happy with conservatives speaking out at town hall meetings, you have only to look to yourselves – you taught us well.