Saturday, September 26, 2009

Compost: Sudden Death

Tell me more about these... death panels:

That's a pretty good Keith Morrison. I'm surprised SNL would even reference 'Death Panels' in an Obama skit, lest they attach the concept to Obama in anyway. I would guess they think Americans believe the idea of death panels is so preposterous that it's inherently humorous.

It would be preposterous if there were five people sitting on a panel making a call on whether a patient would receive the treatment necessary or die. I don't know if that' what Palin envisions when she started using the phrase "death panels," but it's not that blatant. It's not exactly subtle either.

C/o Ace of Spades, this editorial highlights one way in which Obamacare will force patients, doctors and administrators (of hopsitals, insurance companies, and government oversight panels) to make life or death treatment decisions in cases where full treatment used to be the standard.

Yes, there are death panels. Its members won't even know whose deaths they are causing. But under the health care bill sponsored by Senate Finance Committee Chairman Max Baucus, Montana Democrat, death panels will indeed exist - oh so cleverly disguised as accountants.

The offending provision is on Pages 80-81 of the unamended Baucus bill, hidden amid a lot of similar legislative mumbo-jumbo about Medicare payments to doctors. The key sentence: "Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician's resource use is at or above the 90th percentile of national utilization." Translated into plain English, it means that in any year in which a particular doctor's average per-patient Medicare costs are in the top 10 percent in the nation, the feds will cut the doctor's payments by 5 percent.

So, no, there will not be a group of bureaucrats gathered in a windowless room deciding whether a patient gets treatment or not. However there are three ways in which Obamacare will, as the Wash Times puts it, institute "death panels by proxy."

First, Medicare payments to doctors, which are already not to the full cost of treatment, will be reduced if a doctor does everything he can to successfully treat a patient. Every year, doctors will try to push down costs by under-treating patients in order to avoid landing in the 10% of doctors who will have their Medicare payments docked by 5%.

It's not just elderly people who will suffer under this formula, although they will certainly see the availability of treatment reduced. This will undoubtedly hurt low-income urban patients who rely on Medicare and Medicaid. Doctors working in urban clinics or hospitals, where the volume of patients is naturally higher, will be forced to stop seeing patients or to drastically reduce the available level of care to avoid being in the top ten percent. (That and/or the government will set a minimum/maximum number of doctors for geographic regions, whereby doctors will be forced to practice in areas where there is a deficit of doctors).

Second, a government panel will decide the minimum and maximum levels of coverage that ALL insurance policies can provide. There is a minimum so all insurance plans will be watered down in order to limit treatment and drag down costs. There's no magic savings, just a lower standard of care. There is a maximum so the government can tax people over the max coverage in order to subsidize a) the reduced Medicare and Medicaid programs, b) those receiving insurance through a public option (if there is one), and c) lower- to mid-level income people receiving private insurance (with government subsidy).

Third, a government panel will decide which procedures and treatment will be covered by the public option (if there is one) and by Medicare and Medicaid. This will result in savings, but again, only by reducing the standard of care and lowering the level of treatment currently available through public and private insurance.

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