Friday, December 05, 2008

Back to the 70s: Socialism and You

Americans may be in for some unpleasant changes. President-elect Barack Obama,[1] Senator Max Baucus (D-MT),[2] and former Senator Thomas Daschle (D-SD)--Obama's choice for secretary of the U.S. Department of Health and Human Services (HHS)[3]--have outlined policy proposals that, if enacted, would negatively impact private health care for millions of Americans. Private health plans and medical practice might continue to formally exist, but many crucial health care decisions would be made in Washington. All three politicians have advocated the creation of a new public agency--variously described as an institute, board, or council--that would make key recommendations regarding the kinds of medical technologies, treatments, drugs, and procedures that would be officially deemed "effective." To the extent that these recommendations were imposed as a condition for reimbursement, they would constitute an unprecedented level of government regulation and control over the delivery of health care...How a Federal Health Board Will Cancel Private Coverage and Care, Robert Moffit, Ph.D, The Heritage Foundation, 12/4/08

As Dr. Moffit makes clear, this is an evolved version of the 1993 Clinton health plan, decisively rejected by a Democrat controlled Congress. It is based on the British National Institute for Health and Clinical Excellence (called NICE -- silent 'H' -- in Britain). In it, a politically appointed board would, through its members and their staffs, determine whether or not any treatment was "effective." In Britain, this is done solely on a cost basis. If an effective treatment is more expensive than the guideline, you don't get it. Why do you think so many passengers to JFK Airport are Brits too sick to be treated in their own country? And of course, this health board would be unelected, i.e., answerable to the political persuasions of those making appointments to the board.

When evaluating the "fairness" of any national health insurance exchange, a key issue is whether the government's rules--particularly for benefits, financing, and solvency--apply equally to the government plan and the private plans that are supposed to compete with it. If they do not, the proposed "competition," presumably with the government plan having special advantages, is a meaningless charade. If the rules are the same for all plans, then logically there is no point to having a government health plan at all. In any event, the right of an individual to make a personal choice, based on their determination of what package of benefits would be best for them, would simply be out of the question in such an arrangement...Despite official rhetoric to the contrary, genuine market competition is not envisioned in any of these proposals. Indisputably, the professional literature shows that the expansion of government health coverage (Medicaid and SCHIP), a key element of the Obama health plan, "crowds out" existing private health options.((How a Federal Health Board...cont'd)

So, change in this instance has a direct meaning: you're too stupid to make your own choice; we'll do it for you. But, it also encompasses the usual artful avoidance of responsibility, so important to re-election campaigns. Remember the 70s watch word list. Cynicism was one:

"Most members of Congress would be glad to be rid of their responsibility for controversial health policy decisions...", (How a Federal Health Board...cont'd), quote from former Senator Tom Daschl (D., SD).

No kidding. First, Representatives and Senators can howl in their political announcements, circulars and TV ads that they've brought medical care to the people. Then, they can make more announcements, circulars and TV ads that they're not responsible for the Federal Health Board refusing to allow heart surgery in people over 60 (already true in France -- remember the 70,000 old folks who were allowed to die in French nursing homes in the 2005 heatwave? A fine example of socialism at work!).

Here's another from the Back to the 70s list: Surrender. Will you?


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