Nurses for Reform Blog

I have a chapter on Comparative Effectiveness in this this new publication by the Hoover Institution.  In it I discuss the problems faced by Western Europe from government led Health Technology Assessment  describing lessons learned from such institutions as NICE in the UK that has denied women with breast cancer Herceptin, people with Altzheimer’s disease Aricept and MS patients Beta Interferon to name but a few.

I suggest the following three courses of for America;

America should reject the statutory creation of any organization that seeks to centralize government control of patient access to drugs, devices, medical technologies, treatments or procedures.

Comparative Effectiveness research in healthcare and health technology assessments should be undertaken only by the private sector and not governmental bodies.

Comparative Effectiveness research should be patient-centered and supportive of quality and value, not focused simply on cost-containment.  In this respect, it should promote scientific advances, health information technology, and the emerging science of personalized medicine.

I conclude;

As is clear from the British experience and other example from Western Europe, a comparative effectiveness strategy that relies on central planing and coercion will not only be counterproductive in the long run – because it will undermine the incentives for medical innovation – but it will also lead to the imposition of cost constraints that will worsen patients’ medical conditions and damage the quality of their lives.

Now this could be a really interesting opportunity to get some meaningful and sound reform of US healthcare along much freer market lines. When recently asked if inviting Republican Party leaders to the White House meant that President Obama was going to start from scratch, he responded:

“I think that what I want to do is to look at the Republican ideas that are out there, and I want to be very specific, how do you guys want to lower costs, how do [you] guys intend to reform the insurance markets so people with pre-existing conditions for example can get health care…and if we can [go] step-by-step through a series of these issues and arrive at some agreements, then procedurally there’s no reason why we can’t do it a lot faster than the process took last year”.

In truth, US libertarians at places like the CATO Institute,  the Independent Institute and the Competitive Enterprise Institute have invested huge amounts of time, energy and resources over recent years in developing and honing free market solutions to correct the state failures of American healthcare.

What makes Obama’s statement so interesting is not just that it is an admission that Obamacare One has effectively died, but perhaps to save his and his administration’s reputation, the White House appears to be casting around for viable and practical reforms rooted in the real world and not the quasi-Marxian crack pottery we saw during this administration’s first year in office.

This is all good news in as far as there is now a chance (albeit a very slim one) that the term ‘health reform’ might just become associated with the ideas of a freer market. As I have said many times before, in America the word reform has to be rescued from meaning more of the top-down statism beloved by the political class and its friends in the big anti-competitive corporates. Today, there might just be a chance that Obama is starting to understand this. Only, time will tell.

This is a spoof film that purports to show Hitler’s support for Obamacare and the general advancement of the US state.

The problem is that for those who know their history this is all too close to the knuckle. For in Britain the architect of the National Health Service, Sir William Beveridge, told the Daily Telegraph in November 1942 that his proposals would take Britain “…half-way to Moscow”.

More significantly, after the Second World War two papers marked ‘secret’ and providing a detailed commentary on Beveridge’s plan were found in Hitler’s Berlin bunker. One ordered that publicity should be avoided but, if mentioned, the report should be used as “…obvious proof that our enemies are taking over national-socialist ideas”. The other report offered a Nazi assessment of the plan as being no ‘botch-up’. The national socialist analyst wrote that the NHS would be “…a consistent system…of remarkable simplicity…superior to the current German social insurance in almost all points”.

Designed to take Britain half way to Moscow and simultaneously admired by Hitler’s inner coterie, socialised medicine and the Fabian welfare state has a particularly unsavory heritage. It is this history that makes the above film a comedy of human tragedy and one deeply rooted in the darker recesses of coercion.

With Republican Scott Brown having won a landslide victory for the Massachusetts US Senate seat previously held by Democrat Edward Kennedy, NFR smells blood on Obamacare. Thankfully, this nightmarishly statist policy is mobilising American voters as never before. Therefore, it is ironic that while Obama’s personal ratings continue to ride high, it is his policies that Americans simply do not want. They will not accept even more government healthcare.

Beyond the government programs of Medicaid, Medicare and S-Chip (which already have a combined budget greater than that of the Pentagon), Americans are not prepared to accept a trillion dollar programme designed by ideologues who want to further stifle what little remains of a market, so that they can then claim ‘market failure’ and make subsequent calls for full blown nationalisation.

While NFR disagrees with the statist politics of most US Republicans as much as it dislikes the Democrats (both camps implicitly accept largely overlapping degrees of Conservative big-government corporatism), when it comes to the global struggle to get the state out of healthcare, Scott Brown’s victory is good news. In bloodying the nose of his opponents, NFR can only hope that Obamacare will fall to dust. If this happens, instead of more government, it will be vital that thinking Americans capture the word ‘reform’ and make it their own. This is the key challenge for the future. Reform in American healthcare must come to be progressively associated with the market not the coercive state.

Over the weekend the American Senate voted to debate the most recent version of President Obama’s healthcare bill.  Amid discussion of various Senators being bought off to support the bill with promises of increased federal funding for their States there are some very real issues here for the American people.

Many commentators point out that the cost of implementing Obamacare has been grossly underestimated and predict that rather than the promised cost of around $850 billon the final figure is more likely to be over $2.5 trillion over the first 10 years.  This money can only come from the American tax payer and I am willing to bet that if this bill is passed the estimated costs will only rise as implementation gets closer.

The Heritage Foundation in this excellent article point out what they consider to be the five main flaws of the Healthcare bill and conclude with a quote from the Dean of the Harvard medical school from an article in the Wall Street Journal:

So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.

We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.

During my recent trip to the USA I made a short film for the Heritage Foundation titled “How Government Run Healthcare Works”.  Here is the link.

This is a great analysis of the healthcare bill presented to the US Congress last week by Speaker Pelosi.  Grace-Marie Turner of the Galen Institute explains all that is wrong with it and why it breaks promises that President Obama made to the American people.

Breaking Promises

How can President Obama possibly endorse the bill that Speaker Pelosi unveiled to such great fanfare on Thursday? The House bill breaks major promises he has made to the American people about his goals for health reform. To name just a few:

Cost: The president has assured us that health reform would lower health costs. But the House bill would bend the federal cost curve UP, not down, according to the Congressional Budget Office’s preliminary analysis.

And only by using budget gimmicks were House leaders able to get the reported cost to $894 billion over 10 years, just barely under the president’s somehow magic $900 billion number. But that’s not the real cost. Robert Pear of The New York Times reports today, “By the most commonly used yardstick, the bill would cost $1.05 trillion over 10 years, roughly $150 billion more than President Obama had said he wanted to spend on the legislation.”

So the real cost will be over $1 trillion — and that doesn’t include the “Doc Fix.” The Speaker had the audacity to introduce that bill separately so the $245 billion price tag wouldn’t get counted in the total cost of the bill. Senate Majority Leader Harry Reid tried that trick last week, and went down in flames. Can the AMA possibly still stay on board with the House bill, since its deal has now been broken?

And health insurance premiums will soar, especially for younger families because the insurance regulations in the House bill allow only a 2 to 1 premium variation between the youngest and healthiest policy holders and the oldest and sickest.

And this doesn’t even count the huge economic distortions, cost-shifting, and new taxes that surely will be passed along to consumers.

Middle-class taxes: The president promised no tax increases on the middle class, but they surely will be paying the lion’s share of the $500 billion in new taxes to finance the bill. Americans for Tax Reform posted a listing of the new taxes in the House bill which violate the president’s pledge.

And add to that the estimated $33 billion in taxes the CBO says will be collected from individuals who don’t buy the expensive, government-mandated health insurance.

Keeping health insurance: A coalition of major business groups late Thursday sent a letter to Speaker Pelosi and Republican Leader John Boehner saying the House bill falls short of the bipartisan goal of controlling costs and could jeopardize group health insurance provided by employers to 160 million workers.

These are people who should know because they represent the companies that provide health coverage to the majority of Americans: The American Benefits Council, Business Roundtable, Corporate Health Care Coalition, the ERISA Industry Committee, National Association of Manufacturers, National Association of Wholesaler-Distributors, National Business Group on Health, National Coalition on Benefits, National Retail Federation and U.S. Chamber of Commerce.

No savings from the public plan: CBO concludes that the government insurance option would typically charge higher premiums than private plans available in the new Health Insurance Exchange. “That surprising conclusion raises doubts about Democratic promises that a government-run insurance plan would provide a lower-cost alternative to consumers,” Politico reports. And it adds, “At the same time, it calls into question Republican charges that the plan amounts to government takeover of health insurance — because only 6 million people would enroll in the plan, according to the CBO.”

The 400,000-word House health reform bill is absolutely astonishing in the level of government intrusion it would shove into the lives of every American, every business, and every health care professional. I won’t bore you here with the legislative jargon, but pick a page, any page, and you will see what I mean. Here is a link to the bill and a much more reader-friendly section-by-section analysis. You will see that all power and control vests to the government.

Hitting small business hard: Don’t miss the new analysis by WellPoint that mined its own actuarial data to model the basics of the plan incorporated in the House bill, using data from 14 states where it runs Blue Cross plans.

In all 14, it found that the legislation would drive up premiums for small businesses and individuals. Young and healthy consumers would see the largest increases, with premiums more than tripling in some states.

The head of the National Federation of Independent Business, Dan Danner, said the huge cost of the health reform bill “will ultimately come out of small business owners’ pockets and prohibit them from growing, investing in their business and hiring new employees.”

The bill requires detailed recordkeeping on employee health insurance, imposes new taxes and new civil penalties for not complying with the barrage of new federal health insurance laws, and puts burdens on virtually every company to pay for this expensive insurance, in perpetuity. See my article, linked below, in Tuesday’s Wall Street Journal for a report on how this is (not) working in Massachusetts.

Lock out: Speaker Pelosi’s announcement of the House bill had all the trappings of a major campaign rally. The only problem was that the public was locked out. Big chain link fences surrounded the West Front of the Capitol — usually a very open, public space — to make sure only supporters of the bill were allowed in.

This is so symbolic of the whole process: The American people are being shut out of the debate. All congressional recesses have been cancelled since August to keep members away from their constituents as much as possible, doors are locked while negotiations over the bills are taking place (breaking another presidential promise of an open and public process), and now, the public was even shut out of the public space outside the Capitol for the announcement rally.

This legislation is going to have an impact on the economic and health care freedom of Americans for decades to come. It is beyond irresponsible for Congress to be on the verge of passing these bills with this kind of disregard for the will of the people.

Politico carried a full-page ad yesterday with the pictures of 36 former members of Congress defeated in the 1994 elections in the aftermath of HillaryCare. It could happen again unless members open up this process to heed the fears of their constituents about a government take-over of the health sector.

The Independent Women’s Forum conducted its own poll that found women want to make their own choices and decisions about their and their family’s health care and they do not want politicians intruding.

Patients First are a fantastic group of people that I met during my recent trip to Washington DC and New York.  They are running a “Hands off our Healthcare” campaign to warn the American people of the dangers of Obamacare.  They are proactive in making TV ads and having a tour bus that is taking speakers to many parts of the US for public meetings.

The team involved in this campaign really understand the problems that will come from more government interference in healthcare and, along with the majority of the American public, do not want to pay the higher taxes that will inevitably result from these reforms, only to have more rationed and regulated healthcare provision and funding.

There is a common belief amongst Europeans that America has no state funded healthcare.  From 2002 to 2005 when I was living and working in Brussels (the heart of EU) I can’t remember how many times I was told by people working in and around the EU institutions that in America if you don’t have private insurance you will be left to die in the streets!

This is simply not true. Since the 1960’s America has had the state funded and administered systems Medicare, Medicaid and later SCHIP.  I urge my European readers to check out these links for brief explanations of the American state funded healthcare systems.  Even before anything that Obama can add they are costing America a fortune, I was reliably informed by the man who used to run them that their budget is larger than that of the Pentagon.

If Obamacare is adopted Americans will find themselves with organisations such as NICE and with all manner of rationing as we have seen in the UK with the government deciding who it is cost effective to treat and who will be left to die.

This is an excellent website belonging to the Galen Institute, based in Washington DC.  Galen have been campaigning for market oriented reforms in healthcare for the past 15 years and their message is simple.

As their founder Grace-Marie Turner states;

The Galen Institute believes that:

• Consumers and their physicians should have authority and responsibility over health care decisions.

• The vibrant free market will encourage research and innovation and provide better access to new medical technologies.

• A market that supports innovation will lead to lower costs, expanded choice, and increased access to better medical care.

Our task now is to get the politicians to understand this before they make more mistakes with both British and American healthcare.