Wednesday, July 22, 2009

The Voice of Experience

Gimmie Five!!


In his new book, Liberty and Tyranny, the Great One, Mark Levin sites as an example of the heartlessness of government-run health care the plight of Barbara Wagner, a women from Oregon diagnosed with lung cancer (see pages 109-110) who was denied medical coverage for this illness by the state health plan but informed that the state of Oregon would pay for the drugs necessary for her to kill herself.   For you conservatives out there who desire a more detailed account of this women's story, here's a link to an ABC News story.  For you liberals out there I recommend you go to the Daily Kos website to learn what you're supposed to think.


Before I get to the main point of this post notice how Comrade Susan Donaldson James of ABC News sometimes leaves the impression that Ms. Wagner was covered by private insurance instead of the government plan.  At the very beginning of the story, Comrade James says,


The news from Barbara Wagner's doctor was bad, but the rejection letter from her insurance company was crushing.  


And then in short order she reiterates: 


Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.


In the next paragraph she mentions the name of the government-run health care plan without clearly stating that it's a government plan.


What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.


Finally eight paragraphs later, she indentifies the Oregon Health Plan as "state-run".  Now I'm sure that Comrade James knows her business and she's aware that not everybody reads the whole article.  In fact I'd probably bet a fair number of people probably only read the first few paragraphs and came away thinking that some ruthless insurance company had once again screwed somebody out of the care they thought they would receive for their premiums. 


And who's kidding who anyway?  Nobody refers to a government agency as a company.  Do you go the Motor Vehicle Company to get your license mug shot or run to the Police Company after some wacko that a liberal judge freed robs your house?  Of course not.  Comrade James is carefully manipulating language to deceive her readers.  I don't what to belabor this point but you'll note that further into the article Comrade James drudges up condemnations of private insurance practices without bothering to find similar examples, such as this very one, of government abuses.


What I find so interesting in this story is the "Five Year, Five Percent" rule that the government plan uses and more generally, how this plan operates.   As King Hussein Obama the First tries to ram government-run healthcare down are throats, his minions might look to the Oregon Health Plan as an example to emulate.  And as you'll see, the government's interest doesn't necessarily coincide with yours.


The Oregon Health Plan started out like most liberal ideas, with a worthy goal but with no way to pay for it.   (See Section 1 Program History starting on Page 21 of the pdf)  Note how over the years, more and more people are added to the program.  First only those below the federal poverty level were covered.  Then in 1995, the disabled, elderly, and children were added.  Drug addicts and mental patients joined in 1997.  In 1998 two more groups got on the gravy train.  Not only did pregnant women and children with incomes up to 170% of the federal poverty level join but illegal aliens "Citizen/Alien-Waived" who needed emergency medical treatment got coverage.


2003 was the big year.  Coverage was significant expanded "if funds were available in

the State's budget."  Included in this expansion were Medicaid eligible citizens, children, and pregnant women up to 185% of the federal poverty level.  In addition, the State offers its own insurance for the uninsured that don't qualify for the program for which they pay a premium, referred to as OHP Standard.   Governments selling health insurance, sound familiar House Democrats?


I've included this lengthy history as an example of what will probably happen under Obama care.  No matter what promises are made to the Blue Dog Democrats today about limiting the program and paying for it in a responsible manner, in the future, the politicians will come back and gradually expand the program and shoot the funding to hell.


As we're seeing with California, states don't live in the money-printing fantasy world that the federal government does so Oregon was faced with the challenge of how to pay for this service.  Their solution was to limit care by creating a priority list of services.  Let me repeat that, Oregon controlled costs by limiting services.  And as governments always do, they created a separate bureaucracy, the Oregon Health Services Commission, to draw up the list of services and the state then determines how many of these services they can cover. 


So for example, is a link to the current list, which contains 680 ranked services.  If you refer back to the previous link that we obtained the program history from, you'll find on page 14 of the pdf a chart showing how many services the state has covered since the list was first created in 1994.  Currently the Oregon Health Plan pays for the first 503 services on the list.  Note how in prior years the state paid as many of 606 services on the list in use at that time.


And this need to live within a budget is also the reason for the "Five Percent, Five Year" rule.  On page 97 of the pdf listing the current ranked services is the following from the Statement on Intent on Comfort/Palliative Care:


It is the intent of the Commission to not cover diagnostic or curative care for the primary illness or care focused on active treatment of the primary illness which are intended to prolong life or alter disease progression for patients with <5% expected 5 year survival.


There it is in cold, hard print.  And since Ms. Wagner did not have greater than a 5% chance to live 5 years it was not the intent of the Commission to provide her care.  Instead she was eligible for Comfort/Palliative Care, which includes:


Services under ORS 127.800-127.897 (Oregon Death with Dignity Act), to include but not be limited to the attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.


It doesn't take a lot of imagination to see Obama care adopting a similar approach.  And I'm sure some of you are saying so what?  Maybe we should be looking more closely at the costs of providing care versus the benefit received.  Take Ms. Wagner's case for example.  Despite receiving the drugs her doctor recommended for free from the pharmaceutical company that the Oregon Health Plan refused to pay, Ms. Wagner died anyway within nine months of her denial of coverage.   Economically, one could argue that denying her treatment was the rational decision. 


What people who believe this argument are forgetting is that in a free market, consumers are at liberty to choose the level of care they want.  For some, they would prefer a lower premium and hence a lower level of coverage, gambling in essence that they wouldn't be in the same position as Ms. Wagner, who after all contributed to her problems by smoking for years.  Others, who like Ms.. Wagner, that engaged in risky behaviors and/or who preferred a higher level of insurance, could pay a higher premium.  And ultimately the insurance companies have to offer a certain level of care or they will go out of business because nobody will want their insurance.  The effect of all these factors is that the market offers a variety of services, providing at least some minimum level of care, which consumers are free to choose based on their own needs, desires, and ability to pay.


Under Obama care however all leverage of the consumer is lost.  If you don't like it, you can't pay for different insurance or find another job with better insurance benefits.  You'll be screwed because there is no other insurance.  If you need service 504 and Obama is only covering up to 503 on the priority list, I guess you out of luck for that year.  And as you might expect, this monopoly power also allows the government-run plan to treat the citizens like crap.


First of all, it's an outrage to send a potentially terminally ill person a cold impersonal letter letting them know that if they'd like to kill themselves the State of Oregon is willing to pay for it.  Oregon Health Plan spokesman James Sellers says that from now on the plan will call these types of patients instead of just sending the letter.  I'm sure that will be a big improvement.  A bored bureaucrat who's only thinking about their next smoke break calls you to let you know if you feel like killing yourself, it's a covered service.  I'm sure the Oregon Health Plan will get a lot of thank you letters from the next of kin.


More telling is the attitude of the administration of this government run plan.  Listen to Dr. Jeanene Smith, administrator for the Office for Oregon's Health Policy and Research staff; explain the priority list of services:


It's challenging because health care is very expensive, but that's not the real essence of our priority list…We need evidence to say it is a good use of taxpayer's dollars


Somehow I can hear Citizen Gibbs giving the exact same answer when some reporter points out the fate of some unfortunate victim of Obama care.






1 comment:

  1. Lets not forget about The infamous Medicare Prescription Drug, Improvement, and Modernization Act, which prohibits the government from using its bargaining power to negotiate for lower drug prices. How could we ever forget that good old health care reform bill passed by the great defender George Bush. I would say all leverage of the consumer was lost far before Barry got his hands on healthcare.