Sunday, December 16, 2007

We Must STOP Single-Payer Health Care in Delaware (or else) (Part 3)


Time to take a serious look at the devils hidden in the details of the Single Payer Delaware Health Security Act Information that I’ve been talking about during the first two parts.

According to this document and SB 177, the ultimate authority established to control this system will be the Health Security Authority, composed of a

15-member ruling board will be selected from the following sources: five from elected state officials via two from the House committee concerned with health care, two from the Senate committee concerned with health care and the Secretary of Health and Human Services representing the Governor's office; five representatives from different Delaware organizations representing health care professionals; and five members from Delaware consumer organizations that have endorsed single payer health care system reform at least five years prior to passage of our Act.


So what we’re going to do is turn over health care in Delaware to five politicians, five representatives of health care professionals’ organizations (unnamed; will acupuncturists get a seat? What about chiropractors?), and—I like this one best of all: five members of consumer lobbying groups that have already gone on record during the past five years as endorsing this act.

Let’s unpack that last one. If your organization DIDN’T endorse single-payer health care and it passes, your organization is FOREVER BANNED from sitting on the Health Security Authority “ruling board.” No loyal opposition here, huh? No free exercise of dissenting opinions, either.

The message to any Delaware organization is that the sponsors of this legislation have made endorsement of this—and only this—bill a prerequisite for further participation in the decision-making process.

For this sentence alone we ought to vote out of office any legislator who supports this bill.

I know, I know—the advocates will tell us that they have to be sure that the dreaded insurance companies don’t set up fake consumer organizations in order to get in and torpedo the work of the angels.

Whether you are a Libertarian or not, folks, this is fascism and authoritarian government—plain and simple.

As if it wasn’t enough that only toadies can sit on the state-wide board, the same restrictions are placed on the County Advisory Councils:


Council membership will be from the same three sources and in the same number of members as membership on the ruling state Authority. These County Councils will be grass roots individual and organization interactive operations involved in all aspects of county/state planning, implementation and evaluation in carrying out the requirements of our Delaware Health Security Act. State and national single payer leaders who critiqued our Act before its final composition highly praised the provision of these grass roots involved County Advisory Councils.


So all in all, let’s see, we will have a total of 60 people (plus the Executive Director they hire) making all the health-care decisions for Delaware:

Twenty politicians (find me 20 honest, competent DE politicians in either party)
Twenty representatives of health care professional associations
Twenty toadies from consumer organizations that endorsed this bill within five years

Oh, and before we forget about it, the politicians will include twelve members of the General Assembly who have never mustered the political courage to vote for open government, so we can be sure we’ll get accountability and transparency out of them.

Right.

I almost don’t have to go into the details of this travesty, but since—as an IQ test—I don’t have great confidence in my elected representatives to think this through for themselves, I’d better.

Start with the real laugher, first.


Each year the Act's Health Security Authority will negotiate with organizations representing all health care providers to set prices for every health care service.


Did you ever stop to think exactly how many services this entails, especially when you simply list the categories that this nanny-state program intends to cover:


All services of physicians, including specialists; dental care; hospital services; all types of long-term care; laboratory services; all pharmaceutical drugs, all mental health services; professional services of psychologists, social workers, nurses and all therapy specialists, treatment of AIDS patients, treatment of all addictions, including nicotine, alcohol, controlled substances, eating disorders and gambling: all special health care equipment and aids such as wheel chairs, special beds, hearing aids and eye glasses, comprehensive services for disabled citizens, special services such as ambulance services, equal quality services for citizens in special facilities such as special health needs hospitals/facilities, and juvenile and adult correctional facilities, and promoting preventive health programs such as nutrition, exercise and weight reduction;



The advocates of this plan and their national allies will, no doubt, show up the first day with proposed lists of services and prices, which will overwhelm everybody with its apparent comprehensive nature. So let’s think this through before they get there.

The HSA will “negotiate with organizations representing all health care providers to set prices for every health care service.” Really? And who will these organizations be?

Might some of them be the very professional organizations that hold one-third of the places on the governing board? How convenient. And you believe that they’ll advocate for low prices, right?

In point of fact there exists NO SUCH BODY as an organization within the state empowered to negotiate on behalf of all health care providers. This is a straight-out piece of political fiction designed to make you think there is some sort of transparent, accountable, or democratic process involved.

Even if there was such a body, and even if the process (ha ha ha) was on the up and up, let’s take a look at just a few of the problems.

The HSA will set all the prices for every long-term care facility in Delaware? On what basis? If you have ever shopped for nursing home care for a loved one, you know that the range of facilities here runs the gamut from those with great programs, good food, caring staff, and real doctors to those I would not let Osama bin Ladin’s drooling granny set foot in.

Surprise, surprise, there is a cost relationship to purchasing quality long-term care. But pass this act and class acts like Manor Care or Windsor Place will be forced to scale back to whatever minimum standard the state sets. Everybody will get long-term care all right—shitty long term care.

Nor can this plan generate the beds to meet the demand once everyone has the RIGHT to long-term care, especially since that sound you hear will be the corporations that own nursing homes selling them off to any bidder. Eventually, the state may well find itself having to go into the nursing home business, and for that we have the Delaware Psychiatric Center as an indicator of how well that will all work out.

Dental care? Sounds good, doesn’t it? I currently have a 26 year-old daughter with no dental insurance (who works at a nursing home, how’s that for irony?), and let me tell you we’ve paid some pretty steep bills to keep her mouth healthy.

What I wonder is what dental services will be covered by this plan. People who have ugly but functional teeth sometimes go through the month-long process to replace the front of their incisors with porcelain laminates. This is a purely cosmetic procedure that currently costs (when done by a competent dentist) in the neighborhood of $5-6,000.

Will out single-payer plan pay for that? The legislation says “all services,” but this is plainly impossible if everybody in the state with unpretty teeth wants dental laminates.

Or will we tell my dentist that he can only charge $2,000 for the procedure, at which point if he’s competent he packs up and moves to someplace in the United States that still practices free enterprise.

That opens up the question of all “elective” services and whether or not this plan intends to cover them or ration them.

Think about the list:

Breast reduction or augmentation (necessary for deep-seated psychological reasons, perhaps?)

Botox

Elective plastic surgery

Stomach stapling

In-vitro fertilization

Sex change operations

Voluntary mastectomies by those with a family history of breast cancer

There are actually HUNDREDS of medical services that could go on such a list. Will the state pay for all of them or none of them? Will you have a co-pay or a surcharge (think a luxury tax for big boobs) or go out of state and spend your own money?

Will it even be legal within the state of Delaware for physicians and other health care professionals to accept direct cash payments from those who can afford it?

Am I fear-mongering? Hardly. These are real questions. Take in-vitro fertilization as just one example.

At bare bones (using the man’s semen and the woman’s eggs) the process is costly: $12-18,000 a shot, with only about a 33% chance of succeeding. Most couples who have been fortunate enough to have children via this route have undergone the process at least three and sometimes five times.

Now add in the situation wherein the doctor tells you that the woman’s eggs are no good and you require a donor egg. Donor eggs can run from $5-15,000.

Currently, most insurance programs only pay a very limited benefit for such. Even dual-state-employee families are capped at $30,000 lifetime for IVF. What this means is that the people who really WANT to go through this process now MUST COME UP WITH THE MONEY THEMSELVES.

Enter the Brave New World of single-payer health.

Either we let those couples rack up three, five, or eight IVF attempts until they just get tired and quit (at state expense), OR

We mandate a limit on the number of times they can try (rationing of services), OR

We don’t cover the practice at all.

One other note: Delaware is fortunate enough to have within the state one of five reproductive endocrinologists IN THE WORLD who is capable of sonic drilling and culturing immature eggs in vitro. Who on you little board dominated by politicians and toadies gets to tell this individual what those services are worth?

And all of these decisions are in the hands of an HSA board which, strangely enough, has no provision for the appeal of its decisions built into SB 177 (damn, must have been a typo).

While we’re at it, let’s visit another area of concern in Delaware: cancer treatments. There is already a national controversy over how Medicare treats (and dictates to) oncologists in a fashion that threatens their ability to provide the best possible care. In many situations the appropriate treatment regime is intravenous medications infused in the doctor’s office. There are a variety of reasons why this works better in terms of outcomes, including close monitoring by a staff that really knows your case, patient comfort, etc, etc.

But since Medicare began drastically reducing the fees allowed to oncologists for this service a few years ago, the oncologists starting adding surcharges to such treatments in order to simply recoup the operating expenses of their offices. Now, Medicare cost containment strategies are targeting not only these charges but the very existence of this form of treatment, as you can read in that obvious shil for the insurance industry, The Journal of the National Cancer Institute.

Or maybe we should visit that well-known conservative think-tank, The New York Times to discover that, citing cost/benefit analysis Medicare is questioning whether or not the elderly should receive lung transplants, even when medically recommended.

There are just too many issues to consider here to keep you reading (I will devote a separate post to the inevitable waiting lists and rationing of services), but let’s close with two consequences of a single-payer plan that its advocates would prefer I did not mention:

First, this new plan will cause any number of the cutting edge, top-flight health care professionals to leave our state. Delaware excels for such a small state in certain areas, including but not limited to: reproductive endocrinology, oncology, and high-risk neo-natal care.

On the other hand, our treatment of spine-related problems in this state really sucks. Anybody who has back problems will tell you that for first-rate care you have to head for Hopkins, Temple, Penn, Jefferson, etc., because the average level of treatment here is so bad. (Somebody had to get all the guys who got a “C” in their classes.)

In the absence of a major medical research university hospital like Temple or Penn, how in the hell do we expect to hold the top-flight specialists we have, or to recruit new ones?

Answer: we can’t. There will always be physicians willing to work under these conditions, but they won’t be the ones you’d want to hold a knife near your spine.

Secondly, passage of this plan will have the unanticipated consequence of causing many middle-class mid-level managers and professionals TO CONSIDER LEAVING THE STATE.

Why? In many cases the incentive to take a particular job is not so much the salary but the health care plan. To cite only a single example, consider the position of state employees. If both spouses are employed by the State of Delaware, under “State share” rules that family gets its choice of any health care plan that the State offers FOR FREE. Moreover, they qualify for additional benefits (like that $30,000 IVF fund I mentioned earlier), and continuation of their health insurance WITHOUT COST after retirement if both spouses manage to make it to at least 25 years.

You don’t want to stop and think about how many people in our state government (including all our teachers) have long accepted the substandard wages the State pays because of this benefit. Now, with single-payer, wipe it away and watch people start to check the want-ads and spend their lunch hours with Monster.com.

I want to go back to the end of this advocacy document and reiterate the ad hominem attack against anybody who would oppose single-payer health insurance in Delaware:

The core motive of these dishonest special interest propagandists, their hordes of lobbyists, aligned political allies and other "go-along-to-get" parasites is to scare the bejabbers out of us into believing some government bureaucrat will dictate how you or a family member will receive health care services. Factual reality is that our Act will totally free physicians and all health care providers to make all health care decisions now sometimes superimposed on providers by bottom line protecting insurance company broker staff. Our Act will also free covered citizens to make all decisions related to choosing their health care providers.


I do not question the motives of those who believe that the necessity of covering the 105,000 people in this state who have no health insurance requires a single-payer plan. I believe they are well-intentioned if badly mistaken.

Yet this rhetoric gives you not only an example of fascist anti-intellectualism and authoritarian statism at its worst, but also fully illustrates the almost unbounded power of human self-delusion.

Write your legislators. Call them. Send them these posts.

Or get ready to watch our health care system disintegrate while your grandfather waits for a bureaucrat to decide if he gets a lung transplant.

4 comments:

Nancy Willing said...

I am going to post on this exciting rebuttal process!! yeah!
ASAP anyway...As Kilroy excells with the intricacies of education, you have a nitch here but I am not easily able to absorb it all.

Your blue on black is difficult to read with the print so small and especially when the print is italicized, just to let you know.

Steve Newton said...

Thanks for the readability feedback, Nancy. I think you started reading right when I was playing with templates. Hopefully that's fixed now.

Anonymous said...

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Shirley Vandever said...

I am totally digging the new "look".

I am with Nancy in that I am having a problem all the issues surrounding single-payer health care. You and Dana Garrett did a great service in discussing it, but I am afraid I also either don't have the time or the mental fortitude to absorb it all.

Let me ask a question just as a regular person. I will be 54 years old in January. I have always had a job and healthcare (though rarely used). I will probably be layed of from my job in March of 2008.

What are my options under the present system? How are they different from a single-payer systerm?

Or am I screwed either way?