Liberal
hypocrisy knows no bounds. Sen. Teddy Kennedy and pals threatened to
add "patients rights" amendments, so people can sue their health maintenance
organization, to every bill trying to get through Congress before adjournment--as
an absolutely vital reform, and have now rebuffed the GOP half-loaf.
Yet, Hillary-Care would have forced everyone into government-run HMOs--and,
of course, you cannot sue the government! How do they get away with
it?
They do because scaring people about their health works, and the journalism
schools all teach the liberal myth that big daddy government will kiss
the boo-boo and make it all right. In fact, it is the government that
created the health insurance crisis (and HMOs) and makes it so difficult
to fix. During World War II price controls, when salaries could not
be increased, employers petitioned to exempt health benefits so that
they could attract better employees. So the price cops ruled that health
insurance would not count as income. One received, in effect, a 100
percent tax credit for health insurance--but only if their employer
purchased it for them. This created two classes, those with a subsidy
to purchase health insurance and those without--the self-employed, those
in businesses that could not afford insurance, and the unemployed who
often lacked coverage altogether.
Those without the subsidy demanded protection and were rewarded with
Medicaid, Medicare and the rest. But "free" care proved expensive, so
the government had to find ways to cut costs. The so-called "prospective
payment system" is a euphemism for the rates that they pay to health
providers under Federal programs. To save money just pay providers less
and, since doctors are rich, average citizens do not much care.
Some might have queasy stomachs about the Medicare rule that investigates
for "fraud" if people live too long under hospice, as a nasty way to
save money; but the real problem is that the providers are not helpless.
If the rate for visits is cut by half, they can require double the number.
Well, that is inconvenient but, perhaps, bearable. They can call for
unnecessary care--and that is more dangerous because all treatments
have some negative consequences, sometimes lethal. Or they can quit
or go out of business or just work hard enough to get by. Hospitals
are closing every day. Even HMOs are not defenseless. Cigna Corp., one
of the largest, just announced it is pulling out of major-market Medicare
plans and the other major HMOs are expected to follow. A new bill supported
by the American Medical Association would allow badgered physicians
to form labor unions. What does a surgeon with a union work-to-the-rule
attitude do for your confidence before a serious operation?
Few are more at risk than people who need nursing home care. Hospitals
are depressing enough but, at least, are for short-term confinements.
Nursing homes are for long stays, often by the very elderly and those
who will never leave. One would think that a compassionate government
would give them top priority, or close to it. But government does not
respond to need but to the amount of pressure a special interest can
generate. Old and dying people are generally not effective lobbyists.
In 1997, Congress required the Health Care Financing Administration
bureaucrats that determine such things to create a new PPS system for
skilled nursing facilities (SNF) under Medicare. Those cut rates were
to save $9.5 billion over five years. In fact, the bureaucrats will
save $12.2 billion. Wonderful.
But there is a real cost to the government playing politics with health
care, especially over time. With the graying of society, nursing homes
naturally treat increasing numbers of patients (measured in the number
of "patient days"). >From 1992 to 1996, SNF patient days approximately
doubled, from about 25,000 to 50,000. Yet, after the new law, and against
all projections, the number of days patients spent in these nursing
facilities declined two percent. Behind the numbers were real people
who did not receive treatment because nursing homes are not going to
treat patients if they are losing money. Real people suffer from such
government decisions.
The Feds have distorted the whole health care system for a half century.
Their price control scheme is now disintegrating, just like the Wall:
hospitals, hospices, nursing homes and doctors are all defying the control
mechanisms. "Patients rights" only hasten the collapse. Give everyone
a 100 percent health tax credit--refundable for the poor--to spend as
they do for auto or fire or life insurance and get the government out
of deciding who gets what health care at what price. Individuals and
families certainly care more than government or employers about their
own health. Socialism does not work for ill people any better than for
Russians.
Donald
Devine, former director Of the U.S. Office of Personnel Management,
is a columnist and a Washington-based policy consultant and a Vice Chairman
for the American Conservative Union.
