51 Comments

1. Jeb:

This term, quite simply, refers to the drawing-up of those cost-effectiveness spreadsheets state and federal bureaucrats use to approve or deny care prescribed for patients by their physicians.

and how is this materially different than the decision making process of an HMO?

May 21, 2009 - 11:58 pm 2. vivo:

“The “final arbiter” of medical decisions is and should be “the state,” said attorney Robert Highsmith in March 24 oral arguments — and the panel of the 11th Circuit agreed.”

Are they INSANE?

They need to distinguish between MEDICAL FRAUD and MEDICAL TREATMENT.

May 22, 2009 - 3:10 am 3. Fred Beloit:

But how is this materially different from bureaucrats being better able to make decisions regarding the law than lawyers and judges?

May 22, 2009 - 3:23 am 4. Ken Besig:

This is just the beginning. Sooner rather than later, new restrictions on the medical care to be available to individuals will be based on age, a history of substance abuse, and the ability of the person to achieve a viable and productive life. So if you are older than let’s say, 75, or smoked or drank or used illegal drugs, or are a laborer or perhaps intellectually challenged, then your access to medical care will be restricted to support measures only and no extreme, that is, expensive measures will be permitted to alleviate your illness. Just examine any European system of national health insurance to see what is in store for America sick and the Obama health insurance company.

May 22, 2009 - 4:19 am 5. Paul -Indiana:

Jeb, the similarity is a good observation. The only difference would be that the decision would be made by a high school dropout with a GED [at most].

May 22, 2009 - 5:04 am 6. Tomp:

Nationalized health care equals rationing/triage and ultimately leads to a slick way to kill off the elderly to lessen the pressure on Social Security/Medicare for a few more years. I really don’t trust government.

May 22, 2009 - 5:38 am 7. kim:

Ok, so they’re saying that it is OK for the government to let you die (basically, if they deny treatment), there is now an arrest warrant out for the mother of the teen who has decided that he would rather have alternative treaments instead of chemo the COURTS want to force him to have. (And I would say that the kid, at 13, probably understands much more than he is begin given credit for. Kids that ill, at that age, usually do.)

They say it is probably curable if he gets the chemo, but so what? The feds can say whether you live or die, but you now can’t make that choice for yourself?

Sorry, but this whole talk of Nationalized Health Care disgusts me. If Obama, Pelosi and the rest think it is so great, let THIER families be the guinea pigs. Then after the first needless death in their family, they can come back and tell us how great it all was.

I’ve heard Pelosi is going to China soon, and Obama to Russia at some point. Well, they can stay there, and take their buds with them.

May 22, 2009 - 5:53 am 8. Key Howard:

I didn’t go to Korea in the early 50’s to help build a communist satellite. “Big brother is watching you?” “Big brother is an insuduous Europhite who has hoodwinked the entire country! We’d better wake up soon or it will be too late? Where does it say that in 25 years from now there will even be …a United States of America!” Wake up America!!!!!!!!!

May 22, 2009 - 5:59 am 9. Ex Canuck now in USA:

Ten years ago, I read in Canadian dailies that certain Canadian political figures were skipping Canadian health care facilities and going directly to the Mayo Clinic in Cleveland. I figured that they knew something I didn’t about the Canadian system. So I moved here, to the USA where it is not illegal for me to purchase private health care with money I earned and saved (saved, what a concept!!!!!).

Unfortunately, the statist rubbish has followed me.

May 22, 2009 - 6:03 am 10. eyedoc:

He who pays the piper calls the tune, and Heaven help us when the federal government starts writing the checks for ALL healthcare payments. Any idiot who supports a federally- funded, single-payer system deserves to be screwed.

May 22, 2009 - 6:21 am 11. anton:

7. kim: The problem is that their families already have the “Elite” version of National Healthcare, bar no expense and unlimited availability.

They do not plan to share that version with us simple proles. We are simply draught horses to be worked until we can longer pay taxes (or more correctly, until our upkeep exceeds our tax-product) then we will be rationed to death (if not simply put to sleep).

Always remember; Some Pigs are More Equal than others!

May 22, 2009 - 6:49 am 12. Paul:

How is the state’s argument any different than a private insurer’s would be? Basically they want to exercise some discretion over what treatments they have to pay for through Medicaid.

Also whats up with this line ‘The “final arbiter” of medical decisions is and should be “the state,” said attorney Robert Highsmith in March 24 oral arguments — and the panel of the 11th Circuit agreed.’? If that’s what Highsmith said then why is the author only quoting 4 words directly?

May 22, 2009 - 7:24 am 13. AverageJoe:

The trial lawyers won’t like this ruling because it presents a perfect cover for doctors. Now all a doctor has to do is order every possible test and treatment in the book and let the state deny the ones the state doesn’t consider medically necessary. Then when the patient dies or the outcome is not good when the Dr. gets sued for malpractice he can claim “I wanted the patient to be properly treated but the state denied my requests.” Let the malpractice trial attorneys sue the state. Wonder how that will go? Hmm, something called sovereign immunity comes to mind.

May 22, 2009 - 7:41 am 14. Sherab Zangpo:

Truly scary.

And the news from England sound like a badly written horror script.

Thank you for the opportunity to comment.

May 22, 2009 - 7:48 am 15. Mike T:

Medicaid patients should be glad that they get anything. Those that don’t pay for a benefit have no right to gripe about what they get unless it hurts them even worse.

May 22, 2009 - 7:51 am 16. pH-DependentNeocon:

“and how is this materially different than the decision making process of an HMO?”–Jeb

Jeb,
We can often CHOOSE what HMO to buy into at our jobs, or if necessary CHOOSE another job, if you don’t like your options. We cannot CHOOSE to opt out of whatever federally mandated government program is in place, save moving to another country. Therein, my friend, resides the distinction you seek.

May 22, 2009 - 8:01 am 17. Skip:

He who pays the piper calls the tune.

May 22, 2009 - 9:20 am 18. David W. Lincoln:

Let doctors be doctors. This is something that is beyond acceptance by the meddling who simply are power hungry.

May 22, 2009 - 10:05 am 19. ArrghNot:

This will bring on a “black market” of health care. Non-certified doctors doing procedures in their kitchen because you can’t get it done at the hospital.

Oh and to quote #10 and #17, from the “Music Man” you have it backwards:

“When the man dances, certainly boys, what else, The Piper pays him!”

May 22, 2009 - 10:40 am 20. EdGi:

Jeff, as an SF officer myself, the idea of the gov plutocrats making calls for professionals is a horror. I see total mission failure, total team losses and massive waste of tax money in this. Why loss of tax money? Well, the states are referring to the codes used for billing by providers and the provider getting approval for any treatment not included in the diagnosis code. Disaster will result from using plutocrats focused on billing diagnosis codes to decide medical treatments because the fraudsters simply bill everything in the code, needed or not, while needed but unlisted treatments are not done resulting in serious emergencys which then cost a fortune.

May 22, 2009 - 10:43 am 21. eyedoc:

ArrgNot:
Oh and to quote #10 and #17, from the “Music Man” you have it backwards:

“When the man dances, certainly boys, what else, The Piper pays him!”

I guess it’s a good thing I wasn’t quoting the “Music Man” then. Rather, I was paraphrasing a common saying to express the idea that whoever is paying the bill has the right to decide how that money is spent.

May 22, 2009 - 11:08 am 22. Well Educated Cad:

This surprises me (as a doctor) no more than the car crashing with the blind fool driving it. “It seemed like a good idea at the time!”. Entirely predictable step toward socialism. Next step- force all doctors to accept medicaid or they are demonized. Like Russia, all government employees will still have access to better care than the commoners.

May 22, 2009 - 11:34 am 23. Praetorian:

Someone tell me the difference between a government bureaucrat making health care determinations and a private industry bean counter making health care determinations? The fact is that no matter what type of system you have there WILL be controls. My mothers doctor recently gave her a prescription to fill and when she went to the pharmacy to fill it she was informed by the pharmacist that her insurance company wanted her to try a different medication, which not surprisingly was cheaper. Moreover, it was not the same. It differed from what was prescribed in several ways. In the end she had to pay out of pocket for the medication (and will haggle with the bean counters later on). How many elderly people does this happen to? They don’t have the time or energy to fight and just accept the bean counters verdict. How many people have been murdered by the private insurance industry by these sort of practices (drug interactions, allergic, etc.)? When profit is a mechanism by which medical decisions are made you can’t be sure the decision that is made is in your best medical interest. Private health insurance companies do not care about your health. They care about profit. their only function is to take in more money in premiums than they pay out in claims. They answer to shareholders, not patients.

May 22, 2009 - 12:47 pm 24. Yaakov Watkins:

You people entirely miss the goal of the court decision. It is intended to provide full employment for trial lawyers.

May 22, 2009 - 1:31 pm 25. Oscar Wao:

Its a good thing your readership is probably too poor to afford insurance. Otherwise, they’d realize that insurance company bureaucrats are constantly making these same decisions in lieu of doctors in the private health care system.

May 22, 2009 - 1:55 pm 26. Michael:

I say that any attempt at making government the final arbiter must make that absolutly the same for all the polititians. It would just be too bad if a 85 year old Senator was refused care because it wasn’t cost effective or if the President’s son or daughter wouldn’t qualify for some drug or procedure either. Imagine the shock and horror in Washington if the polititans were held to absolutly the same standard as they dictate to others.

May 22, 2009 - 2:24 pm 27. Anonymous:

“Treating physicians … cannot be trusted with this sort of decision. When left to their own devices, they advocate for their patients”

Oh, dear. Can’t have that, can we?

As far as HMOs… I chose a PPO at work, even though the HMO would have saved me a couple hundred dollars a year. I don’t want to deal with the bureaucracy.

If the government offers the same deal… where we can continue to have private insurance and not have to pay taxes to support the national insurance we don’t use… then I wouldn’t complain. What are the chances of that happening?

May 22, 2009 - 3:16 pm 28. Rachel:

For those who argue that insurance and HMOs are making the choices, you are very much right. However, people can turn to the media and the govt (courts, Congress) when there is fault, to which you hear how these third parties are NOT the advocates of health care, that the doctors are.

HOWEVER, let DC run the insurance and the HMOs and they WILL NO longer advocate patient and doctor over insurers as THEY are the insurer. And if you hate the IRS and Most Things Beltway, what makes you think you will love US GOVT Health care? We will not get what Pelosi and Kennedy get: we will be rationed. This is definitely one place where America will be just like everyone else in the world.

And Oscar, don’t even begin to speak for us readers. You are reading the op ed of a black female lib who was without insurance from 1996-2001 and 2003-2006. But I’m not naive or in denial of what could happen. I want national health care to work and pray that I am wrong. But there are too many scenarios, including in the Sainted Health Care system of Sweden, that shows otherwise.

May 22, 2009 - 4:45 pm 29. Mary:

If the insurance company or HMO does not approve the treatment it is possible for some people to actually pay for the treatment. Medicare will not let you spend your own money. If a provider accepts medicare funds they cannot take your money one you are a medicare recipient. I just one the same plan that members of Congress have.

May 22, 2009 - 7:21 pm 30. Praetorian:

#28 Rachel said: ” I want national health care to work and pray that I am wrong. But there are too many scenarios, including in the Sainted Health Care system of Sweden, that shows otherwise.”

I think Sweden, (and Canada along with Great Britain for that matter) are poor examples of what we might expect here in the states. My understanding is that if Obama gets what he wants, and I see no reason why he won’t, our system will resemble more like what they have in Germany and France. The World Health Organization deemed the system in France as the best in the world in terms of overall patient satisfaction and cost (we spend more here per person and get far less than they do in France). We can nit pick about this and that ad nauseam but the bottom line is no system is perfect. However, we can certainly do way better than what we have now. The private insurance companies are going to take a hit and they (and their shareholders) don’t like it. Well, too bad. This is about what is right for the nation and there will be winners and losers. Hopefully, the side that wins serves the greater good and I believe it will.

May 22, 2009 - 7:58 pm 31. Dave:

But Rachel: Oscar is just looking out for you.
We Republicans consume a good deal of available medical care and since we are (by his own words)
racist white xenophobes, that obviously denies you what you as a female of color should have coming to you.

So unless you want to be condemned to back-alley tonsillectomies, be sure to hush up with your rational approach and be ever mindful of your proper station and appropriately labeled entrance to the hospital.

May 22, 2009 - 10:10 pm 32. jeaneeinabottle:

Who wants to be like Germany or France, WTF? Jeez, some people will settle for scraps. This is America for Gods sake WE do not settle! The government has zero business to take over ANY company let alone our health ins. They are lying about the 50 million not covered in this country. Most of them are the illegals! So a quarter of the country is going to dictate what the rest of us has to do? That’s crazy talk! If you think this government cares about you, or anything in this life is free, SNAP OUT OF IT! Oh there will be a price to pay for this mess. Because every person that dies, young and old will be on all the people that voted for Obama. It will be your fault that we are bankrupt and destroyed. Deal with that guilt, REAL guilt! Or we can all speak out as individuals against this progressive crap! Learn the REAL history of this country, do your own research, and demand that you can make your own decisions for yourself and by yourself. Why would you want to be a slave to the state?

May 23, 2009 - 1:10 am 33. vivo:

Again, it’s all in the hands of legislators.

May 23, 2009 - 4:53 am 34. JIMV:

I am of a mixed mind here…this is not a case of a bureaucrat telling a private citizen using private insurance what his money can buy but government saying what it will pay for. If we didn’t have this we would have taxpayers paying for sex change operations, cosmetic surgery, etc…

May 23, 2009 - 8:06 am 35. Praetorian:

jeaneeinabottle please go back in your bottle and stay there for awhile. The healthcare that the get in Germany and France is wonderful and far better than what we get here. What we get here, or should I say what the private insurance industry bean counters allow you to get, is scraps. How can we “bankrupt,” as you say, our nation with a system that spends less per person (as the do in Germany and France) while at the same time covering more people? Sounds to me like your opposition to universal healthcare is more grounded in ideological constipation or listening to too much Rush that a logical comparison between the various ways of providing care in a cost effective manner. Your opposition is hysterical and emotional, not a good approach to problem solving. Bottom line: your an idiot who doesn’t know what your talking about.

May 23, 2009 - 8:41 am 36. Well Educated Cad:

Praetorian;
My guess is that you want socialized medicine so you can continue to take your psychotropic drugs and remain in that blissfully ignorant state that you are in, because it’s obvious that you are oblivious.

May 23, 2009 - 10:18 am 37. davod:

As I recall, during GW Bush’s time as Governor, Texas approved the removal of life support if the patient could not pay the bils.

May 23, 2009 - 1:41 pm 38. Well Educated Cad:

Odd – I am a doctor in Texas and I NEVER heard such a thing. Ever.

May 23, 2009 - 10:30 pm 39. Praetorian:

Well Educated Cad isn’t so educated. If he were he wouldn’t be trotting out those golden oldies like “socialism.” That may be red meat for your teabagging rallies (no pun intended) but it falls on deaf ears elsewhere. Until you and your ilk start talking to ‘real Americans’ you will keep losing elections. But by all means continue to talk amongst yourselves.

May 23, 2009 - 11:30 pm 40. David:

Soylent Green is a 1973 dystopian science fiction movie depicting a future in which global warming and overpopulation lead to depleted resources, which in turn leads to widespread unemployment and poverty. Real fruit, vegetables, and meat are rare, commodities are expensive, and much of the population survives on processed food rations, including “soylent green” wafers.

The film overlays the science fiction and police procedural genres as it depicts the efforts of New York City police detective Robert Thorn (Charlton Heston) and elderly police researcher Sol Roth (Edward G. Robinson) to investigate the brutal murder of a wealthy businessman named William R. Simonson (Joseph Cotten). Thorn and Roth uncover clues which suggest that it is more than simply a bungled burglary.

The film, which is loosely based upon the 1966 science fiction novel Make Room! Make Room!, by Harry Harrison, won the Nebula Award for Best Dramatic Presentation and the Saturn Award for Best Science Fiction Film in 1973.

http://en.wikipedia.org/wiki/Soylent_Green
SciFi is now reality
Go figure
Harry Harrison is a modern Nostradamus ?

May 24, 2009 - 6:05 am 41. Slider:

Praetorian, you are the ignorant one in this group and I suspect it is because you haven’t had a lot of experience with the health care system. I’m happy for you for that.

I belong to a support group with members from around the world who have horror stories from the very countries you claim have such great health care. I have relatives in Canada who have suffered unnecessarily under their system. The care I’ve received to extend my life is often unapproved for them for reasons of patient age, late diagnosis or locally unavailable treatment regimens. I’d like to mention that the BEST treatment for my condition is a drug that was invented here in California. It saved my life and many others.

As a businessman, I can promise you service that is quick, cheap, or high quality. Pick any two. The government won’t get around this. People point to the “success” of Medicare which already uses law to require doctors to accept dictated prices for treatment and still manages to run a huge deficit. (Who do you think pays for the difference?) That is the future of US healthcare and it isn’t difficult to see.

I can’t imagine the politicians subjecting themselves to the same limitations they will apply to us. Such as the proposals under a universal health care that won’t even allow us to spend our own money for treatment.

May 24, 2009 - 8:41 am 42. Praetorian:

Slider, your dead wrong on this. The only function of the private health care insurance industry is profit. They do not care about your health. Their only function is to take in more money in premiums than they pay out in claims. They answer to the shareholders, not the patients. The bean counters make the decisions, not doctors.

I don’t know about your personal situation, and I am glad that you got the treatment that helped you, but I’m guessing that you either have a Cadillac health plan or you had to haggle a whole bunch to get it. People are denied life saving treatment ALL THE TIME and you know it. Bottom line: no matter what system we have there will be controls.

In terms of Medicare, it is running into a demographic problem (we, as a society, are aging) but it, if you judge by the results is a fantastically successful program. Seniors are living much longer and healthier lives (my grandmother was 102 when she died, thanks to Medicare).

Ultimately, I believe there are philosophical differences that anchor your position and mine. Personally, while life is a wonderful thing, I do not believe that it is so precious that it should be extended as long as possible and at any cost. Some people end up getting your, so called, life saving treatments only to add six months to their life. My grandmother died at 102 from a sudden stroke. While she was getting a little slow she was pretty healthy up until then, so she didn’t cost the system massive amounts of money (most health care costs are incurred in the later years of an individuals life). I’m pretty young, but I understand that we’re all going to die someday, some sooner than others. I suspect, if my relatives are any indicator, that I’ll be around a long time but I could also get hit by a bus tomorrow. It sucks but that’s just the way it goes. ACCEPT IT!

May 24, 2009 - 11:24 am 43. E. Andrews:

For a glimpse of what our lives may be like under two of O’s plans for us common folks (socialized medicine and redistribution of wealth), I highly recommend two short stories in “Atlas Shrugged.” They also appear in Rand’s book “For The New Intellectual”:

1. “The Forgotten Man of Socialized Medicine”. (It’s one page long in our paperback edition of “For The New Intellectual”.)

The story basically explains why my husband and many of our physician friends have already given up medicine and taken up other occupations. Many others say they will do the same when ObamaCare becomes reality. Living with Medicare and Medicaid’s frequently changing codes and rules are already a nightmare, as are the constant fear of frivolous lawsuits, the expense of outrageous liability premiums, and the time consumed keeping up with annual changes in Medicare Part D formularies.

2. “From Each According to His Ability, To each According To His Need”. “This is the story of what happened at the Twentieth Century Motor Company, which put the above slogan into practice — as told by one of the survivors.” (It’s about 12 pages long in our paperback edition of the same book.) Even reasonably literate teenagers can understand this one.

May 24, 2009 - 4:10 pm 44. Slider:

Praetorian, this discussion could be endless so I will leave it at this post. Medicare has trillions in debt and has left the insured to pay through higher cost what it won’t. That’s not fantastically successful. That debt will have to be paid back. Private insurance does not carry that debt. It can’t. Your generation and the following have to pay these debts.

The point is not that some people won’t get life saving care when they need it, the point is that even MORE people will not get life saving care.
Government run health care will end up being more expensive, subject to more delay, and what YOU will get will be of lower quality. It’ll be the law and politicians will have removed alternatives.

By all means, remove profit from everything. History tells you what will happen. Competition is the key to improvement and money is how the market rewards success. Once the government steps in, competition disappears, the bureaucrats take over and impetus for improvement disappears. Tax increases will supplement inefficiencies as they always have. Remember these people couldn’t see the housing bubble disaster coming and are telling us that we will save trillions just with electronic records. They also don’t see the perfect economic storm they’re busily creating. Should be profoundly disturbing to all Americans.

To state that you are young was kind of superfluous; the lack of life experience comes through clearly. It’s more about quality of life and having access to highly skilled, tireless, and motivated professionals when your life is threatened by treatable disease. God forbid anything happens to you but if it does, I would like you to have the quality of care I have had (along with thousands of other Americans) from my oncologist, Blue Cross, Genentech, and Stanford. I don’t think that will possible if the government is calling all the shots.

May 24, 2009 - 7:58 pm 45. Beldar:

Mr. Emmanuel, you’ve confused decisions over what course of treatment to pursue with decisions over what a government-sponsored plan will PAY FOR. They’re not the same. No one’s being prevented from getting whatever sort of treatment he or she — and his treating physicians, or voodoo doctors, or whomever — think appropriate, except in the very same sense that the government is “preventing” me from driving a BMW (because, dammit, it won’t make the required monthly payments for me).

Thus, you’ve conflated a question of fiscal responsibility with a question of liberty. It’s sloppy thinking, and I hope you’ll do better in the future.

May 24, 2009 - 8:38 pm 46. dmk3:

It seems to me that the 11th Circuit ruling is in direct opposition to the rational in ‘Roe vs Wade’; i.e., the state may not come between a patient and her doctor in making a medical decession. If the ‘right to privacy’ protects abortion as a medical procedure, why not any other? If the state does not approve, the state doesn’t have to pay but the patient should be free to pay for it themself. If the patient thinks the doctor is guilty of medical malpractice, the patient (or the patient’s heirs) sues the doctor. If the patient (or the patient’s heirs) think the doctor has committed fraud, they file a complaint with the state and the state may prosecute. The Medicare/Medicade practice of preventing the patient from persuing care not approved of by government bureaucrats seems not only unamerican, it seems it should be unconsitutional under the left’s favorite constitutiona opinon.

May 25, 2009 - 11:21 am 47. Mark Kellen:

Many good comments, but you all make a wrong assumption. You assume that either the government or an insurance company must pay your bills for you. Both are wrong. What people think of as health insurance is actually a third party payment plan which the government adds mandates to that keep it much more expensive than it needs to be.

The proper fix to the system is to keep as much money away from the government and insurance companies as possible. We need vastly expanded health savings accounts, so that we control the resources for day to day spending. This and only this approach will lead to quality, innovation, and lower costs.

As a physician, I see this dynamic play out every day. I see people, especially medicaid dependent people, who do not care what anything costs, because to them it is all free. In reality, the court decision is correct. The state, if they pay for you should have the right to decide what you do or do not get. Those who control their own resources, get to make their own decisions. If we do not set it up this way then their is no incentive not to be on the public dole. If we put everyone on the public dole, then nobody gets a choice.

Check out http://www.aapsonline.org for additional information.

May 25, 2009 - 4:19 pm 48. Jane Orient:

If you are dependent on the government, whether for your livelihood or your medical care, you belong to them. And remember, the government is bankrupt.

Universal coverage means that you are forced to pay for everybody’s medical care, and you get whatever the bureaucrats think you should have. If there’s a “single payer,” such as Medicare, you are forbidden to pay extra to get extra, even if you have any money left after taxes, if your doctor or hospital takes any money from the single payer.

May 25, 2009 - 7:03 pm 49. Well Educated Cad:

And we already have a totally government run Health care system- it’s called the VA. Go check out their hospitals- it’s the future for all America.

May 25, 2009 - 9:22 pm 50. G Alston:

This is a funny site. The state can’t make medical decisions, only doctors and patients can!

And yet…

The same people saying this claim that patients shouldn’t be allowed to have abortions. Only the state should be able to make that decision.

So the *real* argument isn’t one of statism, but who’s pulling the strings.

May 25, 2009 - 9:49 pm 51. Class Clown:

I think too many of you are framing this as a choice between government bureaucrats and insurance bureaucrats. Those two are virtually indistiguishable anyway. The real fear is that any options for private medical care are going to trickle away.

And I have spent time in a French hospital. It was not the standard of care that Americans are accustomed too, I can tell you that….

May 30, 2009 - 2:47 pm