Monday, June 29, 2009

Weekly Newsletter: June 29, 2009

Government-Run Health Care and Cancer Outcomes

Two stories in the past week from Great Britain provide an interesting backdrop to the Democrat-proposed creation of a government-run health plan to “compete” with private sector coverage.  In the first, a new report released found that up to 15,000 lives could be saved every year if patients in Britain’s National Health Service received the same type of quality care that patients in the United States obtain.  The report prompted complaints from patient advocates that senior citizens receive sub-standard care, as the government rations access to health services for older patients on cost grounds; one activist found it “appalling that people over 75 are not getting the care they need…it is scandalous that not everyone is getting” access to treatment.  In its coverage of the report, the BBC relayed the story of one 74-year old ovarian cancer patient, who according to her daughter had to travel to Iran in order to receive a proper diagnosis:

Mum started to have bleeding early in 2007.  She went to the [general practitioner], but they just took her off her [hormone replacement therapy] and sent her to a gynaecologist.  He said it was probably just stress.  It was only when she went back to visit family in Iran and saw a doctor there that she was diagnosed.  They did a scan and found a large lump in her fallopian tube.  When she came back to the UK, doctors found the cancer had spread to one of her lymph glands.  It was the size of a tennis ball.  She then had a six-week wait before having a hysterectomy and then chemo.  Her treatment was very good, but the diagnosis was abysmal.  If it had been found 18 months earlier, it could have been removed easily and she wouldn’t have needed a hysterectomy or chemo.”

Today the British Government plans to announce plans to give patients the “right” to see a cancer specialist within two weeks of diagnosis—a “right” that significant numbers of patients currently lack.  Coupled with the lack of tools to diagnose cancer promptly in the first instance, some Members may be concerned that the government-run health plan envisioned by many Democrats could lead to worse outcomes for patients—because, as senior Obama Administration official Sherry Glied has previously admitted, government-run health plans will end up under-funded.

A “Firm Pledge” Falls by the Wayside

During last year’s presidential campaign, then-Senator Barack Obama made very clear that he would not raise taxes on the middle class in order to pay for an expansion of government-run health care.  His most famous iteration of this promise came at a rally in Dover, New Hampshire, on September 12, 2008:

“I can make a firm pledge.  Under my plan, no family making less than $250,000 a year will see any form of tax increase.  Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”

Yesterday, however, senior Administration advisor David Axelrod backtracked from the “firm pledge” made repeatedly during the campaign.  Given multiple opportunities to reiterate the campaign promise, Axelrod backtracked, saying merely that “there are a number of formulations and we’ll wait and see” whether a middle-class tax increase is one of them.

Some Members may be concerned by this message—but not altogether surprised, given the “flexibility” the President has already exhibited from his campaign positions in opposition to an individual mandate to purchase insurance and taxing health benefits.  In addition to questioning how raising taxes in the middle of a recession will help strengthen the economy, some Members may further question how tax increases will help slow the growth of health care costs—purportedly the Administration’s prime goal for any health reform legislation.

Democrats Finally Discover the “Crowd-Out” Phenomenon

For the better part of the past two weeks, Democrats in the Senate have been working to pare back the cost of their health care overhaul, after a Finance Committee discussion draft reportedly weighed in with a price tag of $1.6 trillion over ten years.  Much of the reason for the high spending came from subsidies to families making as much as $88,200—subsidies which, according to the Congressional Budget Office, would merely encourage these individuals to drop their current coverage and enroll in the government-run health insurance Exchange.  Senate Budget Committee Chairman Conrad was quoted in the New York Times as being “particularly concerned about the possibility that people who now have employer-provided coverage would drop it in favor of government-subsidized coverage, raising the cost to taxpayers.”

Some Members may not be surprised by this development, as many Members made the exact same point during debate over reauthorization of the State Children’s Health Insurance Program (SCHIP).  Just last October, officials in Hawaii abandoned their Keiki Care program to expand government-run health coverage to children, because as one official noted, “People who were already able to afford health care began to stop paying for it so they could get it for free” from the federal government.  Some Members may hope that, having finally discovered the “crowd-out” phenomenon and its significant impact on the federal budget, Democrats will shift course from their attempted expansions of government programs as one way to “reform” American health care.