A DISCUSSION OF THE OBAMA HEALTHCARE PLAN OF 2009

WHY THIS IS NOT GOOD FOR THIS

“Healthy, Wealthy, and Wise” , By Daniel P. Kessler and John F. Cogan, Hoover Digest, 2004, No.3, http://www.hoover.org/publications/digest/3020766.html

“The Ethics of Health Care Reform”, Merrill Matthews, Ph.D, Inst. For Policy Innovation, Issue Brief, 07/20/2009

“Trust the Government” , Newt Gingrich , www. Human Events.com, 08/12/2009 ET“The Top Ten Myths of American Health Care, A Citizen’s Guide”, Sally Pipes, Pacific Research Institute, Oct 2008, www.pacificresearch.org

THIS PRESENTATION DREW FREELY FROM THE FOLLOWING 4 REFERENCES

OUR HEALTHCARE SYSTEM - - IS IT REALLY SO SICK ?

The Obama Administration has been a leading critic of Medical care in the USA. They find it highly deficient vs. health care systems in the rest of the developed world. The President and many friendly observers are pushing for a far larger gov’t role in health care. Much of the public accepts his plan because the topic is complex and well supported by the Media. However, before turning to government as the solution, some lesser known facts about America's health care system should be considered.

FIRSTLY - - WE INNOVATE BEST !

OTHER AMERICAN HEALTHCARE ACCOLADES

OTHER AMERICAN HEALTHCARE ACCOLADES

• So there is no excuse to rush this legislation• This will bring profound change and American Healthcare is on the line• We must take the time to debate it properly and to do it right• Let’s look at some critical system requirements and then gage which system is likely to work best

WEIGHING THE ETHICS OF THE HC MODEL 2 basic philosophic avenues to assess ethical implications of actions:

1. Follow Basic Principles2. Project Action Consequences

 EXAMPLE 1: [Principle]• CA contemplated a law that doctors only treat American

Citizens• Doctors complained that they couldn’t obey that law

because of the Hippocratic oath to treat patients in need - - regardless.

• So the Principle would, and did in that case, take precedence over the law and yield an ethical result.

WEIGHING THE ETHICS OF THE MODEL

2 basic philosophic avenues to assess ethical implications of actions:• Follow Basic Principles• Project the Consequences of the Action

EXAMPLE 2: [Consequences]• A doctor defended the Canadian system of universal coverage, even though it led to patient lines and waiting for treatment.• The Doctor agreed that waiting occurs, but argued that this was a small price to pay to achieve the end result of universal coverage.• So the Consequence, universal coverage, arguably an ethical outcome, was deemed, at least in this case, to override the Principle of seeing patients without undue wait that might impact their health.

KEY PRINCIPLES FOR AN ETHICAL HEALTH CARE SYSTEM

There seems to be a growing consensus, reaching across Party lines, behind the following Principle: PATIENTS SHOULD BE THE ONES WHO MAKE THE (INFORMED) DECISIONS ABOUT THEIR HEALTH AND BODIES. Example sub-aspects of this:

Full & honest disclosure of patient prognosis The right of a conscious, competent patient to refuse excessive care Patients should ultimately make their own decisions in selecting their doctors and their treatment plan

ACHIEVING CERTAIN GOALS (CONSEQUENCES) FOR AN ETHICAL HEALTH CARE SYSTEM

These goals seem reasonable to set for our Ethical system:

• Virtually everyone should have access to the system [BUT .. what good is it to say everyone can choose their insurance, if state mandates make the policy so expensive that no one can choose it ?]• Innovation should be encouraged in order that quality of care be high and continually improved [BUT .. what good is it to say the system produces equal care, if no patients are receiving the newest, most effective treatments ?]

• Costs must be kept reasonable [BUT . .what good is it to say all patients have access if budgets are so strained that high quality diagnostics or treatments are rationed ?]

SOME ADDED THOUGHTS ON AN ETHICAL SYSTEMCanadian Supreme Court Chief Justice Beverly McLachlin , noted with regard to waiting lines: “ACCESS TO A WAITING LINE IS NOT ACCESS TO HEALTH CARE.”

An ethical health care system doesn’t just PROMISE people to provide the care they need, IT EMPOWERS PEOPLE SO THEY CAN CHOOSE AND OBTAIN THAT CARE.

THERE ARE MULTIPLE HEALTHCARE “MODELS”

PAY-OUT-OF-POCKET MODEL

$ $

DECISION FLOW

WE’LL LOOK AT THE PAYMENT & CARE DECISION FLOWS FOR EACH MODEL

INSURANCE MODEL

$ $

DECISION FLOW

PURE SINGLE-PAYER MODEL

$ $

DECISION FLOW

SINGLE-PAYER WITH OPT-OUT MODEL

$ $

DECISION FLOW

GOV’T-IMPOSED PUBLIC-PRIVATE

$ $

DECISION FLOW

CONSUMER –DRIVEN MODEL

$ $

DECISION FLOW

HSA TAX DEDUCTIONS;VOUCHER SAFETY NET

SOME COMPETING FACTS, FIGURES & MYTHS

some key subject areas:• “GOV’T HEALTHCARE WOULD BE MORE EFFICIENT ” • “AMERICA IS SPENDING TOO MUCH ON HEALTHCARE”• “WE’RE BEING GOUGED BY THE DRUG COMPANIES”• “UNIVERSAL HEALTHCARE GOV’T INSURANCE” - - (THE ‘PUBLIC OPTION’)• “GOV’T-RUN HEALTHCARE IN OTHER NATIONS WORKS BETTER THAN OURS”

GOV’T HEALTHCARE WOULD BE MORE EFFICIENT

CLAIM REALITYGOV’T CARE USES FEWER MIDDLEMEN

DOES THE IRS MAKE TAXES SIMPLE ?

A SINGLE PAYER CAN NEGOTIATE BETTER PRICES

• THIS IS A EUPHEMISM FOR PRICE CONTROL BY GOV’T FIAT• DURING WWII, THE OFFICE OF PRICE STABILIZATION CONTROLLED PRICES. RESULT: BLACK MARKET GOODS THRIVED FOR A BROAD PRODUCT ARRAY. WE BECOME A NATION OF LAWBREAKERS.

GOV’T HEALTHCARE WOULD BE MORE EFFICIENT

CLAIM REALITYGOV’T IS MORE EFFICIENT .

NO. CHECK OUT SOME EXISTING EXAMPLES OF MEDICARE & MEDICAID

• M&M control price by setting low payments TO DOCTORS & HOSPITALS• AN INCREASING NUMBER OF DRs REFUSE TO SEE M&M PATIENTS• STUDIES SHOW THAT MEDICARE WASTES $1. of EVERY $3. • IN NY STATE, A RETIRED FRAUD INVESTIGATOR ASSERTS THAT AS MUCH AS 40% OF MEDICAID CLAIMS ARE FRAUDULENT

AMERICA SPENDS TOO MUCH ON HEALTHCARE

CLAIM REALITYCOSTS HAVE GROWN A LOT.

SOMEWHAT TRUE.

AMERICA PAYS MORE FOR IT’S HEALTHCARE THAN MANY OTHER COUNTRIES DO

THE QUESTION IS WHY ARE OUR COSTS SO HIGH ?

AMERICA SPENDS TOO MUCH ON HEALTHCARE

CLAIM REALITYCOSTS HAVE GROWN A LOT.TRUE.

IN 1950, AVG AMERICAN SPENT $500./yr ON HEALTHCARE. IN 2006, SAME COSTS (INFLAT’N ADJ’D) HAD RISEN TO $7,026. /yr

BUT THE VALUE RECEIVED HAS RISEN GREATLY ALSO.

CHAD WILKINSON, IN 1998, AGE 25, WAS DIAGNOSED WITH NON-HODGKIN’S LYMPHOMA; HE SAID: “WHEN PEOPLE SAY THAT HEALTH CARE IN THE UNITED STATES HAS TOO HIGH A COST, … THEY’VE NEVER BEEN IN A FIGHT TO THE DEATH WITH CANCER. “MY CHEMO BILLS WERE THROUGH THE ROOF, BUT THAT TREATMENT WAS WORTH EVERY NICKEL.”25, WAS

MANY, MANY OTHER VALUES NOW EXIST AS WELL.

E.g., JONAS SALK’S LIFE-SAVING POLIO VACCINE IS MORE THAN 50 YEARS OLD. UNTIL THAT TIME YOU COULDN’T SPEND $$ TO PREVENT POLIO. SIMILARLY, OTHER TREATMENTS WERE NOT AVAILABLE AND ARE NOW HAPPILY PURCHASED.

AMERICA SPENDS TOO MUCH ON HEALTHCARE - - FIX: “FEE FOR SERVICE”

CLAIM REALITY“FEE FOR SERVICE” INCENTIVIZES ‘EXTRA’ CARE

AGAINST FFS:The problem with fee-for-service is not merely that it pays providers to provide service; it pays them to CREATE service as well. It is this almost limitless ability of doctors to create service that makes our per capita health care costs twice that of any other developed country.“

FFS IS THE WRONG DIAGNOSIS:One result of unduly HEAVY RELIANCE UPON 3RD-PARTY PAYERS is that almost everyone who consumes medical care does so irresponsibly. That is, the typical American is unresponsive to the burdens that his or her medical-care choices impose on others. This irresponsibility exists because we've socialized too much of the costs of medical care. Why should any citizen give close attention to the price of some recommended medical procedure if he, personally, is paying out of pocket almost none of the price of that procedure or drug? With everyone irresponsible, resources are wasted, bringing with it unnecessarily higher costs.

‘FFS’ WORKS FOR BUYING FOOD, ACCOUNTING ETC. WHY IS IT BAD FOR HEALTHCARE ?

LET’S LOOK AT 2 SIDES OF THE ISSUE

DRUG COMPANIES ARE GOUGING THE PUBLIC

CLAIM REALITYDRUG PRICES ARE TOO HIGH !

YES, DRUG DEVELOP-MENT IS COSTLY, BUT MEDICINES REDUCE OTHER HEALTH COSTS.

THE AVERAGE AMERICAN HOUSEHOLD SPENDS ALMOST $2600. /YR. ON PRESCRIPTION DRUGS. IN THE MID-70’s THE NATIONAL SPENDING AVERAGED 5-8% OF GDP; IN RECENT YEARS IT HAS PASSED THE 10% MARK.

BUT DRUG BENEFITS HAVE PERMITTED MAJOR COST OFFSETS ON OTHER MEDICAL BILLS, SUCH AS: REDUCED HOSPITAL STAYS; LESS SURGERY; AND OTHERS.

DRUG COMPANIES ARE GOUGING THE PUBLIC

CLAIM REALITYDRUG PRICES ARE TOO HIGH !

LET’S ANALYZE THE SOURCE OF THE COSTS.

CHRONIC DISEASES LIKE DIABETES, CANCER IN REMISSION, HEART DISEASE, HIV, OBESITY, AND ARTHRITIS—ARE FAR AND AWAY THEBIGGEST DRAIN ON AMERICA’S HEALTH CARE SYSTEM.

CHRONIC DISEASES HAVE LED TO A MASSIVE INCREASE IN HEALTH CARE COSTS IN RECENT DECADES. TODAY, CARING FOR PEOPLE WITH CHRONIC DISEASES ACCOUNTS FOR ABOUT 85 % OF ALL U.S. HEALTH CARE SPENDING.

DRUG COMPANIES ARE GOUGING THE PUBLICCLAIM REALITY

DRUG PRICES ARE TOO HIGH !

BUT IS THAT THE TOTAL STORY ?

A 2005 STUDY PUBLISHED IN MEDICAL CARE FOUND THAT EVERY ADDITIONAL DOLLAR SPENT ON DRUGS FOR BLOOD PRESSURE, CHOLESTEROL, ANDDIABETES SHAVES $4.00 TO $7.00 OFF OTHER MEDICAL SPENDING.

SIMILARLY, A RECENT PAPER FROM THE NATIONAL BUREAU OF ECONOMIC RESEARCH (NBER) FOUND THAT MEDICARE ULTIMATELY SAVES $2.06 FOR EVERY DOLLAR IT SPENDS ON MEDICINES.

DRUG COMPANIES ARE GOUGING THE PUBLIC

CLAIM REALITYDRUG PRICES ARE TOO HIGH !

BUT GETTINGAN EFFECTIVE DRUG TO MARKET IS AN EXPENSIVE ENDEAVOR.

99.9% FAIL.

DIFFERENT PERSPECTIVES ON DRUG COSTS - - PART 1

CLAIM REALITYDRUG PRICES ARE TOO HIGH !

BUT A LONGER TERM VIEW SHEDS SOME ADDED INSIGHT

THINK ABOUT THE HISTORY OF ARTIFICIAL LIGHT. UNTIL THOMAS EDISON INVENTED THE ELECTRIC LIGHT IN THE LATE 19th CENTURY, PEOPLE SPENT MONEY ON WOOD, OIL, AND CANDLES TO LIGHT THEIR HOMES. ONE COULD SAFELY SAY THAT ELECTRICITY ACCOUNTED FOR ZERO COST %. BUT AS THE BENEFIT BECAME CLEAR, PEOPLE WERE HAPPY TO SPEND $$ FOR NIGHT TIME LIGHT.THE WIDESPREAD MYTH THAT DRUGS ARE RESPONSIBLE FOR HIGH HEALTH CARE COSTS IS NOT HARMLESS. IT HAS LED TO A SURREAL SITUATION IN WHICH SOME POLITICIANS ARE TRYING TO PUNISH A COST REDUCER.

DIFFERENT PERSPECTIVES ON DRUG COSTS - - PART 2

CLAIM REALITYFROM THE BEGINNING, PRES. OBAMA PROMISED AMERICANS HIS HEALTH PLAN WOULD NOT ADD TO OUR FEDERAL DEFICIT IN THE LONG TERM. JUST AUG 23rd, HE AGAIN PROMISED THE COUNTRY: “I WILL NOT SIGN ON TO ANY HEALTH PLAN THAT ADDS TO OUR DEFICITS OVER THE NEXT DECADE. … ” PROBLEM IS THE NONPARTISAN SCOREKEEPERS FOR CONGRESSIONAL SPENDING AND REVENUE, THE CONGRESSIONAL BUDGET OFFICE (CBO) AND JOINT COMMITTEE ON TAXATION, KEEP RELEASING ESTIMATES SHOWING THAT REALITY JUST DOES NOT MATCH OBAMA’S RHETORIC.

DIFFERENT PERSPECTIVES ON DRUG COSTS - - PART 3CLAIM REALITY

AUGUST 24TH, 2009 – WITH $2 T OF FRESH RED INK ON ITS FACE, AN EMBARRASSED OBAMA ADMINISTRATION ISSUES A MAJOR UPWARD REVISION OF AN EARLIER DEFICIT PROJECTION, FROM $7 T TO $9 T.

BECAUSE HIS INITIAL ESTIMATE WAS SO WILDLY OFF BASE, FISCALLY CONSERVATIVE MEMBERS OF BOTH PARTIES SERIOUSLY DOUBT HIS ABILITY TO BRING ABOUT THE DEFICIT-NEUTRAL HEALTHCARE REFORM HE PROMISES.

DO OTHER HC SYSTEMS REALLY DO BETTER ?

CLAIM REALITYJUST COMPARESOME KEY HEALTH DATA FOR VARIOUS NATIONS .

OK. BUT LET’S LOOK AT THE DATA CARE-FULLY !

• TAKE INFANT MORTALITY: THE CIA WORLD FACTBOOK RANKS THE U.S. 42ND BEHIND SUCH UNLIKELY COMPETITORS AS PORTUGAL, SLOVENIA, MALTA, THE CZECH REPUBLIC, AND EVEN CUBA.

• OR CONSIDER LIFE EXPECTANCY THE UNITED STATES COMES IN A DISMAL 29TH—BEHIND MEDICAL POWER-HOUSES LIKE BOSNIA AND HERZEGOVINA, JORDAN, AND CYPRUS.

SOMETHING WRONG WITH THIS DATA ? YES INDEED !

DO OTHER HC SYSTEMS REALLY DO BETTER ?

CLAIM REALITY - - LIFE EXPECTANCYKNOW WHAT’S IN THE STATISTICS !

JUST COMPARE SOME KEY HEALTH DATA FOR VARIOUS NATIONS .

OK. BUT LET’S LOOK AT THE DATA CARE-FULLY !

INDICATORS LIKE LIFE EXPECTANCY DON’T JUST REFLECT THE QUALITY OF A HEALTH CARE SYSTEM. THEY ALSO REFLECT A NATION’S HOMICIDE RATE, THE NUMBER OF ACCIDENTS, AND MUCH MORE. ACCORDING TO THE U.S. DOJ, AMERICA’S HOMICIDE RATE WAS 5.9 PER 100,000 INHABITANTS IN 2004. IN CONTRAST, IT WAS 1.95 IN CANADA, 1.64 IN FRANCE, AND 0.98 IN GERMANY. THE UNITED STATES ALSO HAS MORE CAR ACCIDENTS. ACCORDING D.O.T., AMERICA HAD 14.24 FATALITIES PER 100,000 PEOPLE FROM AUTO ACCIDENTS IN 2006. IN CANADA, THE NUMBER WAS 9.25. IN FRANCE, 7.4. IN GERMANY, JUST 6.19 PER 100,000.

AS HARVARD ECONOMIST GREG MANKIW HAS NOTED, “MAYBE THESE DIFFERENCES HAVE LESSONS FOR TRAFFIC LAWS AND GUN CONTROL, BUT THEY TEACH US NOTHING ABOUT OUR SYSTEM OF HEALTH CARE.”

DO OTHER HC SYSTEMS REALLY DO BETTER ?

CLAIM REALITY - - WAITING FOR CARE

JUST COMPARESOME KEY HEALTH DATA FOR VARIOUS NATIONS .

OK. BUT LET’S LOOK AT THE DATA CARE-FULLY !

IT’S NOT JUST DRUG RATIONING THAT HASTENS THE DEATHS OF THE ILL AND THE ELDERLY. SOCIALIZED SYSTEMS RATION SERVICES ACROSS THE WHOLE RANGE OF MEDICAL CARE.

CANADA TODAY, WITH 33 MILLION PEOPLE, HAS MORE THAN 800,000 CITIZENS CURRENTLY ON WAITING LISTS FOR SURGERY AND OTHER NECESSARY TREATMENTS. 15 YEARS AGO THE AVERAGE WAIT BETWEEN A REFERRAL FROM A PRIMARY CARE DOCTOR AND TREATMENT BY A SPECIALIST WAS AROUND 9 WEEKS. TODAY THAT WAIT IS MORE THAN 18 WEEKS.

DO OTHER HC SYSTEMS REALLY DO BETTER ?

CLAIM REALITY - - WAITING FOR CARE

JUST COMPARESOME KEY HEALTH DATA FOR VARIOUS NATIONS .

OK. BUT LET’S LOOK AT THE DATA CARE-FULLY !

FACED WITH THE PROSPECT OF WAITING A YEAR FOR A HIP REPLACEMENT, CANADIAN GEORGE ZELIOTIS TRIED TO ARRANGE WITH HIS SURGEON, DR. JACQUES CHAOULLI, TO PAY PRIVATELY.

BUT HE WAS TOLD THAT WOULD HAVE BEEN ILLEGAL. SO HE WENT TO COURT, LOSING IN TWO QUEBEC PROVINCIAL COURTS, BUT THE CANADIAN SUPREME COURT AGREED TO HEAR HIS APPEAL—AND FINALLY, IN JUNE 2005, THE COURT RULED IN HIS FAVOR.

DO OTHER HC SYSTEMS REALLY DO BETTER ?

CLAIM REALITY - - LIMITING ACCESSJUST COMPARESOME KEY HEALTH DATA FOR VARIOUS NATIONS .

OK. BUT LET’S LOOK AT THE DATA CARE-FULLY !

A BRITISH GOV’T AGENCY, THE NAT’L INST. FOR HEALTH AND CLINICAL EFFECTIVENESS (NICE), DETERMINES WHICH TREATMENTS THE HEALTH CARE SYSTEM COVERS.

IN EARLY 2008, NICE REFUSED TO APPROVE ABATACEPT, SOLD IN THE U.S., AND ONE OF VERY FEW DRUGS CLINICALLY PROVEN TO IMPROVE SEVERE RHEUMATOID ARTHRITIS. NICE DECIDED THAT “ABATACEPT COULD NOT BE CONSIDERED A COST EFFECTIVE USE OF NATIONAL HEALTH RESOURCES.”IN 2008, NICE MADE A SIMILAR DECISION ABOUT THE LUNG CANCER DRUG TARCEVA, DESPITE NUMEROUS STUDIES SHOWING THAT THE DRUG SIGNIFICANTLY PROLONGS THE LIFE OF CANCER PATIENTS.

SOME FURTHER ELEMENTS TO A CONSUMER-DRIVEN

SOLUTION

EXPANDED RETAIL CLINICS

TORT REFORM

EXPANDED INSURANCE OPTIONS:• PATIENT –CENTERED TAX INCENTIVES• PURCHASE ACROSS STATE LINES

FIX INCENTIVIZATION

• 3rd PARTY PAYERS• “FEE FOR SERVICE” ??

AVOID NATIONAL DEBT IMPACT

MODIFYING INSURANCE INCENTIVESTHE PROBLEM? WHAT TO DO ?

Few people expect their employers to provide food or life insurance. Yet because of a wartime (WWII) precedent, people do expect their employers to provide health care. Today, more than 60 percent of those under age 65 are covered by an employer-paid health insurance policy. AS A RESULT: • Employees don’t think about the real cost of medical treatment. So they don’t shop around for the best deal - - resulting in coverage that’s in their employer’s best interest, not theirs.• It also depresses new business creation, as many folks consider: foregoing health insurance to pursue entrepreneurial ventures• The system penalizes the unemployed and individuals, who cannot purchase health insurance with pre-tax dollars.

Level the playing field by giving individuals the same tax break that companies receive when buying health coverage. • Under one plan, the tax code would be reformed to provide refundable tax credits—$2,500 for individuals and $5,000 for families. The second plan allow income tax deductions—$7,500 for individuals and $15,000 for families.• Either change would completely and beneficially transform the health care market.Allow insurance purchase across state lines

EXPANDING RETAIL CLINICS

THE PROBLEM?

WHAT TO DO ?

UNTIL RECENTLY, IF YOU NEEDED MEDICINE FOR A SORE THROAT OR AN EARACHE, YOU HAD TO SCHEDULE A DR’S APPTMT. IF YOU HAPPENED TO GET SICK AFTER BUSINESS HOURS OR DURING THE WEEKEND, OR HAD NO INSURANCE, YOUR ONLY OTHER OPTION WAS TO WAIT FOR HOURS IN AN EMERGENCY ROOM.

RETAIL CLINICS TYPICALLY CHARGE AROUND $50 PER VISIT, DON’T REQUIRE AN APPTMT, AND ARE GENERALLY OPEN 24/7. THIS IS THE ULTIMATE IN PRICE TRANSPARENCY TO THE CONSUMER.

IN SOME STATES, LAWMAKERS ARE PUSHING FOR THE GOVERNMENT TO MANDATE A LOW NURSE-PRACTITIONER-TO-DOCTOR RATIO.

A BEST PRACTICES, CONSUMER-DRIVEN APPROACH SHOULD SUPPORT THE GROWTH OF RETAIL HEALTH CLINICS BY RESISTING CALLS TO PROTECT DOCTORS FROM LOWER-PRICED COMPETITION.

ENACTING TORT REFORM

THE PROBLEM? WHAT TO DO ?ANY MEANINGFUL HEALTHCARE REFORM MUSTBRING MALPRACTICE LAWSUITS UNDER CONTROL, AS THE CURRENT SYSTEM IS COSTING PATIENTS DEARLY. EACH YEAR, ONE OUT OF EIGHT PHYSICIANS GETS HIT WITH A MEDICAL MALPRACTICE LAWSUIT. MALPRACTICE INSURANCE CAN COST SPECIALTY PHYSICIANS AS MUCH AS $240,000 PER YEAR, AND IS DRIVING DOCTORS OUT OF SPECIALTIES LIKE OBSTETRICS AND NEUROSURGERY. THESE LIABILITY CONCERNS PROMPT PHYSICIANS TO ORDER MORE PROCEDURES AND TESTS THAN THEY WOULD OTHERWISE, HENCE ADDING FURTHER COSTS.

POLICYMAKERS MUST PUT AN END TO THE LAWSUIT LOTTERY. SENSIBLE REFORMS INCLUDE CAPPING NON-ECONOMIC DAMAGE AWARDS SUCH AS IN CALIFORNIA UNDER ITS MICRA LAW AND IN TEXAS: ALLOWING DEFENDANTS TO PAY LARGE AWARDS IN PERIODIC PAYMENTS; MOVING TO A SYSTEM OF BINDING ARBITRATION; AND PLACING REASONABLE LIMITS ON ATTORNEYS’ FEES.SUCH REFORMS WOULD SIGNIFICANTLY REDUCE HIDDEN LITIGATION COSTS AND HELP PREVENT A SHORTAGE OF MEDICAL SPECIALISTS IN STATES WITH EXPENSIVE MEDICAL MALPRACTICE INSURANCE

ADDITIONAL HEALTHCARE ETHICS - -

THE REAL PROBLEM OF ALLOCATING SCARCE

RESOURCES

ASSESSING THE ETHICS OF ONE ASPECT OF OBAMA’S HEALTHCARE

ALLOCATING SCARCE RESOURCES? I’ve Spoken to CE Group previously of trying to structure the Conservative message on an ethical basis . So I set out to try this on the issue of Obama’s “Death Panel” recently described by Sarah Palin. Actually, Sarah’s thought stemmed from a speech given by Rep. Michele Bachmann (R- MI) – VIDEO CLIP. AL

• At first, I thought it an easy exercise. • It proved more difficult than I thought.• Rep. Bachmann is a thoughtful person.• She references Dr. Ezekiel Emanuel.

• I checked into him a little.

• Here’s what I found. Let’s discuss this.•ALWAYS

Ref to SOME MEDICAL ETHICS RESOURCES

Principles For Allocating Scarce Resources - - Pt 1

Principles For Allocating Scarce Resources - - Pt 2

NO “DEATH PANEL EVER”

“DEATH PANEL” IS ALWAYS NEEDED FOR THE TOTAL GOOD

CL

WEIGHING THE RIGHTS OF SOCIETY vs THE INDIVIDUAL

• LET’S TRY TO ADD A VERY PERSONAL (PERHAPS EVEN TRAUMATIC) DIMENSION TO OUR THINKING. • CONSIDER THIS THOUGHT EXPERIMENT:• YOU (M or F) ARE ENJOYING A BOAT TRIP WITH YOUR 2 CHILDREN - - WHEN DISASTER STRIKES. THE BOAT CAPSIZES AND ALL 3 ARE THROWN OVERBOARD

A HORRIBLE HOBSON’S CHOICE

• YOU’RE CONFRONTED WITH THIS TERRIBLE CHOICE• WHAT DO YOU DO ?• HERE’S MY OWN PERSONAL ANSWER• YOU SAVE BOTH OR DIE TRYING

• NOW LET’S TAKE IT BACK TO THE ABSTRACT PHILOSOPHICAL REALM.• THE CHOICES AREN’T AS STARK - BUT THE SITUATIONS ARE REAL• WHAT DO YOU DO ?

WEIGHING THE RIGHTS OF SOCIETY vs THE INDIVIDUAL

THE SAME DIFFICULT CHOICE - - BROADER APPLICATION

[ ] INDIVIDUAL ALWAYS

[ ] INDIVIDUAL MOSTLY

[ ] ABOUT EVEN

[ ] SOCIETY MOSTLY

[ ] SOCIETY ALWAYS

C

L

NO “DEATH PANEL EVER”

“DEATH PANEL” IS ALWAYS NEEDED FOR THE TOTAL GOOD

CL

?

?

?

?

• STILL CONFRONTED WITH A KIND OF HOBSON’S CHOICE.• WHAT DO YOU DO ?• HERE’S MY ETHICAL ANSWER:

1. SQUEEZE OUT SYSTEM WASTE SO THAT THE NEED FOR ALLOCATING SCARCE RESOURCES IS GREATLY DIMINISHED

2. BUT THIS TAKES TIME. WHAT IN THE INTERIM? OR IN A MAJOR CATASTROPHE?

LOTTERY / 1st COME – 1st SERVED / SICKEST 1st / YOUNGEST 1st / SAVE MOST LIVES / BASE ON PROGNOSIS / SAVE MOST USEFUL / REWARD PAST GOOD EFFORTS

WEIGHING THE RIGHTS OF SOCIETY vs THE INDIVIDUAL

• THE BEST HEALTHCARE MODEL:• DEPLOY THE CONSUMER-DRIVEN MODEL TO ACHIEVE:• PATIENT AS DECISION-MAKER• ALL-CITIZEN ACCESS• QUALITY CARE• REASONABLE COSTS

• CONFRONTING THE HOBSEN’S CHOICE• DEVELOP THE SYSTEM THAT AVOIDS THE CHOICE TO THE EXTENT POSSIBLE.• IF THE CHOICE MUST BE ADDRESSED, USE THE TECHNIQUE: LOTTERY / SICKEST 1st / YOUNGEST 1st / SAVE MOST LIVES /

THE RECOMMENDED SOLUTION

CRITICAL SOLUTION ELEMENTS-PATIENT

DRIVEN CHOICES &

-ENTERPRISE BASED

COMPETITION

VOUCHER SYSTEM AS SAFETY NET

EXPANDED RETAIL CLINICS

TORT REFORM

EXPANDED HSA’s

EXPANDED INSURANCE OPTIONS:• PATIENT –CENTERED TAX INCENTIVES• PURCHASE ACROSS STATE LINES

FIX INCENTIVIZATION• 3rd PART PAYERS• “FEE FOR SERVICE” ??

AVOID NATIONAL DEBT IMPACT

WE NEED A NATIONAL HEALTHCARE PROGRAM WITH:• LESS GOV’T - - NOT MORE• A CONSUMER-DRIVEN MODEL

• PATIENT AS DECISION-MAKER• ALL CITIZEN ACCESS• NURTURING OF QUALITY & INNOVATION• INCENTIVES TO REDUCE COST

• REFORM VIA BAND-AID - - NOT RADICAL SURGERY

• HSA’s + HIGH DEDUCTIBLE CATASTROPHIC INSURANCE - - PURCHASABLE ACROSS STATE LINES• TORT REFORM• A VOUCHER SYSTEM AS A ‘SAFETY NET’• EXPANDED USE OF RETAIL CLINICS• IMPROVED INCENTIVIZATION FOR RESPONSIBLE CITIZEN COST CONTROL

CONCLUSIONS

WE NEED A LEGISLATIVE PROCESS WITH:• MUCH FEWER, MICRO-MANAGED , 1000-PAGE LAWS• CHASTIZING OF THOSE RESPONSIBLE FOR CONTRIBUTING TO THIS LEGISLATIVE ATROCITY:

• THE DRAFTERS• THE CONGRESSIONAL LEADERSHIP• THE ADMINISTRATION• THE MEDIA

• MORE OBEISANCE TO THE PRECEPT THAT THE GOV’T IS OWNED BY THE PEOPLE - - NOT CONVERSELY.• ADDED CONSIDERATION OF THE MOUNTING FEDERAL DEBT AND HEALTHCARE COSTS.

CONCLUSIONS

THEEND