August 17, 2009
The Road Not Mentioned
The scoffs that have been so prevalent in response to right-wing talk of "death panels" and such repeat a common liberal tactic of missing the point through deliberate myopia: "Why, this bill merely provides for consultations about end-of-life options, hardly a group of bureaucrats voting to pull the plug. As for rationing, show me one instance in which such a thing will occur." This citation assists in response to both paraphrased points:
Hey, you know those Scooter commercials, where the owner of the company promises that Medicare will pay for 100% of the cost of your motorized wheelchair or they'll eat the difference? In §1141, the phrase "power-driven wheelchair" shall now be replaced in the Social Security Act with "complex rehabilitative power-driven wheelchair." In other words, if you don't specifically need the motorized chair for complex rehabilitation, Obamacare says you can freaking walk or crawl from now on. Or pay for it yourdamnself. On the one hand, the Czar can see how this is a claim to save money—right, GOP? Why do those pesky elderly folks need taxpayers to help them live normal lives? On the other hand, there's something wickedly disingenuous about this. If AARP lived up to its name, this would be the first thing to decry.
That's the sound of rationing in a big government system. A couple of multisyllabic words added in the middle of a legal document so complex that it's barely English and so heavily cross-referenced that it's more like a kidnapper's cut-and-paste ransom note than a coherent narrative. And as Mark Steyn explains, the "death panel" has more of a passive authority:
The problem with government health systems is not that they pull the plug on Grandma. It's that Grandma has a hell of a time getting plugged in in the first place. The only way to "control costs" is to restrict access to treatment, and the easiest people to deny treatment to are the oldsters. Don't worry, it's all very scientific. In Britain, they use a "Quality-Adjusted Life Year" formula to decide that you don't really need that new knee because you're gonna die in a year or two, maybe a decade-and-a-half tops. So it's in the national interest for you to go around hobbling in pain rather than divert "finite resources" away from productive members of society to a useless old geezer like you. And you'd be surprised how quickly geezerdom kicks in: A couple of years back, some Quebec facilities were attributing death from hospital-contracted infection of anyone over 55 to "old age." Well, he had a good innings. He was 57.
The point is that criticism of healthcare reforms takes a longer view, accounting for that which the installed principles make inevitable. Technically, leaving a man floating in the mid-Atlantic on a 2x12 board isn't killing him, but it's likely a death sentence. Although progressives — who admit by their very name that they've got their eye on a broader project — may wish to hold the debate to the immediate effects of specific provisions, a wise electorate should workshop and brainstorm their lasting consequences.
A similar sleight-of-hand is behind the administration's apparent change of tactic in backing away from "public option" talk. In the end, without that fundamental change, the legislation will only exacerbate bureaucracy and complicate a healthcare system already crawling under the weight of regulation. Both political parties will lift up their arms in a declaration of victory, but the necessary reform would merely have been postponed.
There are two paths to the future enabled by the current legislation: a single-payer system that impinges on freedom and ensures the erosion of healthcare around the world, or the gradually corrosive over-medication of a regulatory bonanza. The path that we ought to follow — decreasing regulation and allowing choice to blossom from fertile demand — has scarcely been mentioned.
Does anyone believe that government run healthcare won't end up like government run schools?
We'll see treatment options cut or eliminated to fund grossly excessive union contracts (just as we see with sports, gifted classes and the like).
We'll see a total lack of accountability for quality or outcomes. The teachers unions don't give a rat's behind about the harm they're causing to children - at best inhibiting their future prospects, if not worse. Does anyone believe that their healthcare union counterparts are going to give a rat's behind about Granny, or anyone else for that matter?
The primary healthcare union is SEIU for God's sake - their even worse than the NEA. Do you want them effectively calling the shots with their bought and paid for Democrat politicians who in turn will call the shots with your healthcare????
And we'll see ever-spiraling taxes going to support ever-declining quality.
It'll be a disaster.
The only missing link for far is appeasement to the green movement. Perhaps after Granny's "end of life counseling" they'll add a recycling mandate, and we'll soon be eating government mandated, low fat, nutrient rich "Soylent Green."
Posted by: Tom W at August 17, 2009 12:05 PM>The primary healthcare union is SEIU for God's sake - their even worse than the NEA.
This is what I get for using dictation software.
Should be "... they're even worse ..."
Posted by: Tom W at August 17, 2009 2:14 PMJustin,
That specific section in the Health Reform Bill has nothing to do with rationing, or as the source says ‘…if you don't specifically need the motorized chair for complex rehabilitation, Obamacare says you can freaking walk or crawl from now on. Or pay for it yourdamnself. …’
Here’s the section of the Social Security Act as it is now that the HRB would modify:
(iii) Purchase agreement option for power-driven wheelchairs.—In the case of a power-driven wheelchair, at the time the supplier furnishes the item, the supplier shall offer the individual the option to purchase the item, and payment for such item shall be made on a lump-sum basis if the individual exercises such option.
So if someone needs a motorized chair, they’ll still be able to get it… it only modifies a purchase agreement option - an option that is only in there because payment for the rental item (wheelchair) must be made on monthly basis. That source’s interpretation is completely false, and way off base.
(I) In general.—Except as provided in clause (iii), payment for the item shall be made on a monthly basis for the rental of the item during the period of medical need (but payments under this clause may not extend over a period of continuous use (as determined by the Secretary) of longer than 13 months).
The source--me--does not interpret this to be rationing. My objection is that this word game appears to be one of two things: either a needless change to add "complex rehabilitative," or an intent to restrict the number of medical devices which qualify for this payment. If the former, why do it? If the latter, why do it? There is no explanation within the bill for the necessity of the change. It therefore appears to be working a specific political angle.
There is further no other provision within the bill for non-complex/non-rehabilitative power driven wheelchair. I welcome any rational explanation for the change.
Posted by: The Czar of Muscovy at August 18, 2009 12:35 AM
My point was that it’s neither rationing of benefits as Justin suggested, nor an outright denial in benefits for people to get their “scooters” as you suggested in the statement:
‘…if you don't specifically need the motorized chair for complex rehabilitation, Obamacare says you can freaking walk or crawl from now on. Or pay for it yourdamnself. …’
Payments are still going to be made, but it won’t be coming out of the pockets of individuals. The payments for the majority of motorized wheelchairs will now have to be made on a monthly basis rather than having the option of paying for it up front in a lump-sum payment. My guess is that won’t sit well with companies furnishing those items, but grannie will still get her scooter… and if she’s not paying for it, why would she give a sh!t whether it was being paid off on a monthly basis or all up front?
There’s no limitation as to who will or won’t get a motorized scooter, just a modification of the payment options. My only guess to the necessity of this is to help spread out the costs over a period of time rather than being burdened with numerous lump sum payments to suppliers.
Thanks. I've mentioned your benign assessment in a followup post. It's odd to me though that this particular medical appliance would be so specifically singled out, but I have also assumed that much of the odd organization within HR 3200 is a reflection of the SSA sections itself. Rather than reform the SSA, the authors of the bill created hundreds of cross-references with proposed changes.
But now that I understand the intent of the funding, why do you suppose they changed the wording on the name of the medical appliance? This is where I concluded the intent was to restrict the broad "generosity" of Medicare down to rehabilitation-specific applications. Couldn't the remainder of the revision have worked without changing the name of the device? I welcome your thoughts again.
Posted by: The Czar of Muscovy at August 19, 2009 4:57 PM