A Letter to a Senator on Healthcare

Dear Senator McCaskill:

This is in response to remarks you made yesterday with respect to health care reform on Kansas City’s Morning News with EJ & Ellen.

First, here’s a bit of context for your consideration.

·    The United States does not have a unitary “health care system.” Instead, there are multiple providers and competing methods of paying for care (Commercial Insurance, Blue Cross/Blue Shield, PPOs, HMOs, Medicare, and Medicaid, for example). Freedom can be a messy thing and the results are certainly uneven, but the variety of choices and the absence of centralized bureaucratic control have always been among the strengths of the American approach.

·    Health care and insurance coverage are not the same thing. It is claimed that 46 million Americans are uninsured; the implication being that those 46 million Americans cannot obtain health care. That implication is simply false. Millions of people, mostly young, have simply decided not to purchase health insurance. A very large number of the alleged “46 million” uninsured are illegal aliens (or, if you prefer, “undocumented immigrants”). When these two categories of the uninsured are removed from the calculation, the number remaining without coverage is relatively small and it cannot be claimed that they have no access to care. American hospitals and physicians voluntarily provide millions of dollars worth of uncompensated charity care every year. In addition, almost every hospital in America is required by the Emergency Medical Treatment and Active Labor Act (EMTALA) to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. The law applies to all patients and they can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer their required treatment.

·    Hospital care, medical care, and health care insurance have all become very expensive, but price increases for individual services and the increases in total health care expenditures are not the same thing.

·    Government intervention, government regulation, federal program cost shifting, and unnecessary litigation are the primary causes of hospital and medical care price increases. These are the very things that the most vociferous advocates of “health care reform” refuse to address, primarily because their policies caused them in the first place!

·    Increases in total health care expenditures are caused by all of the things described in the previous paragraph, plus increased demand for service spawned by first dollar insurance coverage and the provision of “free” or subsidized health care through government programs. Providing additional “free” or subsidized coverage to the uninsured under a public option will produce increased service demand and, consequently, produce even greater increases in total health care expenditures.

Although the mandatory end-of-life counseling requirement has reportedly been removed from at least some pieces of draft legislation, that provision is not the greatest threat to treatment access for the elderly ill. The Medicare program already refuses to pay for physician-ordered treatment that it deems “inappropriate” so the mechanism for a government agency to effectively override a personal physician’s judgment is already in place and is used on a daily basis. However, at the moment the patient retains at least potential options because Medicare is not a universal program. Fears that the public option will potentially threaten that option are well founded.

Here is what the President had to say on this subject just one week ago in Portsmouth.

President Barack Obama, “Town Meeting,” Portsmouth, NH, August 11, 2009

“…The idea is actually pretty straightforward, which is if we’ve got a panel of experts, health experts, doctors, who can provide guidelines to doctors and patients about what procedures work best in what situations, and find ways to reduce, for example, the number of tests that people take — these aren’t going to be forced on people, but they will help guide how the delivery system works so that you are getting higher-quality care.  And it turns out that oftentimes higher-quality care actually costs less.”

The President’s remarks are disingenuous. The issue isn’t whether tests will be “forced on people.” The issue is whether treatment will be denied to people. If the public option insurer refuses to authorize payment for a physician-ordered treatment disapproved by the federal “panel of experts,” that refusal will certainly amount to denial of treatment for many, if not most, elderly ill.

The President and other public option proponents have characterized fears of care denial to the elderly ill as “outlandish,” but consider the President’s own thoughts on this topic just four short months ago.

President Barack Obama, April 14, 2009, New York Times Magazine Interview

“April 29 (Bloomberg) — President Barack Obama said his grandmother’s hip-replacement surgery during the final weeks of her life made him wonder whether expensive procedures for the terminally ill reflect a ‘sustainable model’ for health care. …“‘That’s where I think you just get into some very difficult moral issues,’ he said in the April 14 interview. ‘The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health- care bill out here.’”

If a public option is included in the final legislation to emerge from Committee, the strong probability exists that it will include “comparative effectiveness,” a dehumanizing and immoral rationing methodology, strongly favored by the President’s advisors. Comparative effectiveness literally grants to government the power to decide who lives and who dies. This rationing method compares the estimated cost of a particular treatment against the imputed dollar value of a specific patient’s remaining years of life and makes the decision to approve or withhold care based on that cost-benefit analysis. In other words, it substitutes a computer’s statistical calculation for the clinical judgment of a real physician treating an actual human patient, reduces the value of each human life to mere dollars, and treats each patient as a statistic.

In summary, the argument against a public option, quite apart from its prohibitive cost, is compelling.

·    No private insurance company can be price competitive against a public option that can operate indefinitely at a loss. Any public option will, in short order, become the only option.

·    Because the potential demand for free health care is potentially unlimited, the public option’s need to limit expenditures will result in denial of treatment to the elderly ill, just as it already does in the many countries that promise universal health care.

Mussolini wrote in Fascism: Doctrines and Institutions, “The fascist conception of life stresses the importance of the State and accepts the individual only in so far as his interests coincide with the State.” Comparative effectiveness elevates the calculated financial interest of the state over the value of a real human being’s life. This is the literal antithesis of traditional American thinking.

Frank J. Brady
President, Brady & Associates

September 11, 2009

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