With government health care, the government makes decisions on who lives and dies: Italians over 80 'will be left to die' as country overwhelmed by coronavirus

Battlefield triage in Italy. From the UK Telegraph:

Coronavirus victims in Italy will be denied access to intensive care if they are aged 80 or more or in poor health should pressure on beds increase, a document prepared by a crisis management unit in Turin proposes. 

Some patients denied intensive care will in effect be left to die, doctors fear.The unit has drawn up a protocol, seen by The Telegraph, that will determine which patients receive treatment in intensive care and which do not if there are insufficient spaces. Intensive care capacity is running short in Italy as the coronavirus continues to spread. 

The document, produced by the civil protection deparment of the Piedmont region, one of those hardest hit, says: "The criteria for access to intensive therapy in cases of emergency must include age of less than 80 or a score on the Charlson comorbidity Index [which indicates how many other medical conditions the patient has] of less than 5." 

The ability of the patient to recover from resuscitation will also be considered.One doctor said: "[Who lives and who dies] is decided by age and by the [patient's] health conditions. This is how it is in a war."

Huge increases in health insurance premiums to hit right before the November election

The death spiral for health insurers.  Higher prices will mean that more young people will drop their insurance and lead to higher losses and higher premiums.  From Politico:

The last thing Democrats want to contend with just a week before the 2016 presidential election is an outcry over double-digit insurance hikes as millions of Americans begin signing up for Obamacare. 

But that looks increasingly likely as health plans socked by Obamacare losses look to regain their financial footing by raising rates. 

Just a week after the nation’s largest insurer, UnitedHealth Group, pulled out of most Obamacare exchanges because it anticipates $650 million in losses this year, Aetna’s CEO said Thursday that his company expects to break even, but legislative fixes are needed to make the marketplace sustainable. 

“I think a lot of insurance carriers expected red ink, but they didn’t expect this much red ink,” said Greg Scott, who oversees Deloitte’s health plans practice. "A number of carriers need double-digit increases.” . . .

One big reason is lower-than-expected enrollment of younger, often healthier people who balance the costs of those who require more costly care. Roughly 12.7 million Americans signed up for Obamacare plans during the most recent open enrollment period. That’s far below the 22 million projected by the Congressional Budget Office, and it’s certain to decline as some drop out. 

“The pool is far less healthy than we forecast,” said Brad Wilson, CEO of Blue Cross Blue Shield of North Carolina, which says it lost $400 million on its exchange business during the first two years and is weighing whether to compete for Obamacare customers in 2017. “That’s an issue not just here in North Carolina, but all over. … We need more healthy people in the pool.” . . .

U.K. authorities had refused to give child medical treatment he needs, parents take child out of country, UK seek extradition to force family back to country

Socialized medical system in the UK can't give a young boy suffering a brain tumor the specialized medical treatment he needs.  So the family, trying to save the boy's life, takes the boy out of the country.  In response, the government puts out a criminal warrant for the family.  From the Associated Press:

The grandmother of a 5-year-old British boy with a severe brain tumor accused U.K. authorities on Monday of cruelty for seeking an arrest warrant and pursuing the family abroad after his parents removed him from a British hospital against medical advice.
Hours later, a Spanish judge ordered the parents' detention for 72 hours while a court in Madrid considers whether to grant Britain an extradition request. 

Grandmother Patricia King told the BBC it was an "absolute disgrace" that her son and daughter-in-law were accused of child neglect after they took Ashya from Southampton General Hospital last week. The family says U.K. authorities had refused to give Ashya the kind of treatment he needed. 

The family has criticized Britain's health care system, saying he needs an advanced treatment option called proton beam therapy and that it wasn't being made available to him. 

King's parents were arrested Sunday in southeastern Spain after a European arrest warrant was issued by Interpol at the request of British police. Their son is receiving medical treatment for a brain tumor. After his parents' arrest, he was admitted to a Spanish hospital. . . .

With all the corruption and unnecessary deaths in the Veterans Administration hospitals, it is interesting to see who has touted it as the big success story

With even the Obama administration admitting that 27 veterans have died because of the waiting list scam, Democrats even having a hard time with the VA now.  But a few years ago, while these problems were festering, liberals were pointing to the VA as the example that we should all follow.  As to the Obama administration's explanation On Sunday’s “Meet the Press,” NBC News chief Pentagon reporter Jim Miklaszewski claimed, “You have a VA that is overwhelmed and under-resourced,” John Merline points out that was incorrect. 

Paul Krugman in 2011 wrote of the VA’s “huge success story”:

Multiple surveys have found the VHA providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers…the VHA is an integrated system, which provides health care as well as paying for it. So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense. . . . Yes, this is ‘socialized medicine’… But it works, and suggests what it will take to solve the troubles of US health care more broadly. . . .

Nicholas Kristof of the Times wrote in 2009:

Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more “socialized medicine” than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effectiveelements in the American medical establishment. . . .

Uwe Reinhardt of Princeton wrote in the pages of the Times:

Remarkably, Americans of all political stripes have long reserved for our veterans the purest form of socialized medicine, the vast health system operated by the U.S. Department of Veterans Affairs (generally known as the V.A. health system). If socialized medicine is as bad as so many on this side of the Atlantic claim, why have both political parties ruling this land deemed socialized medicine the best health system for military veterans? Or do they just not care about them?  . . .

Ironically, President Obama now explains that the current problems are nothing surprising, with the VA’s issues go back years:

[A]ll of us, whether here in Washington or all across the country, have to stay focused on the larger mission, which is upholding our sacred trust to all of our veterans, bringing the VA system into the 21st century, which is not an easy task….  caring for our veterans is not an issue that popped up in recent weeks. Some of the problems with respect to how veterans are able to access the benefits that they've earned, that's not a new issue.  . . .

Click to make the screen shot from the website from when Obama was president-elect larger.

Swedes getting tired of long queues to get health care, moving to private health insurance

Seven day waits to visit primary care doctor? As someone who has had relatives through marriage in Sweden, I can attest first hand that there have been extremely long delays of months once one gets past primary care.  From The Local in Sweden:

More than half a million Swedes now have private health insurance, showed a new review from industry organization Swedish Insurance (Svensk Försäkring). In eight out of ten cases, the person's employer had offered them the private insurance deal. 

"It's quicker to get a colleague back to work if you have an operation in two weeks' time rather than having to wait for a year," privately insured Anna Norlander told Sveriges Radio on Friday. "It's terrible that I, as a young person, don't feel I can trust the health care system to take care of me."  

The insurance plan guarantees that she can see a specialist within four working days, and get a time for surgery, if needed, within 15. 

In December, the queues in the Swedish health care system pushed the country down a European ranking of healthcare. 

"Why can Albania operate its healthcare services with practically zero waiting times, and Sweden cannot?" the report authors from the Health Consumer Powerhouse (HCP) organization in Brussels asked, albeit acknowledging modest improvements. "The Swedish queue-shortening project, on which the state has spent approximately €5 billion, has achieved some shortening of waiting times." . . .  

"The target for maximum wait in Sweden to see your primary care doctor (no more than seven days) is underachieved only by Portugal, where the corresponding figure is 15 days," the report stated. . . .

"Bloomberg banned food donations to homeless shelters"

Mayor Michael Bloomberg in March instituted a ban on food donations to homeless shelters. Not because of food contamination, but because the city can’t properly assess salt, fat and fiber in donated food and thereby ensure starving people are getting what he deems to be appropriately healthy meals.

. . . In conjunction with a mayoral task force and the Health Department, the Department of Homeless Services recently started enforcing new nutritional rules for food served at city shelters. Since DHS can’t assess the nutritional content of donated food, shelters have to turn away good Samaritans. 

For over a decade, Glenn Richter and his wife, Lenore, have led a team of food-delivery volunteers from Ohab Zedek, the Upper West Side Orthodox congregation. 

They’ve brought freshly cooked, nutrient-rich surplus foods from synagogue events to homeless facilities in the neighborhood. (Disclosure: I know the food is so tasty because I’ve eaten it — I’m an OZ member.) The practice of donating such surplus food to homeless shelters is common among houses of worship in the city. 

DHS Commissioner Seth Diamond says the ban on food donations is consistent with Mayor Bloomberg’s emphasis on improving nutrition for all New Yorkers. A new interagency document controls what can be served at facilities — dictating serving sizes as well as salt, fat and calorie contents, plus fiber minimums and condiment recommendations. . . .

More more recent nuttiness from the New York Daily News.

. . . Bobby Eustace, a firefighter out of Ladder 27 in the Bronx, has been serving free hot food to the homeless and displaced and to relief workers and volunteers in Breezy Point, Queens, since two days after the hurricane hit. 

On Sunday, Eustace and dozens of fellow firefighter volunteers served 800 free hot meals from a steamy Army tent in this hemorrhaging beach community, where there are no longer stores or restaurants, where most people have no gas to cook with, no heat or hot water and no hot food. 

That afternoon, a freon-blooded inspector from the city’s Department of Health issued Eustace a notice of violation for not meeting the same food-handling standards as, say, the Four Seasons. . . .

Some comments are of interest are available here.

"Bureaucracy Still Seen by Britons as Biggest Problem with NHS"

So much for the notion that government provision will make health care more responsive to patients' care.  Here is a survey from Angus Reid:

. . . While there has been a noticeable spike in the proportion of Britons who are satisfied with the National Health Service (NHS), more than a third of respondents believe bureaucracy and poor management remain its biggest hurdles, a new Angus Reid Public Opinion poll has found.In the online survey of a representative national sample of 2,033 British adults, 35 per cent of respondents (+6 since October 2011) think the NHS works well, and only minor changes are needed to make it work better.
Half of Britons (52%, -5) believe there are some good things in the NHS, but many changes are required. Only one-in-ten respondents (9%, -1) believe the NHS has to be completely rebuilt. . . .

So where will Americans end up going for health care?

Obama has often said that he would like a health care system like they have in Canada. Look at how so few doctors these days are taking new Medicare patients. If that type of pricing policy is applied across the board, we would see fewer doctors providing services there also.

A Canadian study released Wednesday found that many provinces in our neighbor to the north have seen patients fleeing the country and opting for medical treatment in the United States.

The nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent — more than double — compared with statistics from 1993.

Specialist physicians surveyed across 12 specialties and 10 provinces reported an average total wait time of 19 weeks between the time a general practitioner refers a patient and the time a specialist provides elective treatment — the longest they have ever recorded.

In 2011, Canadians enrolled in the nation’s government-dominated health service waited long periods of time for an estimated 941,321 procedures. As many as 2.8 percent of Canadians were waiting for treatment at any given time, according to the Institute.

“In some cases, these patients needed to leave Canada due to a lack of available resources or a lack of appropriate procedure/technology,” according to the Institute. “In others, their departure will have been driven by a desire to return more quickly to their lives, to seek out superior quality care, or perhaps to save their own lives or avoid the risk of disability.” . . .

On a related note:

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court. . . .

Government created drops in drug production

Have you wondered why there seems to be shortages of important medical drugs?  Well, it appears that the answer is actually pretty straightforward.  From the Washington Examiner:

President Obama's Food and Drug Administration has caused "a public health crisis" -- a prescription drug shortage over the past two years -- by increasing the number of threats issued to raid and close drug manufacturing plants, according to House investigators.
"This shortage appears to be a direct result of over-aggressive and excessive regulatory action," House Oversight and Government Reform Committee Chairman Darrell Issa, R-Calif., said  . . .
The committee report concluded that a significant portion of the drug shortage is a problem of the Obama administration's making. "Among shuttered manufacturing lines that occurred over the previous two years, the committee’s review did not find any instances where the shutdown was associated with reports of drugs harming customers," the report says, noting a 30 percent drop in the manufacture of certain prescription drugs at the largest manufacturers in the country. . . .
The FDA sent just 474 such letters in 2009, but that number spiked to 1720 in 2011. "A common sense approach to regulations must be restored at the FDA," the committee report advised . . . .

New York taxing both unhealthy and healthy activities

Well, if the government is going to put a heavy tax on healthy activities, this must justify them putting a really heavy tax on unhealthy ones.  From the WSJ:

The New York Department of Taxation and Finance decided that yoga studios fall into a category of businesses -- specifically weight control or health salons -- that must pay the city's levy, officials said.
The decision was revealed last April in a bulletin from the department and now is sinking in as yoga studios across the city prepare their taxes.
The state -- which collects the city's sales tax -- already began auditing yoga studios, presenting them in some cases with bills for back sales taxes for the past three years.
"We do see this as a fairness issue," according to Edward Walsh, a spokesman for the Department of Taxation and Finance, noting that Pilates studios have to pay sales tax. "Businesses that provide similar services should be subject to the same taxes in the city." . . .

More Mandates in Obamacare

From ABC News:

The individual insurance requirement that the Supreme Court is reviewing isn't the first federal mandate involving health care. There's a Medicare payroll tax on workers and employers, for example, and a requirement that hospitals provide free emergency services to indigents. Health care is full of government dictates, some arguably more intrusive than President Barack Obama's overhaul law. It's a wrinkle that has caught the attention of the justices. Most of the mandates apply to providers such as hospitals and insurers. For example, a 1990s law requires health plans to cover at least a 48-hour hospital stay for new mothers and their babies. Such requirements protect some consumers while indirectly raising costs for others. One mandate affects just about everybody: Workers must pay a tax to finance Medicare, which collects about $200 billion a year. It's right on your W-2 form, line 6, "Medicare tax withheld." Workers must pay it even if they don't have health insurance. Employees of a company get to split the tax with their employer. The self-employed owe the full amount, 2.9 percent of earnings. . . .

Paul Krugman's embarrassingly weak analysis on the Supreme Court debate over health care

Krugman's piece on Friday, "Broccoli and Bad Faith," continues his trend for polemics over accuracy or analysis.

Let's start with the already famous exchange in which Justice Antonin Scalia compared the purchase of health insurance to the purchase of broccoli, with the implication that if the government can compel you to do the former, it can also compel you to do the latter. That comparison horrified health care experts all across America because health insurance is nothing like broccoli. Why? When people choose not to buy broccoli, they don't make broccoli unavailable to those who want it. But when people don't buy health insurance until they get sick -- which is what happens in the absence of a mandate -- the resulting worsening of the risk pool makes insurance more expensive, and often unaffordable, for those who remain. As a result, unregulated health insurance basically doesn't work, and never has. . . .

OK, so if you wait until you are sick before you buy health insurance, you drive up the price of insurance for others. But the exact same argument exists for broccoli. If broccoli makes you healthier and you don't eat it, you are more likely to get sick and you will shift up the demand curve for health care, raising the price of insurance.

unregulated health insurance basically doesn't work, and never has. . . .

Krugman is well-known for his assertions. If you got rid of insurance regulations, prices would be set according to risk.

I was struck, in particular, by the argument over whether requiring that state governments participate in an expansion of Medicaid -- an expansion, by the way, for which they would foot only a small fraction of the bill -- constituted unacceptable "coercion." One would have thought that this claim was self-evidently absurd. After all, states are free to opt out of Medicaid if they choose; Medicaid's "coercive" power comes only from the fact that the federal government provides aid to states that are willing to follow the program's guidelines. If you offer to give me a lot of money, but only if I perform certain tasks, is that servitude? . . .

The discussion before the Supreme Court was over "coercion," not "servitude." "Coercion" means to impose a cost on others. As any economist knows, costs are always opportunity costs. Giving up money represents an opportunity cost. But let me make it simple for Krugman: You take money from me by force and give it back only if I do want what you want me to do. That sure seems like coercion.

How the costs of Obamacare are going to ramp up quickly

Over the eleven years from 2012-2022, Obamacare will add an average of $114 billion a year to the deficit. From 2015 to 2022, the average increase in the deficit rises to $148 billion a year. The CBO numbers can be found in Table 2 is available here. Of course, if the Supreme Court strikes down the individual mandate, that will increase the average annual deficit over the 2015-2022 period by about $7 billion a year.

Thanks to Tony Troglio for the link.

Another year of faster than promised increases in health insurance prices after Obamacare

Last year I had this post available here. This year we have this news:

The good news is that the cost of employer-sponsored health insurance is growing at a stable rate. The bad news is that the rate still exceeds inflation and worker wage increases, according to a survey from benefits consultant Towers Watson and the National Business Group on Health.
The annual cost of health coverage will rise nearly 6 percent to an average of $11,664 per employee in 2012, said the survey, which was released Thursday. The employee portion of that bill — or what comes out of worker paychecks — will climb, on average, 9.3 percent to $2,764. . . .

A question for Sandra Fluke

Just out of curiosity, if Fluke can't afford contraceptives, why can't she ask her boyfriends to themselves buy condoms before they come over? This woman is 30 years old and if she can't afford the $15 to $50 that the pill supposedly costs each month, can she use condoms? I just looked online and you can get condoms for about 43 cents each (free shipping). So having sex once a day for the year would cost her about $157. The average price for the pill would be about $390 a year. Cut these costs in half if she can get her boyfriends to chip in equally.

The Obama administration rejects Dem Gov. Jerry Brown's attempts at modest health care cost savings

Even very modest co-pays will make people use resources more responsibly. Why be careful at all with what you ask for if the price to you is zero? Co-pays for drugs ($3) and doctor visits ($5) seem very trivial compared to their true costs. From the WSJ's Political Diary.

Strapped with a $13 billion deficit last year, Mr. Brown sought to squeeze $1.6 billion of savings out of the state's Medicaid program. Since more than half of the state's Medicaid dollars come from the federal government, Mr. Brown had to request waivers from Health and Human Services Secretary Kathleen Sebelius to implement many of his cost-saving solutions. While Ms. Sebelius last year signed off on a 10% rate cut to providers, which was projected to save the state about $600 million, she drew a line in the sand on the governor's request to charge Medicaid recipients a co-pay for drugs ($3) and doctor visits ($5).

The co-pays would save the state more than $300 million a year, but the Obama administration reasoned that they would deter recipients from seeking treatment and thus restrict health-care access. While in Washington, D.C., for the National Governors Association's winter meeting earlier this week, Mr. Brown lobbied Obama senior advisor Valerie Jarrett and Ms. Sebelius again for a waiver but didn't sound too optimistic about his prospects. The governor said that Ms. Sebelius had raised "legal issues" about charging co-pays and indicated that there were other ways to reduce Medicaid costs, which she didn't specify.

Trouble is, the Obama administration won't countenance limiting eligibility or introducing incentives that encourage doctors and patients to use health resources more judiciously. . . .

Surprise increase in the cost of Obamacare for next fiscal year

Some technicalities apparently have some real consequences. So much for Obama's promises about how much Obamacare would cost.From the AP:

Cost estimates for a key part of President Obama's health care overhaul law have ballooned by $111 billion from last year's budget, and a senior Republican lawmaker on Friday demanded an explanation.
House Ways and Means Committee Chairman Dave Camp, R-Mich., wants to know by Monday why the estimated ten-year cost of helping millions of middle-class Americans buy health insurance has jumped by about 30 percent.
Administration officials say the explanation lies in budget technicalities and that there are no significant changes in the program.
The revised numbers, buried deep in the president's budget, stumped lawmakers and some administration officials for most of the week. At a congressional hearing Tuesday, Health and Human Services Secretary Kathleen Sebelius, who is in charge of carrying out the health care law, indicated she was unaware of the changes.
At issue are subsidies that will be provided under the health care law to help middle class people buy private coverage in new state insurance markets that will open for business in 2014.
Last year's budget estimated the cost of the aid to be $367 billion from 2014-2011. This year's budget puts it at $478 billion over the same time period. . . .

When Doctors need medical what choices do they make?

From the WSJ:

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life. . . .

Cost of government risk insurance double what was previously estimated

Only a fraction of the people who were supposed to sign up for this program have done so (see here). The government has gone all out to try to convince more people to sign on to it. But the costs for those who have turned out to be wildly higher that the Obama administration had estimated. From the Washington Post:

The health-care law set aside $5 billion for a Pre-Existing Condition Insurance Plan, meant to provide health insurance to those who had been declined coverage by private carriers. Since its launch last summer, nearly 50,000 Americans have enrolled in the program.

The PCIP program will phase out in 2014, when insurers will be required to accept all applicants regardless of their health-care status.

Those who have enrolled in the program are projected to have significantly higher medical costs than the government initially expected. Each participant is expected to average $28,994 in medical costs in 2012, according to the report, more than double what government-contracted actuaries predicted in November 2010. Then, the analysts expected that the program would cost $13,026 per enrollee.

The costs also are significantly higher than those of similar high-risk pools that many states have operated for decades. States spent an average of $12,471 on enrollees in 2008, according to the National Association of State Comprehensive Health Insurance Plans.

The Obama administration has spent $600 million of its $5 billion budget for the program over the past 18 months. . . .

So much for the Obama administration claim that mandating abortion and contraception coverage would lower insurance costs

Obviously it is right that people will pay for these benefits one way or the other. From The Hill Newspaper

:

The insurance industry is concerned it will take a hit from the Obama administration’s mandate that they provide birth control in health plans for employees of religious organizations that object to the coverage.

Publicly, the health insurance industry has avoided getting involved in the fight.

But in private, the industry is dubious of the administration’s argument that the insurance industry wouldn't take a hit because birth control is cheaper than unwanted pregnancies.
The trade group America's Health Insurance Plans has limited its comments to saying it worries about the "precedent" the mandate would set. The concern is that the government could eventually require health plans to cover any number of preventive services – even prescription drugs - without copays or deductibles, under the theory that they save money in the long-term.

Privately, however, insurers say there's nothing "free" about preventing unwarranted pregnancies. They say the mandate also covers costly surgical sterilization procedures, and that in any case even the pill has up-front costs.

"Saying it's revenue-neutral doesn't mean it's free and that you're not paying for it," an industry source told The Hill. . . .