Government's Plan For Killing A Bunch Of Old People To Save Money
When government's paying for your medical costs, government has a considerable interest in seeing you die after you've become old and aren't working anymore.
This generally isn't what people think of when they think of Medicare -- but it's what they should.
Scott Gottlieb writes in the WSJ about aortic valve replacements -- which are superior to open-heart surgery and cost the same:
An ingenious medical device now allows the heart to be repaired using a catheter that introduces a replacement valve through a main artery in the leg--another miracle of modern medicine.
So, why is our government making them hard to get?
Government bureaucrats feared that the new replacement valve's lower risks and easier administration would mean that many more elderly patients would seek to fix their failing heart valves, pushing up Medicare's total spending. To limit their use, regulators created coverage rules based on a set of strained medical criteria. It was a budget prerogative masquerading as clinical reasoning.This episode is a vivid example of the government's increasing practice to regulate medicine and ration care.
How contrived are the guidelines?
For a patient to be qualified for the aortic valve device, Medicare required two cardiac surgeons to certify first that a patient wasn't a candidate for the open-heart repair.
So, you could have the less risky operation, but government is pushing you to have the riskier, more invasive one.
In fact, it's government policy that you have the riskier, more invasive one.
Nice!
Also mandated was the presence of a cardiothoracic surgeon and an interventional cardiologist in the operating room during the procedure.While regulators argued that both doctors had to be on site to rescue the patient in case of a botched procedure (which is extremely rare), in reality this costly and redundant condition was a not-so-veiled way to squelch "competition" between the two different medical specialties that might stoke wider use of the valve device. Medicare also confined the procedure to primarily large academic medical centers.
The limits represented an unprecedented collaboration between Medicare and the FDA, which put labeling rules on the valves that enabled the restrictions. Such a clumsy and forceful intrusion into the practice of medicine would never let medical care evolve with the pace of scientific advance.
The studies unveiled in Chicago confirm that many more patients could benefit from noninvasive valve repairs, and with a lower risk of death and other complications associated with open-heart surgery.
A commenter on the WSJ writes:
william O'Neill
I too have implanted hundreds of TAVR valves and could not agree more with Dr. Gottlieb. Today we know there are two major trials that show mortality is lower for TAVR than surgery.I cannot use that information today to offer the next lower risk patient I see a TAVR valve
because CMS will not pay for it. A very nice 80 yr old man was referred to me for TAVR evaluation. The man was the sole care provider for a wife with Alzheimers. He had no other family to help with the wife's care. Heart surgery would incapacitate the man and the wife would need other care for months. He wanted a less invasive valve procedure so he could cobble a few days of care for his wife from neighbors. He was distraught to learn that he was too low risk to qualify for a TAVR valve. I would have gladly called to plead his case..but guess what, there is no medical person to appeal to! The mechanism for this rationing is called National Coverage Decision (NCD). NCDs are the end of physician autonomy.
UItimately, as Gottlieb writes:
The alternative to this bureaucratic logjam is to leave the decisions to market participants like health systems and insurers who will compete to offer patients good prices and timelier access to the best services.
Whom do you sue when a government bureaucrat denies you health care?
I R A Darth Aggie at April 13, 2016 6:44 AM
Yes, here we come full circle on socialized medicine.
1. Bending the cost curve upward. The TAVR procedure will eventually be less expensive than open-heart surgery, if it isn't already. Pushing the latter over the former is short-sighted at best.
2. Classism in medicine. Someone will set up a clinic in Mexico. People who can afford to pay cash will go there and get the TAVR procedure. People who can't afford to pay cash are stuck.
3. "Right to health care". We see here what that really means: you have a "right" to whatever the government thinks you deserve, based on your political class membership. It's only a short step from there to the government deciding what medical treatments you will have, whether you want them or not. Forced sterilization, anyone?
(That last point is also my objection to euthanasia... once it's legal and accepted, it becomes an irresistible temptation to the ruling class.)
Cousin Dave at April 13, 2016 6:59 AM
Makes sense. The deceased are the most reliable democrat voting bloc around, after all
dee nile at April 13, 2016 7:48 AM
Once it becomes legal and accepted it will become your patriotic duty to king and country to choose that option.
I R A Darth Aggie at April 13, 2016 7:48 AM
The government death panels are here.
Matt at April 13, 2016 8:39 AM
We should turn this over to giant corporations!
20% don't even pay their taxes so figuring THIS out should be a breeze.
Bring on the private sector sociopaths! Do away with the public sector sociopaths!
Gog_Magog_Carpet_Reclaimers at April 13, 2016 12:41 PM
I don't get your beef Gog. Do we need to get you a little skirt for you to do your cheerleading in?
The private sector people your article refers to aren't sociopaths. Everything referred to are legal and ethical tax breaks. Also, you can vote with your wallet. Private company doesn't provide what you want just go somewhere else. The government gives you one choice with no incentive to ever do better.
Honestly we should just scrap the corporate income tax. It doesn't bring in much revenue and just leads to a lot of screwy paperwork.
Ben at April 13, 2016 1:24 PM
"Whom do you sue when a government bureaucrat denies you health care?"
"Yes, you're sick; sorry, fill out the form and wait. Wait some more. You've been promised that no one will be denied care. "Sorry, madam, you'll have to wait. You're not being denied care, it just isn't available right now." Oh, you want to go somewhere else, because some bureaucrat has not got it through their thick head that disease does not wait? Sorry. You can't."
You will not get to say what happens unless you are the one paying.
Radwaste at April 13, 2016 2:48 PM
Hah.. one of the top comments to Gog's linked article:
Miguelitosd at April 13, 2016 4:02 PM
Why would you expect your government healthcare to be any better than that provided (belatedly or not) by the VA?
MarkD at April 13, 2016 5:14 PM
Yea, Sarah Palin mentioned that Russia would be a problem - and they mocked her by saying that the cold war wants its ideology back.
Palin also mentioned death panels - and they mocked her on that too.
Hmmm, it looks like both are coming true.
But, that's okay - we've got Barry to play hoops; and soon to have Hillary lying as Americans die overseas. And, Bill will be stalking interns with all his free time in the halls of the White House. So maybe an early death would be better?
charles at April 13, 2016 6:11 PM
"Do we need to get you a little skirt for you to do your cheerleading in?"
Only if I can borrow one of yours, cupcake.
Gog_Magog_Carpet_Reclaimers at April 13, 2016 6:48 PM
"Only if I can borrow one of yours, cupcake."
It only comes in red, OK? After all that is the only valid color for a cheerleader skirt. All the rest are phonies.
Ben at April 13, 2016 7:07 PM
"Why would you expect your government healthcare to be any better than that provided (belatedly or not) by the VA?"
Yeah, that's the thing... we already have socialized medicine, and it's called the Veterans Administration. Observe how well it works.
"Oh, you want to go somewhere else, because some bureaucrat has not got it through their thick head that disease does not wait? "
This is your assigned health care facility. If you want to request a transfer, fill out this form in triplicate and send it to the Adjudication Board. They will hear your case six months from now.
Cousin Dave at April 14, 2016 7:15 AM
Healthcare from the government is like getting a pension from Al Capone. Things change, and who are you going to argue with?
Andrew_M_Garland at April 14, 2016 8:54 AM
I read an article a while back about the Canadian system and the shortage of MRI machines. The attitude of the Canadian bureaucrat being interviewed was that having an excess of MRI machines means they would not be utilized as efficiently as having fewer machines serving the same number of customers. He even called the US healthcare system "inefficient" because it had more MRI machines than it needed. Excess capacity is anathema to a planned economy. Having fewer machines means they are used more frequently, therefore the usage is more efficient from a cost per use perspective.
If you pay $15,000 per month for your MRI machine and you only use it 15 times per month, the cost-per-use is $1,000. On the other hand, if you use it 45 times per month, the cost-per-use is $333. So, fewer machines means more use of each machine and lower cost-per-use, at least in government accounting.
Karl Marx used excess manufacturing capacity as his bete noire. Capitalism, in his view, engendered competition, which meant too much manufacturing capacity would be dedicated to making duplicate products, an inefficiency he despised.
Single-payer healthcare would rather you wait for an MRI that is in constant use, even at the risk of your life, than have under-used machines.
Conan the Grammarian at April 14, 2016 7:52 PM
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