The Editorial Board of the Washington Post called out the Senate for trying to hide the true cost of Obamacare. Now they say the House “plays make-believe, but the bill to taxpayers is real.” Read the whole thing:
HAVING PASSED a health reform bill that is, at least theoretically, paid for, the House of Representatives is poised this week to blow a quarter-trillion-dollar hole in the federal budget involving, you guessed it, health care. This is the so-called doc fix, to prevent scheduled cuts in Medicare reimbursements to physicians from taking effect.
Say you are a member of Congress who agrees that the cuts should be rescinded — that physician payments shouldn’t be reduced, that is — but also believes that the payments should not add to the national debt? Under the rule governing the House debate, you won’t be allowed to suggest any offsetting savings. Either you go for the doc fix and add massively to the deficit, or you torpedo the fix and wreak havoc in the Medicare program, with a 21 percent cut set to take effect Jan 1. Nice choice. It puts those who believe in both fiscal responsibility and averting these draconian cuts in an impossible situation.
By the way, don’t be fooled by the incredible shrinking “cost” of the fix. The official Congressional Budget Office estimate used to be $245 billion over 10 years. Now it’s $210 billion. In fact, the real hit to the budget will be closer to $300 billion. The lower CBO numbers stem primarily from the administration’s move to change the rules about which physician payments are subject to the cuts. The administration proposed a regulation to exempt drugs administered in doctor’s offices, such as chemotherapy, from the spending ceiling. That has the effect of making the cost of the fix look smaller, but it doesn’t change the ultimate drain on the treasury: Medicare will end up paying out the same amount of money.
All of this is, to some degree, Medicare kabuki to placate the American Medical Association. The Senate doesn’t have the votes to pass a permanent fix without paying for it — though, of course, it also doesn’t have the votes actually to pay for it. So while the House might pass the unpaid-for fix, it will likely die there. The result will be another year-long, or possible two-year, patch slapped on this mess. Finding the money to pay for the fix and, more to the point, cobbling together the political coalition to support it, is difficult. Which is why Congress and the administration have joined hands in the pretense that the doc fix has nothing whatsoever to do with health reform.
The Oregon Health Plan is a government run health insurance option that, like some current health plans being pushed in Washington, is designed to increase access to health care and contain health care costs. The cost of the OHP far outstripped original estimates so new enrollment in the program was closed from mid-2004 until early 2008, when a lottery-based system was introduced to limit new enrollments. As this June 2008 local news story from KATU in Portland shows, the Oregon Health Plan also found other ways to limit costs as well:
Click here to view the embedded video.Here is the text of KATU’s report:
Barbara Wagner has one wish - for more time.
“I’m not ready, I’m not ready to die,” the Springfield woman said. “I’ve got things I’d still like to do.”
Her doctor offered hope in the new chemotherapy drug Tarceva, but the Oregon Health Plan sent her a letter telling her the cancer treatment was not approved.
Instead, the letter said, the plan would pay for comfort care, including “physician aid in dying,” better known as assisted suicide.
“I told them, I said, ‘Who do you guys think you are?’ You know, to say that you’ll pay for my dying, but you won’t pay to help me possibly live longer?’ ” Wagner said.
Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, said Wagner is making an “unfortunate interpretation” of the letter and that no one is telling her the health plan will only pay for her to die.
One critic of assisted suicide calls the message disturbing nonetheless.
“People deserve relief of their suffering, not giving them an overdose,” said Dr. William Toffler.
He said the state has a financial incentive to offer death instead of life: Chemotherapy drugs such as Tarceva cost $4,000 a month while drugs for assisted suicide cost less than $100.
Saha said state health officials do not consider whether it is cheaper for someone in the health plan to die than live. However, he admitted they must consider the state’s limited dollars when dealing with a case such as Wagner’s.
“If we invest thousands and thousands of dollars in one person’s days to weeks, we are taking away those dollars from someone,” Saha said.
But the medical director at the cancer center where Wagner gets her care said some people may have incredible responses to treatment.
The Oregon Health Plan simply hasn’t kept up with dramatic changes in chemotherapy, said Dr. David Fryefield of the Willamette Valley Cancer Center.
Even for those with advanced cancer, new chemotherapy drugs can extend life.
Yet the Oregon Health Plan only offers coverage for chemo that cures cancer - not if it can prolong a patient’s life.
“We are looking at today’s … 2008 treatment, but we’re using 1993 standards,” Fryefield said. “When the Oregon Health Plan was created, it was 15 years ago, and there were not all the chemotherapy drugs that there are today.”
Patients like Wagner can appeal a decision if they are denied coverage. Wagner appealed twice but lost both times.
However, her doctors contacted the pharmaceutical company, Genentech, which agreed to give her the medication without charging her. Doctors said that is unusual for a company to give away such an expensive medication.