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EDITOR OF REDSTATE

Healthcare Paid for With Unicorn Farts

By: Erick Erickson (Diary)  |  February 13th, 2013 at 12:31 AM  | 

RESIZE: AAA

There will be many words from many people about much of the President’s State of the Union speech from last night.

I will only focus on one line, which distinctly highlights again just how out to lunch the man is when it comes to real healthcare reforms in this country.

During his speech the President said this:

We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital – they should be based on the quality of care that our seniors receive.

In other words, we should stop paying for tests based on the number performed and we should stop paying for hospitals based on the number of days in which a patient stays in the hospital. Instead, we should pay based on the quality of care given, which I guess means if suddenly your stool sample turns to gold, we’ll charge more.

His approach makes no sense. Healthcare cannot be paid for based on quality of care without introducing subjective standards that will themselves drive up the costs of healthcare. He might as well claim he does not want to pay for healthcare at all or, at best, will cover the costs with unicorn farts.

The President’s speech was a defense of big government.

He started his speech referencing John F. Kennedy.

John F. Kennedy said, “ask not what your country can do for you — ask what you can do for your country.”

Barack Obama now only wants to tell us what Uncle Sam will do for us so that we need do nothing for ourselves. If he is successful we will each be too dependent on the federal government to set our own course in life.

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COMMENTS

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  • Tbone

    No triple bypass in the budget, here’s your aspirin.

    See, that’s how it works.

  • talgus

    If you are a gun owner, please die. You guys are scary. Or just remove the bolts from your weapons. Like in my inauguration.

  • PowerToThePeople

    We were the prophets of what was to come when losers demanded more for *free* which really meant more on the backs of the working/wealthy class. Problem is, the well is nearly dry. We told them, we fought it, they wanted it, they won, now they will have the prize they sought for. But just as a King was what Israel wanted but turned out oh so bad, they have their demands.

    Just hope they do not whine when they see what they won.

  • joshinca

    His proposal is to pay for results instead of process, which would work if consumers directly controlled the money spent for their healthcare and that spending was happening within a competitive free market.

    The problem, of course, is that Obamacare further separates consumers from costs and limits competition.

  • neiman1

    We will afford health care not by what we do to make you well but by how little we do so we can keep the cost down…. to the elderly…just hurry up and die.

  • brah

    The “plan” is to pit the financial incentives of the doctor vs. the healthcare needs of the patient. Doctors will no longer have the health of the patient foremost, but rather how cheaply they can get you in and out of the hospital in the CMS bundle payment plan. http://innovation.cms.gov/initiatives/Bundled-Payments/index.html

    CMS will eventually force every hospital into bundled payments by drastically cutting reimbursements for individual fee for service costs. This has started already – unsubstantiated reimbursement cuts have hit my field, radiology, hard in the past few years with the only saving grace that the Republican House has stopped even more Draconian cuts from occurring. However, with the creation of the independent advisory board (IPAB), Congress will largely be removed from the equation. As a result, we will certainly see the closing of most independent physician offices and many community hospitals. Most unfortunate though is the drastic change to the doctor patient relationship, where the cheapest “fix” to your healthcare needs will now be sought.

  • PaladinLostHour

    It’s not just that healthcare will simply become a ‘push them thru the system cheap’ caricature of itself (it will). It’s what will happen to the sickest patients under one size fits all, quality of care metrics.

    The reality of medicine is a bell curve -= trivial illnesses in young patients, high quality outcomes easily achieved; serious compounded illness in the elderly, mortality near certain.

    Under Obama’s framework, highly regarded physicans and surgeons will have -zero- incentive to take on the truly tough cases, where disproportionately poor outcomes will drive down both their compensation and reputation. Instead those treating the ‘left side of the bell curve’ will either be those few skilled healers with a Mother Teresa complex (not real common these days), or those with already compromised metrics- i.e., the lowest skill physicians and surgeons.

    Sickest patients turned into medical pariahs, and relegated to the worst doctors.

    Sounds like a plan, when there’s no ice floe handy.

  • gawken

    Erick…reading the headline at 4:30 AM, BEFORE the coffee had finished brewing, I mistakenly read it as “……UNION farts..”

    Which also works….

  • PaladinLostHour

    Nope. No aspirin for you, either. Daily doses have been linked to an increased risk of blindness from macular degeneration (http://www.webmd.com/eye-health/news/20130118/aspirin-blinding-eye-disease); and blindness is expensive to treat as well.

    What we can provide is this Youtube training link, so your impending demise will have maximum comic / dramatic effect:

    http://www.youtube.com/watch?v=stdi-1tIUhM

  • ilandgrl

    Why doesn’t he expect Quality of Education when talking about teachers? Has he seen the test scores of Chicago, DC and NY city public schools? Oh that’s right, he’s connected with the unions at the hip. Screw everyone else.

  • sta46

    I went with Storage Wars Texas myself. I too would have hurled something at the tv. Besides that little mamby-pamby hissy-ssssss thing that he does at the ends of his words scares the crap out of my dogs and they start peeing all over the house

  • Jack_Savage

    It is times like this where Netflix is truly useful.

    Here is an inside tip from someone who is intimately involved in this situation – they are saving Medicare money by not paying doctors nearly what they need to earn. Simple – right? Nearly all Medicare reimbursements have gone down drastically this year. And guess what is happening? Providers across the health care spectrum, by the hundreds, are filling out the paperwork (yep, you have to fill out paperwork) letting the government know they will no longer be seeing Medicare patients.

    This is going to be a horror which will hurt the poor beyond what we can imagine.

  • jawilson58

    My wife’s an LPN in the late great state of Illinois, and I can assure you that they are slowing down the payments. No pay, no play, unless your health professional is a missionary.

  • funwithknives

    What performance metric is Barry gonna suggest “… the Secretary shall…” use ?
    Is I P A B going to be the fall-back position/fall-guy/whipping boy here ?
    How does an appointed Progressive rubber-stamper come up with ‘acceptable success’ any-old-way?
    One thing is for sure after last night : The State of the Union is cruising merrily along, and the driving instructor is still ‘really clueless’, has not the foggiest ‘Eff’ of an idea how cars work, and could seemingly care less, about that ‘very large object’ we all can see,
    just up-ahead…..

  • spinoneone

    O very clearly outlined his three primary goals for the next 18 months: 1) raise taxes, especially on “bad” industries and the “rich”; 2) increase spending to increase dependence on the Government; and, 3) crush the Republicans, especially in the House. He is convinced that if he can succeed history will call him a “great” President. If he fails, well,… Count on the slimestream media to go all out to help him.

  • WY_Cowboy

    Didn’t watch the SOTU address. Watched Disney Channel with my son and daughter instead. A far more valuable use of my time. Then I read to them before I put them to bed. FYI – It was “Where the Sidewalk Ends.”

  • http://www.ajharaldson.com lakeworthcane

    Counselor, you’ve touched on the simple, unadorned truth: healthcare isn’t free, and somebody’s has to pay for it. As the healthcare reform bill’s effects kick in over the next couple of years and “the people” start realizing that they’ve been proverbially handed the proverbial bill of proverbial goods, and healtch care is isn’t free, and somebody has to pay for it, and it’s going to be them and–now, here’s the clincher–that was the original intent all along–to reduce public-sector healthcare costs while increasing the public-sector’s workforce (read: leftist voting block) and control–”the people” are going to get mad.
    It could happen, then, that Obama’s presidency–based on his “cult of personality”–begins to seriously unravel. He’s got by–and from his state-of-the-union address, I’d say he’s still getting by–on confounding, ultimately meaningless rhetoric: the sweet-sounding bologna that flies highest in meat-market pick-up bars after two A.M.
    But when the cost of healthcare–even lousy healthcare–suddenly goes through the roof, and people realize that the healthcare reform bill–which Obama certainly didn’t write and likely hasn’t read, but to which he allowed his name to be attached–was intended to do that all along . . .. When “the people” realize that the healthcare reform bill, for all its complexity, is nothing more than an instrument that shifts healthcare costs from the public to the private sector, and that’s what it was intended to do, because that’s what it had to do, because the public sector has to find ways to reduce its spending, and healthcare was the big egg . . ..
    When “the people” realize that it’s all been a big con job–when that $20,000 annual bill for third-rate healthcare hits them in their faces–it could happen, then, that “the people’s” blind, lemming-like belief in Obama will disintegrate like . . . well, like a unicorn fart.
    I’ll add this: Reagan and the congress set this up in the mid-1980s with the Emergency Medical Treatment and Active Labor Act, which guaranteed everybody and anybody free healthcare, without any questions about their ability to pay or whether they had health insurance. All they had to do was walk into an emergency room and, of course, that’s what they did, and costs skyrocketed, and hospitals suffered, and along came the smooth-talking Mac Daddy, who agreed to have his name attached to the law that would put an end to the endless Christmas.
    He wisely waited until his second term.

  • joetexan

    He sounds like Bucky Beaver imitating Captain Kirk.

  • lineholder

    Did you know that the circumstances you’ve described regarding readmission rate of Medicare patients is the direct result of policies implemented at the federal level via prospective payment system aligned with MS-DRG categories? That was the impetus that kicked in the “quicker but sicker” discharge pattern that you’ve described. So what is being done under Obama’s lead? Tighter evidence-based medicine standards that perpetuate the “quicker but sicker” phenomenon coupled with increased penalties if patients are readmitted within 30 days (which is going to be 3% rather than the minuscule 0.1% that you’ve stated) along with somewhat unrealistic expectations of holding hospitals responsible in seeing that patients receive follow-up care (which could be extremely difficult to do depending on the provider-to-patient ratio in the area). In other words, Obama’s admin is implementing policies that are likely to make things worse rather than improve the outcomes.

    What really stuns me about your response is that you have bought into the line being sold by Liberals that it is “evil providers” and “evil insurance companies” who are totally responsible for the mess our healthcare system is currently in. It isn’t. The federal government carries the bulk of the responsibility.

    I will say that I definitely agree with your comments pertaining to activity at the state level. I’ve been disappointed so far to see states, particularly red states, respond as they have. They need to be taking a proactive response and following though with as many options as they can find to keep healthcare delivery within their state intact. Too many of them act as if they’ve been plodding through mud.

  • plh

    Maybe we could expand on our “picking winners and losers” argument. The low information voter must be told again and again that every Government program does help some, but a cost to others, who can be family or friends or neighbors. In addition, Government programs are the costliest way to provide this help, and require a subjective definition of “fairness”, which is inherently not fair. Delivered by spokespersons of the caliber of Dr. Carson, perhaps a message such as this can resonate within at enough of the misled masses to allow our nation to return to sanity.

  • rabun1016

    This bit from the Rand Paul response summed up the budget issue for me “It is time Democrats admit that not every dollar spent on domestic
    programs is sacred. And it is time Republicans realize that military
    spending is not immune to waste and fraud.”

  • gmat

    “Healthcare cannot be paid for based on quality of care without
    introducing subjective standards that will themselves drive up the costs
    of healthcare”

    Maybe it can. Aetna has been doing it for a while. Aetna encourages providers to follow “evidence-based” treatment protocols which have outcomes at least as good as, and sometimes better than, more costly treatment.

    So Aetna reimburses based on the cost of the evidence-based protocol, plus an incentive payment to the provider.

    http://managedhealthcareexecutive.modernmedicine.com/news/aetna-manages-cancer-care?id=&pageID=1&sk=&date=

  • Wubbies

    My first reaction is we are about to receive, or be forced into a national HMO health care plan where doctors are paid a flat rate for their time with no measures for actual work performed. The wild part is that this is how government employee’s performance is measured now. In other words, doctors will be rewarded for doing a good job of following the rules with a complete disincentive to show any concern for timeliness of service.

  • skorrent1

    Are you saying that a government program intended to solve a problem only made things worse; requiring a new program to solve the new problem;which only made things worse; requiring …
    Gee, we’ve never seen that before! (sarc off)

  • skorrent1

    Though somewhat skeptical of any treatment based on the “average response” of the “average patient”, I would trust Aetna’s protocols much more than those ginned up by a government bureau guided (as it surely will be) by “politically correct” and “politically corrupt” influences.
    To assure ourselves that government health science avoids those influences, we only have to peruse the extensive work done by CDC over the decades on the health consequences of the gay lifestyle. Oh! Wait!! …

  • giatny

    I did not have the stomach to watch the speech but just reading
    it was no picnic. Seniors don’t seem to realize that Medicare
    restraints are going to be a major source of funding for other
    parts of ACA. It is easy to claim that “benefits” won’t be cut
    while ignoring the fact that changes in the “delivery” of benefits
    is even more harmful. A MRI will still be a benefit but approval will be delayed and involve multiple steps including a doctor’s having to justify it in writing. The IPAB will also be allowed to analyze cost and age. Sure a hip replacement will remain a benefit but won’t be approved if you are 85. How did this country get so so so stupid?

  • gmat

    You’re right, it works fine as long as you’re not one of the outlier patients. Another issue is, if everybody is going evidence-based, who is breaking new ground?

    But one really glaring omission in the whole cost-containment conversation is medical liability reform. That has to be one of the main contributors to per capita costs being so much higher in the US.

  • WmCraig

    “Healthcare cannot be paid for based on quality of care without introducing subjective standards…..”

    Think “death panels” .

    This is gonna work for him. Everybody is going to buy in to the idea that someone has to regulate the level of care to save money without thinking that means death panels. Which it does.

    Obama doesn’t want to balance the budget or pay for healthcare, because while we are all worried about the numbers, he is focused unremittingly on power. Acquiring and applying power. Power to punish, power to reward, power to intimidate.

  • markkozikowski

    Eric,

    I read that a little more to the Dark Side.
    I see this as a declaration by the president to take over the doctors and hospitals. Thereby giving the government the say in every action and service provided by our medical industry.
    Once the government has full control, then it can mitigate the cost by saying NO.

    This is not a statement on how to spend the money.
    It is a statement on how to ration health care.

  • spandrel

    And we are both wrong on one point. The maximum at risk in 2013 is 1% of DRG payments, rising to 2% by 2017.

  • lineholder

    Your copay may be the same, but the reimbursement amount is NOT. The reimbursement rate for a PA is less than that of a physician.

  • cbartlett

    “clueless driving instructor”. Exactly. We came home from work late and only saw the 30 second segment (before we could find the stupid remote to change the channel) stating how he plans to “raise the minimum wage to $9″. We nearly threw up. Did he ever, ever, study economics? He thinks raising the minimum wage will “cure poverty” in America. “These people will have more money in their pocket to spend and stimulate the economy.” Nevermind that the Big Mac and the gas for their car and their insurance and their electricity and – well – everything – will cost more if the minimum wage is raised. And my daughter also pointed out that these are the same people who are already receiving a government check. They’ll just raise the level to qualify and now they’ll get an even BIGGER check. Debt? What debt? We don’t have no stinkin’ debt. Yep. Definitely clueless.

  • spandrel

    FWIW, here’s the link I found to support the 1% and 2% numbers:

    http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/

    go to the bottom and open the FAQ

    http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/FY-2013-Program-Frequently-Asked-Questions-about-Hospital-VBP-3-9-12.pdf

  • lineholder

    And I found this from the NEJM pointing out the flaws in the formula provided by CMS
    http://www.nejm.org/doi/full/10.1056/NEJMc1212281

    For right now, spandrel, with RBRVS payment schedule to private practice docs being revised and hospitals on the verge of losing DSH payments, going overboard with so-called “quality of care” performance measures is a very bad idea. That’s what the NEJM has drawn attention to.

  • sta46

    Good one! Also sounds like Harry Potter speaking “snake”

  • paul11201

    It is true that Obamacare is convoluted. A single payer system would have been much simpler and probably more efficient–but due to fierce resistance from the republican party, it became necessary to advocate an idea first espoused by conservative think tanks years ago. However, once Obama advocated this health care idea it became poison to the republican party. Chalk up another one as to why the majority of voters simply tune out the republican arguments–it is clear republican hatred for Obama trumps any rational discussion on healthcare. People would be more willing to listen to republican arguments if you left some of the constant melodrama behind. And since no serious alternatives were floated by the republican party, this is what we are left with. While this may be hard for republicans/conservatives to understand, the fact that the US is the only major developed country in the world that does not address universal healthcare is shameful and an embarrassment to many people. (Feel free to get all excited about how embarrassment is beside the point)

    I don’t think anyone knows how this will all turn out, despite the hysteria and doomsday scenarios. some of it will work, some of it will not work. And most likely over the course of the next decade Obamacare will be modified and hopefully improved. But at least we have started the journey.

  • macbookben

    That’s right, the physician assigned to you will be a GS-14 who works “to the clock.”

  • WmCraig

    And carries a Gov’t union card, making your party registration an issue to be considered. After all dead Republicans don’t vote. Dead Democrats do, but dead Republicans do not.

  • Duke

    This might be wishful thinking, but I’m guessing by 2014 a lot of stuff will be going south. That will bode well for the GOP to stumble back into the majority in the Senate. The trouble with this scenario is that the Dems will resort to various “nuclear options,” and the propagandist media will help them blame the whole crapola on the GOP. I wonder when the GOP will come up with a strategy to be able to get the defense off the field and give their QB some playing time.

  • spandrel

    Hmm, not sure about the liberal narrative thing. But I’m fairly sure that even private, for profit insurers, as well as large employers, are pursuing the same goal of paying for quality of care, and using the same criteria – pretty much all the payers (including Medicare) rely on the National Quality Forum (a non-profit consortium of payers, providers, and patients) – to agree on what comprises quality of care. And they all – public and private insurers – have exactly the same motive, to drive down costs.. So while there are surely going to be unanticipated and unwelcome consequences, I fear that increased costs is the one we least need be concerned about.

    I’m not sure what you mean about not portraying food consumption and lack of excercise accurately. There are societies as wealthy as ours where greater value is placed on both eating healthy and moving around more. We don’t share those values, and we have an array of incentives and misinformation to reinforce the status quo.

    As for the value of life, nothing has rendered it less sacred than the application of money and technology to prolonging it beyond the point at which anyone – the life in question or those who care for that life – have any but the most transient connection with it. My father spent his life as a Baptist missionary, a man of God and the Bible, and when he was sick and knew he wouldn’t get better, he said: God wants us to die the way we live, without fear and with dignity, so I’m just going to go. I didn’t then and still don’t think that is a leftist sentiment; in fact, it is mostly the godless I see holding on for dear life when it’s clear their time has come.

  • http://www.TerriersOfTheRight.blogspot.com Flagstaff

    Typical Obama pronouncement. I guess a surgeon who doesn’t save his patient doesn’t get paid at all. Unless it’s the anesthetist’s fault. This is a lawyer’s idea of heaven.

    Rush hit it out of the park today. He noted that BO is in campaign mode all the time. Nothing new in that observation, but he followed it with the fact that The Won NEVER makes a non-Progressive decision that might go wrong and he’d have to defend it. Look back.

    Shut down drilling after Deepwater Horizon, but never announced a restart.

    Keystone Pipeline shut down and now he won’t approve it.

    Benghazi, MIA, so can’t be blamed.

    SStorm Sandy comes and goes, he gives a photo op, but never really DID anything to help so the lack of progress isn’t his fault.

    He did promise to help the Fort Hood victims, but he hasn’t done anything other than talk. He won’t even approve Purple Hearts.

    He wouldn’t even push Obamacare, leaving it to his henchmen. He only “approved” of the name after it passed and got glowing reviews in the lefty press.

    He never really has PUSHED any legislation, he just TALKS about it.

    The only thing besides OCare he is attached to was the killing of bin Laden, and he only let that become public AFTER THE FACT.

    But beyond that, BO simply says ANYTHING HE WANTS TO, whether it makes sense or not. The only people who are going to call him on these ridiculous statements are those like us, in the marginalized right-wing webspace. No MSM outlet is going to sweat such small stuff.

  • http://www.TerriersOfTheRight.blogspot.com Flagstaff

    I have to verify this, but I’ve heard second-hand that when OC kicks in it won’t cover anesthesia for colonoscopies–not “medically necessary.”

  • funwithknives

    This commentor [Kudos and salutations to you, M K ] brings up a point that I am notorious for expounding and it ends so many political exchanges with statists and Progressives it is simply not funny:
    “If Government can give ‘It’ to you , Government Can also take ‘It’ away…..”
    So simple, Occam probably thought of this creating his Razor, but having not been there who am I to guess…?

  • Jack_Savage

    Then Obama will have good use for all those bullets he plans on confiscating. We can just all clench them in our teeth while we are having surgery. Of course, since he has reporter’s heads up his rear with no anesthesia I guess he thinks that would work for the rest of us.

  • http://www.TerriersOfTheRight.blogspot.com Flagstaff

    That was a LOL.

  • pgrajnert

    Of course, the fact that the US has the highest medical care costs with some of the worst returns on those dollars spent, makes sense? It’s obvious to anyone who belives in using the market to help people instead of it using them: Single payer is the only way to go.

  • Bill S

    Lookie there – someone forgot to switch off the leftist Talking Point-o-Matic today.

    And now that we have a Posting Rules link, I can point you to that and your blatant violation of Rule 13.

    See ya.

  • Bill S

    It was inevitable.