Friday, April 2, 2010

Kaiser and Its Myths

The Kaiser Health News presented a recent set of true or false statements regarding the new health care plan. It is worth a short discussion regarding their analysis since for the most part we disagree based upon the facts in the Bill, now the Law.

It is first interesting to see that they like we do focus on the Comparative Clinical Effectiveness issue first. It is that issue that we have argued for almost a year is the one which is the most concern.

First let us define the CCE issue. Basically CCE is the process of performing many clinical studies and determining the relative merits of various procedures, process, medications and the like and presenting the results in a logical clinical manner so that physicians can assess the best approach for their patients. It is critical, however. to recognize that all patients are different and that no average person ever exists in nature. The CCE as presently conducted, as in the gold standard of the New England Journal of Medicine, is published each week in an open and critical manner, and as expected the results may be valid for some period until another study is performed.

Thus CCE is like our legal system and living dynamic system of confrontation with the facts. It is not stable and is subject to near instantaneous rebuttals in the court of medical procedure.

In contrast the CCE plan in the current law directs the process to a single point of Government control with a Board overseen by political appointees including union leaders, patient rights advocates and the like. Frankly what union leader knows anything except how to get more for less! That has been the collective history of unions since the 1930 under FDR. That is why we have lost our manufacturing base and why many companies have fled to other lands. But that is a tale for another day. The issue is why in God's name would anyone appoint an SEIU representative to a CCE panel! That is am immediate cause for the rejection of the results. Yet the CCE panel will memorialize the results and recommendations and not suggest as Kaiser states.

As Kaiser states:

The law states that the institute does not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment. Medicare may take the institute’s research into account when deciding what procedures it will cover, so long as the new research is not the sole justification and the agency allows for public input.

This is a shift from Congress’ position when it created the Medicare Part D drug benefit in 2003; back then it banned any use of comparative effectiveness research in determining what would be covered.

In fact once the Government takes over this process it will degenerate into a "standards" setting body. The very proposal is the antithesis of science. The science of Medicine requires a free market of ideas and studies, one rejecting the conclusions of another as freely as the first set of conclusions was presented. The Government CCE Panel will as surely as the sun rises each day place a chilling effect on all. Kaiser is in my opinion clueless of this or complicit in the destruction of medicine as we now know it!

The second Kaiser statement regards Medicare. They state:

Cuts in the Medicare Advantage plans under the health care overhaul "will cause massive disruption for the more than 10 million seniors" and many of them will lose coverage.

Partially true.

That was the warning in a statement from America's Health Insurance Plans, a lobbying group, days before the health overhaul cleared Congress, echoing a Republican criticism.

The new health law will cut $136 billion in spending on the Advantage program by 2019, which currently pays private plans to administer Medicare benefits and pays them about 14 percent more than the per-patient cost of the traditional Medicare program. Plans use that subsidy to lure members with lower premium costs or extra benefits not normally paid for by Medicare, such as vision care or better prescription drug coverage. Some Democrats and analysts have argued the higher rates are wasteful.

In fact Medicare will suffer greatly. As Medicaid has been reduced to that pool of physicians with no other source of income, the Medicaid mills, so too may Medicare be reduced to the same sorry state. It will reduce the practice of medicine to the practice of teaching in public schools, a sinecure for the intellectually lacking. Anyone familiar with Medicaid knows all too well that it is at best marginal care and in all cases the lowest bidder type of care. One can already see this transition in the fleeing of quality physicians who treat those over 65 to non-Medicare practices.

The third point is the IRS as enforcer. They state:

The IRS will be hiring thousands of new agents to check that people have health insurance and people who don't will be sent to jail.

Mostly not true.

This claim arises from a provision of the health care law that would require Americans to purchase health insurance or else face fines. The Internal Revenue Service will be tasked with enforcing this provision.

The Congressional Budget Office said the number of new employees the IRS will need has not been determined, though it did estimate the agency’s cost could reach approximately $10 billion over the next 10 years.

House Ways and Means Committee Republicans used the CBO estimate in a report on the bill's effect on the IRS. In that report, Rep. Dave Camp, R-Mich, said, "the IRS could have to hire more than 16,000 additional agents, auditors and other workers just to enforce all the new taxes and penalties." Camp called such an increase in personnel, "a dangerous expansion of the IRS’ power." The IRS currently has about 93,000 employees.

The IRS is clearly the enforcer. This is another point we made almost a year ago! Kaiser rejects its true validity. The Law is quite clear, the IRS shall enforce its compliance or fine accordingly. How does Kaiser think they will do this, by individual and personal compliance. The number of people being controlled will be massive since it is now individuals and not families! The costs of the new IRS software alone will be tens of billions and we all know that the first three to five software contacts will be disasters, it is after all a Government contract! There will be horror stories about the IRS and terminally ill old ladies, just wait! This is the IRS after all, we know they are not there to be helpful, they collect taxes.

Kaiser continues but I believe my first three points clearly demonstrate what in my opinion is a false fluff piece on behalf of the current Administration. This is a shame for Kaiser could have played a useful role here if they had in my opinion been more targeted on the facts and not their agenda, whatever it is.