Return of the Death Panels?
If President Obama wants to allay everyone’s fears about where health reform is headed, it’s hard to imagine a worse decision than his recess appointment of Don Berwick to run Medicare and Medicaid.
Dr. Berwick explicitly endorses health care rationing and he loves the British National Health Service. As I explained at The Health Care Blog, Britain is the country where people routinely die because they cannot get the care they need and cannot afford to pay for it on their own, while this almost never happens in the United States. Details below the fold.
- Research by Brookings Institution economist Henry Aaron and his colleagues confirms that tens of thousands of Britons die prematurely because they do not get the care Americans tend to take for granted.
- According to the World Health Organization (WHO), 25,000 British cancer patients die every year because they do not have access to drugs that are routinely available in the United States and on the European continent.
- Those who can afford to so go private: about 6 million have private health insurance and roughly 12 million get private health services of some sort every year, paying with their own funds for care that is supposed to be theirs for free.
- When one cancer patient paid out of pocket for an expensive drug she was being denied, the NHS retaliated by threatening to make her pay for all of her other care out of pocket.
What makes the NHS immoral in my view is that it forcibly takes peoples’ money and spends it on health care services they easily could have purchased on their own, while denying them access to the expensive care for which people really need insurance.
I don’t mind Berwick’s view that rationing of health care is inevitable. I do mind his unwillingness to allow individuals to make their own choices between health care and other uses of money when they are able to do so. I also mind his desire to force people into a system that collectively rations care on a daily basis and allows them to escape only if they have political connections or the ability to pay.
I liked your calling him “Dr. No.”
Why did they not want to have a hearing? The answer is obvious.
Nice post here and at The Health Care Blog.
“Dr. NO” is good. But I also like “Rationer in Chief.”
I’m thinking that the Brit’s shadow market of private insurance is a good thing. It’s not as good as a free market, but it’s not as bad a 100% state-run health care. It suggests that consumers, when given the option, will make their own purchasing decisions, especially when the state alternative is not so good.
John, you claim that “Britain is the country where people routinely die because they cannot get the care they need and cannot afford to pay for it on their own, while this almost never happens in the United States.”
There is well documented evidence that there are annually 45,000 excess deaths because people don’t have health insurance. I’ve included the pointer to the research. Given one of the common threads here is how when the new health care bill goes into effect there’s won’t be enough doctors to fill the demand, that’s another way of saying that there are currently many people with unmet health care needs. Fixating on the flaws of the NHS doesn’t fix the flaws in our system.
http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf
excess deaths in the US of a lack of heath insurance.
Artk,
I am familiar with the study by Physicians for a National Health Program, claiming 45,000 people die each year from lack of health insurance. This was the latest in a string of flawed studies analyzing mortality and insurance status.
In these studies nobody actually ever counts the bodies of those who supposedly died from being uninsured. In the survey, the subjects were interviewed only once. In other words, we are expected to assume (for the results to be valid) that the uninsured at the beginning of the survey stayed uninsured for a full 19 years!
Former CBO Director June O’Neill and her husband Dave (using a similar approach) also looked at this. They found that the involuntarily uninsured (i.e. low-income people) were only 3% more likely to die over a 14-year period than those with health insurance. There was no statistically significant effect on the “voluntarily uninsured” (higher-income people who could afford coverage).
Here is a link to John’s Health Affairs Blog post explaining why this study – and all the ones that preceded it are flawed. http://healthaffairs.org/blog/2009/09/21/does-lack-of-insurance-cause-premature-death/
Devon and artk, the studies were not merely flawed they were conducted by people who basically don’t know anything about economics. Which is the same thing as saying that they don’t know anything about statistical inference in complex social systems.
John, Devon: Thank’s for the standard response. Every statistic that shows deficiencies in our system is flawed: life expectancy; infant mortality; any study showing an obvious problem. Every anecdote about the horrors of one of the universal health care systems is the gold standard.
I don’t know about every statistic, but those two are certainly flawed. They reflect on too much outside our health care system to be useful.
Back to the main topic, what’s wrong with having an avowed rationer in charge of Medicare and Medicaid? Isn’t this more-or-less what those programs need (mostly more)? I just wouldn’t want him running all of health care.
artk: Please stay consistent. You can’t jump from statistic to statistic and claim that John and Devon are giving the “standard response” when it has been known for some time now the PNHP study about deaths due to a lack of insurance was seriously flawed. Are you saying that what Devon is showing as a serious flaw to the study is not a flaw, but is accurate and acceptable? That one interview 19 yrs ago is acceptable, and that becasue they were uninsured then they were uninsured when they died, and that even if they had insurance they would not have died? Rather than accuse them of “standard” answers please explain to us how the study is not flawed and it should be used for the purposes of national healthcare policy?
Chris Jacobs has a good summary of Berwick’s most controversial views here: http://www.ncpathinktank.org/pdfs/Berwick-Top-Ten.pdf
ArtK–Are you still claiming 45,000 deaths from a lack of health insurance? This blog has published a number of entries giving detailed explanations of the way in which the 45,000 number was constructed, why it is incorrect, and why it is therefore little more than a made-up number useful only as a talking points for the uninformed.
At some point, serious discussion requires engaging the other side’s arguments.