A False Compromise on Conscience Protections

Update from Oregon: Gov. Kitzhaber’s health care overhaul passed the Senate Ways and Means Committee, heading to the floor on a 19–6 vote. But an amendment addressing medical liability tort reform under the plan did not pass. This could be problematic for some members.

A bill to implement the state’s long-discussed health reforms is facing a sudden roadblock in Salem: a pledge by 15 Senators to block it unless limits are placed on Oregon Health Plan members’ ability to sue for malpractice.

All 14 Republicans and one Democrat, Sen. Betsy Johnson, D-Scappoose, signed the Feb. 6 letter to Gov. John Kitzhaber and legislative leaders. That amounts to half the Senate – enough to block a bill from proceeding into law.

The letter said a reformed system would have problems attracting doctors without caps on medical malpractice awards, and therefore “we will not support any transformation bill without these liability provisions included.”

Johnson confirmed Thursday she signed the letter. “Things are evolving quickly,” she said.

The senators want the coordinated care organizations at the heart of Oregon’s health reforms to be included under the Oregon Tort Claims Act, which limits damages to governmental bodies. Specifically, the law would limit damages to $566,700 for each person injured.

The new organizations, called CCOs, would be collaboratives of hospitals, clinics, doctors and other providers. They could be for-profit or non-profit under legislation being considered by the Legislature, Senate Bill 1580. The law would set guidelines for the groups, thus advancing the health care reform law enacted by the Legislature last year.

The Medicaid-funded Oregon Health Plan covers about 600,000 people. By 2019, it is expected to cover almost 1 million people, or nearly 1 in 4 Oregonians.

The Romneycare/Obamacare architect speaks:

Massachusetts Institute of Technology economist Jonathan Gruber, who also devised former Massachusetts Gov. Mitt Romney’s statewide health care reforms, is backtracking on an analysis he provided the White House in support of the 2010 Affordable Care Act, informing officials in three states that the price of insurance premiums will dramatically increase under the reforms.

In an email to The Daily Caller, Gruber framed this new reality in terms of the same human self-interest that some conservatives had warned in 2010 would ultimately rule the marketplace.

“The market was so discriminatory,” Gruber told The DC, “that only the healthy bought non-group insurance and the sick just stayed [uninsured].”

“It is true that even after tax credits some individuals are ‘losers,'” he conceded, “in that they pay more than before [Obama’s] reform.” …

During his presentation to Wisconsin officials in August 2011, Gruber revealed that while about 57 percent of those who get their insurance through the individual market will benefit in one way or another from the law’s subsidies, an even larger majority of the individual market will end up paying drastically more overall.

“After the application of tax subsidies, 59 percent of the individual market will experience an average premium increase of 31 percent,” Gruber reported.

The reason for this is that an estimated 40 percent of Wisconsin residents who are covered by individual market insurance don’t meet the Affordable Care Act’s minimum coverage requirements. Under the Affordable Care Act, they will be required to purchase more expensive plans.

Asked for his own explanation for the expected health-insurance rate hikes, Gruber told The DC that his reports “reflect the high cost of folding state high risk pools into the [federal government’s] exchange–without using the money the state was already spending to subsidize those high risk pools.”

Sarah Kliff crunches the demand numbers:

The greatest threat to the health-care overhaul might not be the Supreme Court, which is scheduled to hear challenges to the law next month. Or the shifting alliances of an election year. In the end, it’s more likely to be a lack of medical providers. If the law succeeds in extending health insurance to 32 million more Americans, there won’t be enough doctors to see them. In fact, the anticipated shortfall of primary-care providers, by 2015, is staggering: 29,800.

The Obama administration’s options to address that threat are limited. It does have Medicare, which covers the lion’s share of the cost of training medical residents: In 2009, it spent $9.5 billion on residents’ stipends, teaching physicians’ salaries and related expenses. But when Congress passed the balanced budget amendment in 1996, it capped the number of residencies that Medicare can fund. Since then, hospitals’ slots have been tethered to 1996 levels.

The health overhaul, some hoped, would address that issue. But with the health insurance expansion’s $971 billion price tag–and the Obama administration goal to keep the law’s cost under $1 trillion–funds for more slots didn’t turn up.

In the context of a $1 trillion overhaul, the White House’s main effort on this front seems modest: a $167 million sliver of the $15 billion Prevention and Public Health Fund created as part of the health-care law.

“It’s good,” Stream says, “but it’s also a drop in the bucket.”

Last summer the White House launched the Primary Care Residency Expansion at 82 hospitals across the country, with two strings attached: The programs must train residents dedicated to primary care, and the residents must work in underserved areas.

Medical students see good reasons not to sign up, as primary-care doctors often find themselves at the bottom of the pecking order. Research published last month in the journal Family Medicine found that medical students, even those planning to pursue careers in primary care, viewed the work lives of primary-care doctors more negatively than those of other doctors.

“The income gap that stratifies much of society often stratifies the physician community as well,” a 2009 report on primary care from the Robert Graham Center concluded. “The ‘heart hospital’ side of a medical campus may have fountains and artwork, while the mental image of the primary-care offices is a necessarily full waiting room of a practice where physicians see 40 or more patients a day.”

AEI’s Christopher Conover calculates, “To pay for the increases in federal health spending promised 75 years from now, federal income taxes that year would have to be 175 percent higher than they are today.”

The alternative fiscal scenario is the most credible current projection of how much we will have to pay for Medicare, Medicaid, and Exchange subsidies under the Affordable Care Act. Even the actuarial experts who work for the government do not believe the baseline forecast. Yet the percentages I cite above greatly underestimate the size of the tax rate increases actually needed to raise the revenue to cover these promises since they do not take into account the behavioral effects of higher taxes. I assure you that increasing federal income tax rates by 175 percent will not produce a 175 percent rise in income tax revenues. So think of all these figures as very conservative estimates of the tax increases looming over the horizon should we fail to get health entitlements under control.

Ask all your friends how comfortable they would feel imposing such punishing tax levels on their grandchildren. And if there’s no public sentiment for raising taxes by the gargantuan amounts required, then why are today’s policymakers making such promises? And if there’s no credible way we can tax our way out of this mess, why hasn’t the president offered a bold plan to substantially dial down on our promises (e.g., increase the Medicare retirement age) or fundamentally reform Medicare? The economy assuredly is a critical issue in the upcoming election. But well-informed voters also should be demanding that those wishing to inhabit the Oval Office answer some very tough questions about health entitlements as well.

An interesting study from Health Affairs:

The Charter on Medical Professionalism, endorsed by more than 100 professional groups worldwide and the US Accreditation Council for Graduate Medical Education, requires openness and honesty in physicians’ communication with patients. We present data from a 2009 survey of 1,891 practicing physicians nationwide assessing how widely physicians endorse and follow these principles in communicating with patients.

The vast majority of physicians completely agreed that physicians should fully inform patients about the risks and benefits of interventions and should never disclose confidential information to unauthorized persons. Overall, approximately one-third of physicians did not completely agree with disclosing serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients. Just over one-tenth said they had told patients something untrue in the previous year.

Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.

Obama’s proposed budget once again includes “savings” from Medicare and Medicaid over the next ten years.

More than $360 billion in savings to Medicare, Medicaid, and other health programs over 10 years to make these programs more effective and efficient and move our health system to one that rewards high-quality medicine.

How this is done? Unclear.