Impeding changes to our Health Care system

[TheMercenary]

Another great one!

Health Care 2020
A dispatch from the future on the effects of health care reform

March 23, 2020—At the beginning of the last decade, there was great excitement about the future of medicine. Advances in biotechnology, nanotechnology, diagnostics, information technology, stem cell treatments, vaccines, and organ transplants were poised to radically improve the health prospects of Americans. Looking back from 2020, we can see that most of these major biomedical advances failed to materialize. What happened? Three words: health care reform.

Thanks to the health care reform legislation, a higher percentage of Americans are now covered by health insurance than ever before—up from 83 percent in 2010 to nearly 95 percent of the legal population now. About half of the newly insured are covered by Medicaid and Children’s Health Insurance Program. Most of the remainder purchased subsidized coverage through the new state insurance exchanges. There have been some improvements in the overall health of Americans. Cardiovascular disease continued its decline because cholesterol lowering statins, which are no longer under patent protection, are more widely prescribed under new federally set treatment guidelines. Over the past 10 years, cancer mortality rates have also continued to decline, at least in part because people now covered by government programs or subsidized insurance now receive earlier cancer screening. Nevertheless, in 2020, cardiovascular disease and cancer remain the leading causes of death among Americans.

It seems like 2020 is a good time for American health care. But these benefits are what 19th century economist Frederic Bastiat would call the visible, or “seen” effects of health care reform. Bastiat pointed out that the favorable “seen” effects of any policy often produce many disastrous “unseen” later consequences. Bastiat urges us “not to judge things solely by what is seen, but rather by what is not seen.” A bad economist looks only at seen effects, according to Bastiat, while a good economist tries to foresee the unseen effects of a policy. So trying to play the role of a good economist, what were some of the deleterious unseen effects of health care reform enacted back in 2010?

Since 2010, insurance companies had been turned essentially into public utilities with the feds setting strict minimum benefits requirements. The health reform bill also limited the administrative costs of insurers, which has ended up basically guaranteeing their profits. With competition all but outlawed, the increasingly consolidated insurance industry has had very little incentive to pay for new treatment regimens outside those specified by government standard-setting agencies. Federal government health agencies have been reluctant to authorize newer treatments because they often lead to higher insurance premiums that then must be subsidized by higher taxes.

Then there is the doctor dearth. The signs of the impending shortage were already clear back in 2010. For example, as reimbursement rates from government health care schemes tightened, more and more doctors were refusing to accept Medicaid and Medicare patients. After health care reform passed, the physician shortage was exacerbated when many doctors faced with declining incomes simply chose to retire early. Already bad in many areas back in 2010, waiting times for a doctor’s appointment 10 years later have nearly quadrupled, reaching the Canadian and British average of about 110 days.

The hardest unseen effect of health care reform to evaluate is what it did to biomedical innovation. Innovation is a trial-and-error process, and making predictions about what might have been is speculative at best. But let’s take a look back at where budding biomedical technologies to treat cancer, replace damaged organs, and develop new vaccines stood back in 2010.

Big pharmaceutical companies initially did fairly well under health care reform, but as the cost of health care rose partly as a result of covering more Americans, Congress enacted legislation allowing government health care schemes to “negotiate” pharmaceutical prices. The negotiation requirement quickly devolved into price controls that have ultimately turned the big drugmakers into little more than cost-plus government contractors. In addition, the feds have established a comparative effectiveness evaluation commission similar to the British National Institute for Health and Clinical Excellence which limits patient access to treatments based on their overall cost-effectiveness. The result of these restrictions is that investments in pharmaceutical and biotech research and development have fallen off sharply.

In his first address to the nation, President Barack Obama promised to seek “a cure for cancer in our time.” In 2020, the five year survival rate from cancer has marginally improved as standard treatments have been more widely deployed, but there is no “cure.” It didn't have to be this way. For example, back in 2010 the biotech startup InCytu was developing a very promising technology that aimed to educate and harness a person’s immune system to destroy tumors. BIND Biosciences was creating a nanoparticle therapy that targeted and destroyed tumor cells while leaving normal tissue alone. Numerous startups were pursuing cancer immunotherapies using cancer vaccines. A couple of treatments, like Dendreon’s prostate cancer vaccine, made it through government approval process. But as health care budgets tightened, private research and development (R&D) funds for new cancer therapies dried up. Sadly, InCytu went out of business in 2014. In 2020, a “cure” for cancer seems as far away as ever.

Hoping to address the shortage of transplant organs, Congress changed the law in 2015 on organ donation to a system of presumed consent. This change did boost the availability of organs, but eventually donations leveled off and tens of thousands of patients needing organs remained on the waiting lists. Back in 2010, treatments using stem cells to repair damaged organs looked promising, especially induced pluripotent stem cells that matched the immune systems of individual patients. An even more visionary proposal was using three dimensional printers to print organs to order, as explained in this retro YouTube video from the startup Organovo. Of course, these possible therapies might have come to nothing, but we’ll never know since private R&D investment funding became scarce as increasing government price controls made the prospects for profiting from new treatments much riskier.

Finally, there's the flu. The 2010 flu epidemic turned out not to be nearly as severe as many at first feared, which is fortunate since vaccine production fell far short of initial goals. Production relied on an 80-year-old technology using inoculated chicken eggs that didn’t work well with the new virus strain. Ever risk-averse, government agencies rejected newer cell-based technologies that could produce flu vaccine three times faster than old-fashioned egg-based technology. In addition, R&D on a universal flu vaccine was put on the shelf for lack of funding. As we now know, this shortsightedness turned tragic when the long-predicted bird flu pandemic finally broke out in 2018, killing over one million Americans. The foregone development of innovative vaccine production techniques could have greatly speeded up the process of inoculating people against the disease.

The seen aspect of health care reform is that it has had some success in providing more Americans with access to vintage 2010 medical therapies. The unseen aspect is that more people are suffering from and dying of diseases that might well have been cured had the Obama version of health care reform never been enacted. As a result of health care reform, Americans forfeited 2020 medicine in favor of more equal access to 2010 treatments.

http://reason.com/archives/2010/03/23/health-care-2020

[TheMercenary]

Originally Posted by Redux

So we'e back to your opinions and the opinions of libertarian columnists with an agenda and whom you agree are facts and my opinions are not?

Its been fun.

It has been fun to continue to expose you as a shill of the Demoncratics and White House. So far you have provided nothing to support your positions, only the bill which most Americans see as being filled with smoke and mirrors. Good luck in Nov.

Personally I can't wait to vote the whores out.

[TheMercenary]

Here is a great story about Orszag.

An unlikely power figure has emerged in the Obama Administration. He’s not a great orator, nor trendy, nor well-known. But, if the ability to influence national leaders, shape a national agenda and influence public opinion are indicators, then, Peter Orszag, the Director of the Office of Management and Budget (OMB), is, arguably, the most powerful and, potentially, most dangerous, man in Washington, DC.

As Director of OMB, Peter Orszag is the arbiter of all financial information shared with Congress. A series of little-known, OMB “circulars”, such as A-11, have established the rules, and repercussions if violated, by which Executive branch agencies communicate with Congress, especially regarding budgets, funding and agency priorities.

OMB, the President’s gatekeeper for budget matters, executes a complicated juggling act, balancing Obama Administration priorities and budgetary spin, against agency needs. Frequently, to secure a critical vote, an elected member may be rewarded with a pork project for the folks back home, and, often, it’s the OMB director that has to figure out how to avoid the appearance of a bald-faced bribe, while manipulating CBO scoring on infrastructure projects. Orszag, as the former head of CBO, understands exactly how this game is played. Thus, most of the project and budget information that Congress reviews have been shaped by OMB’s preferences.

Peter Orszag controls much of the content and quantity of the data flow to Congress, to the President and to American citizens. Orszag has oversight over most of the federal government’s critical data reporting structures. Apart from the ineffective and error-prone Stimulus reporting sites (data.gov, recovery.gov),, OMB oversees federal contract opportunities and federal grants.


Perhaps even less well known, OMB reviews and edits most of the testimony submitted to Congress, and edits most of the responses that Cabinet members and federal agencies submit in response to Congressional queries. Hence, Mr. Orszag is able to not only manipulate the numbers, but is simultaneously able to insure that there is discipline throughout the Administration regarding talking points.

The great concern is that Mr. Orszag, by all accounts a bright fellow, seems to demonstrate an ability to misrepresent facts and figures to further the confusion. Put bluntly, Mr. Orszag does not seem to be a truthful man. Moreover, he seems unusually good at deception. From the deceptions and messiness of his personal life, where salacious stories, recently publicized about his personal life, of two girlfriends and an illegitimate child, generated a media frenzy, we learn that Peter Orszag seems especially adept at deceiving those closest to him, people that know him best. In his official capacity, Mr. Orszag seems to have been especially deceptive, able and willing to misrepresent facts.

This past year, to advance the myth of “jobs created/jobs saved”, Orszag seems to have used his power to fudge the Bureau of Labor Statistics unemployment numbers (dropping millions of unemployed Americans off the reports, thereby enhancing the monthly unemployment statistics) and he has enhanced the “jobs created” numbers, by issuing a memo, directing Agency heads to claim that all existing federal government jobs, where work is performed administering Stimulus funds, should count as “jobs saved”.

Nowhere will this willingness to deceive be more keenly felt than in the follow-up to the recent Healthcare Reform legislation signed into law by President Obama. Congress has trusted a CBO scoring that requires over $500Billion in cuts to various government programs and entitlements. OMB is the office that will ultimately have the responsibility for identifying, tracking and reporting on these cuts, since expenditures for Health and Human Services (HHS) and Social Security Administration (SSA) report to OMB. What OMB decides to show Congress is what Congress is going to see.

The Administration will, understandably, be eager to claim that cuts were made, but if the past year’s accounting by OMB is any indication, the cuts are unlikely to occur, though the data may be manipulated to imply that the cuts occurred. This kind of obfuscation is bad for Congress, which will be trying to measure whether the Healthcare Reform program is working as advertised, and bad for American taxpayers, who are getting stuck with the bill.

Americans might expect that others , wise to these sorts of shenanigans, might blow the whistle, but that’s not likely to happen since for the OMB Deputy Director chairs the (President’s) Committee for Integrity and Efficiency (PCIE) which oversees the federal government’s Inspectors General. Indeed, when one IG at OPM recently tried to go around OMB, an OMB staffer bluntly asserted that “we will make your life miserable”.

Peter Orszag is responsible for implementing President Obama’s campaign promise of a line-by-line review of the federal budget to eliminate any non-performing federal programs , exposing federal programs that are non-performing and wasting taxpayer money.

Mr. Orszag’s most publicized, cost-cutting effort was the SAVE competition, designed to encourage federal employees to identify waste and propose solutions to trim the ever-growing $1,300,000,000,000 deficit. The winning idea recommended that patients at Veteran Hospitals take home unused eye drops and other over-the-counter medication when discharged. Not a bad idea, but it is becoming clear that the SAVE program, like so many of Mr. Orszag’s other efforts, was primarily a PR gimmick that helped deflect criticism about the Administration’s out-of-control spending.

When all the man hours, and effort, that was poured into implementing the SAVE program at OMB are considered, Americans will likely find that the costs of running the SAVE program far exceeds any gains or savings that the program may achieve.

Mr. Orszag has been especially active in government contracting, (the head of federal procurement – the Office of Federal Procurement Policy [OFPP] is part of OMB) and Orszag has boasted of improvements. But, the results flowing from his decisions are making existing procurement problems worse, crushing small business opportunities and exacerbating the very problem he hopes to solve. Indeed, the health of the once-vibrant, small business, government contracting community has probably never been so dire, and is likely to get much worse as a result of Mr. Orszag’s ham-handed efforts to improve the federal acquisition system.

What makes Peter Orszag so dangerous is his access to more information, at a granular level, than any federal employee. Information is power, and the ability to sculpt information with impunity makes Orszag dangerous. Information withheld can cause as many problems as information that has been doctored, and whether intentional, or not, inaccurate information, disseminated by OMB, presented as fact to Congress and the American people, is what has often occurred.

So, at a time when our nation needs to confront our budgetary problems with honesty and determination, Americans should be asking themselves: are Orszag’s skills at deception what we really want to see in our OMB director?

http://biggovernment.com/ldoan/2010/...ag/#more-94786

Originally Posted by TheMercenary

It has been fun to continue to expose you as a shill of the Demoncratics and White House. So far you have provided nothing to support your positions, only the bill which most Americans see as being filled with smoke and mirrors. Good luck in Nov.

Personally I can't wait to vote the whores out.

Seriously, Merc. I honestly dont know how to discuss it further with you if you insist that your opinions and other libertarian opinions are facts and all else is just partisan bullshit.

Perhaps I will have better luck having an honest discussion with UG on the constitutional issues, but I doubt it.

[TheMercenary]

Originally Posted by Redux

Seriously, Merc. I honestly dont know how to discuss it further with you if you insist that your opinions and other libertarian opinions are facts and all else is just partisan bullshit.

Perhaps I will have better luck having an honest discussion with UG on the constitutional issues, but I doubt it.

So anyone who does not buy your partisan Demoncratic Talking Points, many right out of the White House web site, are automatically partisan? No, there are many varried groups who disagree with the party currently in power. That does not make all those who disagree with the Dems partisan and your party not partisan. That only makes you partisan.

This party has failed the American public and lied to them to get through one sided bills that may bankrupt the future of this country does not make your party the party of the people. That is the problem when you Rham bills through the process. More people disagree with your plans for this country than there are those who agree when it comes to healthcare.

The only saving grace is that it is all reversable. That is what makes our country great. But the promises you have tried to sell on here and that your party has tried to sell to the electorate will fail when it comes to healthcare reform. And I have stated how and why numerous times, and now everyone is talking about the very same issues I have raised. Again, good luck in Nov.

Merc...for the record, partisan is not limited to Democrat and Republican.

Partisan means supporting or espousing a particular position or cause with a bias.

noun
1.an adherent or supporter of a person, group, party, or cause, esp. a person who shows a biased, emotional allegiance.

adjective
3.of, pertaining to, or characteristic of partisans; partial to a specific party, person, etc.: partisan politics.

..and when you flood the discussion with links to libertarian opinions, not facts, you are flooding the discussion with partisan talking points.

[Urbane Guerrilla]

Originally Posted by Redux

Seriously, Merc. I honestly don't know how to discuss it further with you . . . Perhaps I will have better luck having an honest discussion with UG on the constitutional issues, but I doubt it.

Look: objectively, neither of us believes the other is quite honest.

I see no reason for anyone of intellect to remain a Democrat. None. Why, do you suppose, might I come down to that? Would it be the Dem's penchant for economic illiteracy? Would it be their inability to win any war against totalitarians and undemocracies, which are the one sort of war we fight -- and have fought for over one hundred years? (1898, and still counting -- we shed blood for the greater liberty over the lesser liberty, every time) Would it be their socialist-leaning policies, always trending to develop a dependent class of Americans rather than Americans of the free, adult variety? Damned insidious, I must say -- and no longer veiled. Would it be their habit of policy support for dictatorships of policy inimical to the United States and humanity's interest worldwide, viz., Senator Kerry and the Sandinistas? Let these few examples stand for many blemishes upon the Dems' record. They are permanent black marks.

In furtherance of this, I should really go bother a Democrat I know, who is bright. But I haven't seen him since months before the Health Care Intrusion And Just-About Poll Tax, and I'd like to find out how he feels now that his team has done something like this.

[Urbane Guerrilla]

Originally Posted by Redux

..and when you flood the discussion with links to libertarian opinions, not facts, you are flooding the discussion with partisan talking points.

Don't change the subject: it is Democratic talking points, not Libertarian. (I'll try to be a gentleman, and wag this reproving finger -- not some other.)

The Libertarians, however unwise they may be from time to time, reject Democratic talking points as half truths.

And do they not make a case sufficient to persuade the objective viewer? That means you'd end up wondering why you just can't make a dent. You seem to believe your ideas are persuasive enough to air them, rather than keep silent. We have our reasons, readily enough expressed, for holding a different view.

[Spexxvet]

Originally Posted by TheMercenary

http://biggovernment.com/egeorge/201...ck/#more-94402

There are no citations. How can we check the veracity of his points if he doesn't cite chapter and verse?

[Urbane Guerrilla]

Originally Posted by Redux

. . . who consistently calls anyone who might disagree or challenge him either a hypocrite or a partisan and whose own opinion he expects to be treated as factual while he dismisses the facts of others as partisan opinions.

You know the one...who consistently refers to one side as scumbags and whores and/or Nazis but claims not to be a hypocrite or a partisan.

Merc probably comes to these characterizations through his targets' manifest lack of anything he can recognize as values worth valuing.

Nor, Redux, have you been any too slow with the P-word yourself, here. And do remember, as your quoted post seems to forget in the phrase "the facts of others" that while one is entitled to one's own opinion, one is never entitled to one's own facts. Not even in representative politics. Reality doesn't give a damn about your opinion of it.

[Urbane Guerrilla]

Originally Posted by Spexxvet

There are no citations. How can we check the veracity of his points if he doesn't cite chapter and verse?

[Sigh] Well, you can try finding an opposing bias, propping them up against each other, and dropping a plumbline and seeing if it lands somewhere that would satisfy a critical view. That's the least you can do.

UG... I assume this means you have no interest in defending your position on the constitutionality of the legislation.

Then again, you were going to get back to me on how the Bush DoJ was not the most politicized in recent times and how gun control leads to genocide.....and you went silent on both.

Just keep throwing those stones.

[Urbane Guerrilla]

Oh, I know I ought to hurry up instead of dillydally... but I promise you the epiphany you are due on how disarmament by law helps genocides like practically no other measure. Redux + Didn't Study doesn't add up to Urbane + Bizarre.

Now what was that remark about "Assume" again? You keep feeding me those straight lines... well, if it entertains, I'm okay with that.

Meanwhile, I still believe I can induce you to become quite honest.

Or you could explain why you believe the legislation is unconstitutional.

[Urbane Guerrilla]

For starters, you show me where in the Constitution you're going to find authority for Congress to tell the citizenry where they are going to spend their moneys. And if you reply "Commerce Clause," I'm going to say, "Oh really?"

See, your overriding assumption is that Government intrusion on any and every level is invariably good. What possessed you to try and tell that to a libertarian? To quote the present Speaker of the House, "Are you serious?" And if you think you're serious, why?

Is the problem any other than that the medical-insurance market has been impaired and gone expensive precisely because of government mandate? Even as mildly centrist a libertarian as myself (about minus one and change towards the libertarian end of the Political Compass' axis) would say you're not thinking libertarianly enough. As far as you're concerned, the political creation of a dependent class of Americans is a fine thing -- along with every other doctrinaire lefty Democrat. I can't see the fineness in being kept in a subadult condition. It's suboptimal psychologically, and deprives America of her economic engine.