Guaranteed Access to Health Care? Good Luck

From Oregon: “Oregon Rep. Mitch Greenlick wants to change the state constitution to ensure that every resident has access to health care.”

Good luck with that. Cast aside for a moment that everybody DOES have access to health care of some sort–even if it might include sitting for a while in the emergency room. Government programs don’t always guarantee that you’ll be able to find a doctor, or even get the treatment that you want. Check out, oh, stories from the UK, Canada, and even Medicaid programs in the U.S., and yes, Oregon’s health plan, which in one case was willing not to pay for care, but for assisted suicide.

Another Victim of Medicaid (And Employer Benefits)

Nicholas D. Kristof has pretty much shoved Prof. Paul Krugman aside as the News York Times’ leading advocate of government-centered medicine. He seems deliberately not to see that government has created the problems of fragmented coverage, by using the tax code to give employers unfair advantage over employees in acquiring coverage.  In today’s column, he parrots a discredited study, which asserts that 45,000 Americans die from lack of insurances (which is already debunked, along with the entire literature on “mortality due to insurance” here).

Mr. Kristof also recounts a horrible story: A man who suffers an abnormal growth of blood vessels in his brain, which has rendered him unable to work.  Of course, he lost his employment-based “benefits,” and was unable to acquire individual insurance because of his severe condition.  As usual, the story has an element of unreality, because Mr. Kristof claims that the man exhausted his COBRA continuation coverage, after which his wife could not get him covered as a dependent on her employer-based plan because of his condition.

I write “element of unreality” because (as I’ve noted before in other cases), the information given suggests that the man should not have suffered an exclusion for his pre-existing condition.  My reading of Oregon law indicates that an employer does not have to offer any dependent coverage.  However, if it does, he has to cover all dependents without differentiation.  Because his wife was already covered, and he had continuous creditable coverage and exhausted COBRA.  both Oregon and federal law should ensure that the man would get coverage.

But I digress: My point is that Mr. Kristof knows that the man is enrolled in Oregon Medicaid!  And the man cannot find a specialist to treat him because reimbursement is too low.  From this, Mr. Kristof concludes that we need more government-centered health care.

There is really no explaining what kind of thought-process arrives at such a conclusion.

Health Insurance Rates Soar in Oregon

Oregon’s insurance regulator has approved premium hikes ranging from 9% to 23% in the individual and small-group markets. The media, of course, blame bonuses paid to plans’ senior executives for the hikes.

That’s unlikely: Top execs’ total compensation ranged from $248,000 to $765,000 last year.  These are utterly trivial “causes” of health-insurance premiums.

The Oregon Insurance Division (which approves all rate hikes), notes that plans’ surpluses have consistently been about 1% of revenues.  Obviously, medical spending is driving premiums, not the other way around.

Not discussed is the role of mandatory benefits, which the Oregon legislature has been laying on to health plans: hearing aids, and oral anti-cancer drugs (which was imposed without the legally required cost analysis).  Are these worth what they cost? We’ll never know, because the legislature has decided that people will not be able to negotiate benefits with health plans.

Nor does the discussion include the effect of the federal “stimulus” plan, which includes a huge subsidy for COBRA continuation coverage that I predicted would drive up small-group premiums.  I have little doubt that this is also a factor.

Help You Live, No; Help you Die, Yes

Health care "coverage" isn't the same as actually getting health care. Case in point: the Oregon health plan denied a cancer patient's request for a new prescription drug–but was willing to pay a doctor to help her commit suicide.

You can watch a short video from a local TV newscast, which features the patient herself, as well as the head of the rationing board.

The Oregon Rationing Model

The State of Oregon has a plan for giving health care to a large number of people. But since it can't possibly get enough money to give everyone everything they want, it has come up with a list of what diseases and conditions it will treat, and what it won't.

As you might expect from a government problem, politics plays a significant role.

The Independence Institute has a 90-second video called health reform that describes the situation.

Oregon Separates Children from Parents’ Insurance Plans

The state of Oregon has officially established a goal of seeing that every child is covered by insurance, even if it's taxpayers who have to pick up the tab.

In some cases, a lack of intact families is the proximate reason for a child entering the new program. "Babcock, a single stay-at-home mother in Salem, said the state rejected her daughter years ago after concluding the girl's father was capable of providing her insurance, though he didn't." (Interesting side question: How can a single person be a "stay at home" parent? If that person is financially able to pull it off, shouldn't he or she also be able to pay full freight for insurance?)

It's not only the poor who will be receiving taxpayer support: "In January, the state will begin subsidizing on a sliding scale private employer insurance for children in families earning between 201 percent and 300 percent of poverty."

Serving all those children is going to be a challenge. To take one example, "The Children's Health Alliance, which includes 110 pediatricians in the Portland area, expects up to 60,000 more children." That's 545 children per physician–on top of whatever patient load those physicians have. There's also the problem of rationing by cheapness: "Most metro pediatricians have stopped taking any more state plan children because the health plan's Medicaid payments do not cover the doctors' costs."

Other than that, it sounds like a swell idea!

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

Oregon Houses Enacts $500 Limit

The micromanagement of the health care industry continues. The Oregon House has approved a measure requiring pharmaceutical and medical supply companies to report to the state if they give physicians and other medical professionals $500 or more in a year.

Some of the events that trigger the requirement are payments for consulting (perhaps even participating in a clinical trial) and honoraria. It also includes dividends, but not only if they're from stock in, say, Merck and not in a mutual fund that owns Merck.

I can see someone being concerned about a doctor's judgment being clouded by such activities, though gross misconduct (prescribing a totally inappropriate drug) should be covered under the umbrella of malpractice.

The first step in banning a practice is to require its reporting, so politicians can pressure groups can trumpet the information in their arguments. So the ultimate end of this bill could be a ban. I suspect that would have some unintended but adverse consequences.

Oregon Tables Proposal to Expand Prescribing Authority

Should psychologists be able to write prescriptions for anti-depressants or other conditions? Some of them say yes, as has the Oregon House. Many physicians as well as the Oregon Senate have said no.

The question goes back to a Senate committee.

Another Week, Another Mandate

Insurance companies in Oregon–or at least those that are governed by state regulations–will now be required to pay for hearing aids for children.

We’re now up to about 2,000 such mandates across the country.