Bart Stupak

Don't forget to pick up your 20 pieces of silver on the way out.

Mark Steyn says:

We are screwed.

Mandating IVF coverage

Ridiculous.

In 2002, Harvard Medical School researchers found, unsurprisingly, that compared with women who pay out of pocket, those whose insurance fully covered IVF were significantly less likely to have multiples since they chose to have fewer implanted embryos. And while international comparisons are fraught with confounders, it's worth noting that Sweden and Australia have almost twice as many IVF births per capita as we do, yet their infant mortality rates remain comfortably lower. At least one difference may be that their national health insurances subsidize IVF, and thus there is less incentive to implant multiple embryos per cycle.

...


Taken together, America has selected a policy that encourages multiples. Since insurers aren't compelled to cover costs for IVF, self-paying women attempt to get pregnant in as few cycles as possible. As a result, officials find it hard to justify legally restricting how many embryos can be implanted. Since they're paying for it, the thinking goes, women should be free to implant as many embryos as they wish. The result? More multiples, more costs, poorer child health, and, on occasion, bizarre cases like that of Nadya Suleman.

Having children is not a right. I shouldn't have to pay higher health insurance premiums--were I lucky enough to even have health insurance--to finance someone's unrequited maternal instinct.

And as for Nadya Suleman, how about screening patients for psychological problems? Even plastic surgeons do this and people who have a mania for repeated plastic surgery are only hurting themselves. And they aren't doing it on the taxpayer's dime.

Reproductive specialists have a responsibility to the lives they are creating as well as to their primary patients. Clearly, this unemployed single mother with six children already has more than a natural, human desire to be a parent. It's become an obsession that's been fed by her doctor, who looks to be a sort of Dr. Frankenstein of infertility.

The case of the missing liver transplant

Scott Gottlieb looks at the story of Nataline Sarkisyan, a 17-year-old girl who was denied a liver transplant by her health insurer and subsequently died.

John Edwards used the girl's story as a morality tale in which the big, bad insurance company allowed an innocent child to die out of greed. The implication being that the poor girl would have been saved had we the single-payer plan Edwards supports. Not so, says Gottlieb, who looks at data from the US and the UK, which has a single-payer system.

A study published in 2004 in the journal Liver Transplantation compared the relative severity of liver disease in transplant recipients in the U.S. and U.K. The results were striking. No patient in the U.K. was in intensive care before transplantation, one marker for how sick patients are, compared with 19.3% of recipients in the U.S. Additionally, the median for a score used to assess how advanced someone's liver disease is, the "MELD" score, was 10.9 in the U.K. compared with 16.1 in the U.S. -- a marked gap, with higher scores for more severe conditions. Both facts suggest even the sickest patients are getting access to new organs in the U.S.

On the whole, the U.S. also performs more transplants per capita, giving patients better odds of getting new organs. Doctors here do far more partial liver transplants from living, related donors, but also more cadaveric transplants (where the organ comes from a deceased donor). In 2002 -- a year comparative data is available -- U.S. doctors performed 18.5 liver transplants per one million Americans. This is significantly more than in the U.K. or in single-payer France, which performed 4.6 per million citizens, or in Canada, which performed 10 per million.

The truth is that liver transplants are costly and outcomes aren't always certain. In any given "system" someone must make the decision as to whether a transplant--or other costly procedure--should be performed. Edwards would merely replace an insurance company executive with a government official as the ultimate arbiter. Most of us would rather rely on our doctor.

The Sarkisyan case is particularly poignant because the insurance company eventually changed its mind about the transplant, but not in time to save her. Who thinks it would have been approved faster if a government agency was making the decision?

Members of Congress love their insurance plan

At least the Democratic ones running for President do.

Readers will note that of the candidate health plans outlined so far, all have based their plan on the Federal Employees Health Benefits Program. So what is it about his plan?

The FEHBP is a voluntary plan open to federal civilian employees. Actually it's a group of health insurance plans, 190 in all, from which federal civilian employees can choose. Employees can choose between fee-for-service plans and HMOs. There are also organization-specific plans and a government-wide program available. Some features:

coverage is provided without a medical examination or restrictions because of age, current health, or pre-existing conditions;

there are no waiting periods for benefits to kick in after the effective date of enrollment;

there is catastrophic protection against unusually large medical bills; and

you have an opportunity, during annual open seasons, to enroll in a health benefits plan if you are not already enrolled, or if you are enrolled, to change to another plan or option.

The government also offers workers a choice of dental and vision plans. A flexible spending plan is also available.

Employees and the government split the cost of the premium. Rates change each year and are negotiated by the Office of Personnel Management with the individual carriers:

• 2008 premiums for non-postal employees in fee-for-service plans.
  
• 2008 premiums for non-postal employees in HMOs.
  

Congress's health care insurance program has been touted by some as the Rolls Royce of plans, but not everyone is thrilled with their coverage.
In fact, each individual plan is not unlike other plans offered by employers in the private sector, but government employees have more choices than most workers in the private sector.

Cross-posted here.

Doctors try prepaid plans

And why not?

Dr. Wood is one of several hundred doctors across the country offering flat-rate, pay-in-advance plans. Though still experimental, proponents argue that the approach tackles two crises in U.S. health care: the rapid decline of doctors practicing primary-care medicine and the growing number of Americans who are either uninsured or underinsured.

"I'll sign up one patient at a time if I have to," says Dr. Wood, who has so far enrolled 100 people in his plan. The streamlined system, he says, cuts down on administrative hassles and costs, compels more office visits -- and delivers better profits than one that relies on insurance dollars. "I can't see my practice surviving for the next 10 years without this model," he says.

On Graeme Frost, the wingnuts and the moonbats

The issue is being demagogued to death. You already knew that, but allow me to stick my oar in.

I really hate the whole out-of-the-mouths-of-babes schtick. I, for one, am not in the habit of consulting 12-year-olds before making major decisions. I don't care how cute and tow-headed the kid is, I'm simply not interested in his opinion on the issues of the day.

Using a kid to score political points is low, no matter how you slice or dice it. It can also backfire, badly.

Also, the use of Graeme Frost as the SCHIP pinup boy was misleading: Graeme was covered under the plan--whether you agree he should be or not. The issue was never that Graeme was going to lose his coverage, but that's what the Democrats implied when they trotted him out to speak on their behalf. No one, not George Bush or any of the other cold-hearted Republican bastards in Congress, has suggested that SCHIP coverage should be cut back. The issue on the table is whether it should be expanded.

Having said that, it's perfectly legitimate to question whether families like the Frosts should be covered. This does not mean that the people who ask such questions are amoral wingnuts who would shoot Bambi if given half the chance. Although remarks like "Let 'em twist in the wind and be eaten by ravens" are more than a little harsh.

For the record, I agree with my favorite venom-spewing wingnut and I would not deny care to the Frost children. I also wouldn't require the Frosts to sell all their assets in order to pay for their children's treatment. It doesn't make sense to force a family into poverty to pay for their medical bills.

But was there ever any danger that they would be denied treatment?

Hospitals that receive federal funds are prohibited by law from denying emergency treatment to patients who can't pay. So when the Graeme children were brought in after the 2004 automobile accident that led to this debate, there was never any danger that they would be turned away. True, the hospital may have gone after the Frosts for payment later, but that's another issue.

Also, isn't the Frost's car insurance policy supposed to pay for medical bills incurred during an accident? Health care insurance in Maryland may not be mandatory, but car insurance sure is. And what's the point of having such a policy if it doesn't cover medical expenses?

I may be wrong, but the car insurance angle seems to me to be the one angle no one has covered in this story. From what I can gather, a car insurance company can subtract medical costs for which the patient is NOT out of pocket when it pays for medical expenses related to an accident. But it seems as though the insurance company and not SCHIP should have footed the bill for these medical expenses and not the state. Is this a loophole in SCHIP? Can the state go after the auto insurance company to recoup it's costs? Did the Frosts contact their auto insurer in regard to their medical bills?

Every time the so-called healthcare crisis is discussed, someone brings up the bogeyman of the preexisting condition. It is said the Graeme's can't get insurance because of such a condition. But having a preexisting condition doesn't you'll never be eligible for insurance. the Health Insurance Portability and Accountability Act puts a time limit on non-coverage of preexisting conditions for those eligible for group insurance. And even then, you can be accepted for insurance and receive coverage for healthcare costs unrelated to the preexisting condition. True, private insurers can turn down people for preexisting conditions, but the Frosts own their own business and HIPAA "guarantee[s] availability of health insurance coverage for small employers and renewability of health insurance coverage for both small and large employers."

Tony Snow's cancer is Bush's fault

That appears to be Daniel Gross' conclusion in this rather muddled discussion of Snow's decision to leave his job as White House spokesman.

Gross asks: Why is Tony Snow's 401(k) empty? It turns out it's empty because Snow didn't put any money in it. But Gross doesn't see it that way.

And yet Snow's own life in many ways symbolizes the downside of the ownership society—and suggests how much a government role in health and retirement benefits is necessary.

When Snow came to the White House after several years at the Fox News Channel, it was clear that he had relied entirely on others to save for his retirement. Snow conceded: "As a matter of fact, I was even too dopey to get in on a 401(k). So there is actually no Fox pension. The only media pension I have is through AFTRA [a union]." Even though his employer provided a 401(k) and would have matched contributions, and even though he was earning hundreds of thousands of dollars, Snow had not shown either the interest or financial capability to manage his own retirement benefits.

Clearly then, the government should have stepped in and made sure that Snow took advantage of his 401(k). Or Fox should have a traditional pension plan. Or the government should provide a lavish retirement plan for Snow because he's incapable of managing his own affairs.

Then Gross takes Snow to task for putting a positive spin on the economy, when Snow himself couldn't afford to live on his salary.

As part of his press secretary job, Snow had to spin economic news to make it seem as if the typical American was doing well in an economy in which gains have been distributed unevenly. A report issued by the Census Bureau last month showed that median household income, at $48,201, hasn't budged since 1999. Snow admitted to feeling pinched on his salary of $168,000, which is about 3.5 times the median U.S. income. "We took out a loan when I came to the White House, and that loan is now gone," he said. "So I'm going to have to pay the bills."

I'm no expert money manager, but I'm pretty sure I could manage well on a salary of $168,000. And just because Snow was unable, as an individual, to pay the bills on that salary doesn't mean that he doesn't believe that the economy isn't doing well. Nor does it mean that the economy isn't doing well.

Maybe it means the Snows are spendthrifts. Who can say? It might just mean that a man with serious health concerns dropped out of a public service job because he could make much more money in the private sector. A man with a chronic disease who might want to leave a little something to his wife and children should he die before his time.

Snow's cancer is another cudgel with which to beat the administration.

Snow survived colon cancer in 2005, but earlier this spring it returned to his liver. Snow is fighting it valiantly. "I finished chemo two weeks ago today," he said last week. "We did CAT scans and MRIs in the last week and it indicates that the chemo did exactly what we hoped it would do, which is hold serve. The tumors that we've been tracking have not grown. … We'll be doing what's called a maintenance dose of chemotherapy just to keep whacking this thing." He also noted that he'd be having scans every three months, "just to stay on top of everything."

That's great news for Snow and his family, and we wish him much success in his battle. But such treatment is enormously expensive and only available to people who have good insurance—like the kind taxpayers fund for public employees such as Snow. If Snow had owned his own benefits, or approached health care as a consumer, as the administration wants people to do, he'd certainly be singing a different tune. Had Snow stashed a few thousand dollars in a health savings account, which is one of the administration's chief proposals to reduce the rising number of the uninsured, he likely wouldn't have enough cash to afford chemotherapy. According to the Census Bureau, there were 47 million Americans without insurance in 2006, up from 41.2 million in 2001, when Bush entered office. Were any of them to be afflicted with cancer as Snow has been, they'd be largely out of luck—unable to pay the bills for all those scans and chemo doses, and unable to find an insurer willing to cover such a pre-existing condition.

Let's skip over the fact that Snow's first bout with cancer came when he was working for Fox so the taxpayers had nothing to do with that treatment. And since Snow left public employ, the taxpayers won't be footing the bill any longer. Snow can opt for a temporary continuation of coverage, but it'll cost him.

In addition, one can take advantage of a health savings account and still have insurance. Most people who enroll in HSAs, in fact, opt for a high-deductible insurance plan and use the HSA to pay for routine care, like checkups, while saving the insurance for catastrophic events, like cancer.

It's touching that Daniel Gross is so concerned about Tony Snow's well being. But maybe it's just a tad disingenuous to use a man who's leaving a job paying $168,000 for a chance to make hundreds of thousands more.

Medical tourism

This piece on health care for the insured v. care for the uninsured reminded me of this piece that I heard on the radio this morning.

It's about medical tourism generally and specifically about a hospital in Thailand that caters to foreigners. I thought medical tourism was something rich people did to save a few bucks on cosmetic surgery, but the reporter who did the segment claimed that more and more uninsured Americans are resorting to medical tourism. A woman who'd had both knees replaced in Thailand was duly trotted out. She said the cost of surgery in the US was around $100,000, while it cost her only $20,000 to get her knees replaced in Thailand.

Now my first thought was: "You can afford to pay $20,000 to replace your knees, but you can't afford health insurance?!?" And these people want cash upfront; they don't have to settle for an insurance company's negotiated rate. I thought the uninsured were supposed to be too poor to even be able to scratch up one-thousand-plus dollars for a plane ticket to Thailand let alone $20,000 for a new pair of knees.

What am I missing here?

Three crises in one

Eric Cohen and Yuval Levin look at the American health care system and find that policymakers treat health care as one issue when really there are three problems to be addressed.

Three different “crises,” then, each of a different weight and character. The crisis of the uninsured, while surely a serious challenge, has often been overstated, especially on the Left, in an effort to promote more radical reforms than are necessary. The crisis of insured middle-class families has been misdiagnosed both by the Right, which sees it purely as a function of economic inefficiency, and by the Left, which sees it as an indictment of free-market medicine. And the crisis of Medicare has been vastly understated by everyone, in an effort to avoid taking the painful measures necessary to prevent catastrophe. In each case, a clearer understanding may help point the way to more reasonable reforms.

Interesting. Americans, it seems, have a vague generalized anxiety about the healthcare system even though a majority--89 percent--are satisfied with the quality of their care. And no one seems to be especially worried about the spiraling costs of Medicare.