SURGEON GENERALS WARNING!!!

Feb. 9 (Bloomberg) -- Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

Elderly Hardest Hit

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.

Hidden Provisions

If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.

The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).

Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”

More Scrutiny Needed

On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.

The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.

Is this gonna work???

The Stimulus and Health Care


The massive amount of spending in the so-called “stimulus” bill is startling, yes—but entirely predictable given the way the bill was set in motion.

In the weeks after his election, president-elect Obama told the country and the Congress, that economic experts had advised that a large-scale fiscal stimulus was necessary to supplement the financial sector bailouts and the Fed’s efforts to expand the money supply.

This, of course, was music to the ears of the Democratic majority controlling Congress. They enjoy nothing more than solving America’s problems with spending and programs, and Obama had essentially given them license to draft the largest single spending bill in history, with virtually no presidential strings attached. All that was needed was a list of “shovel ready” back to work projects and “downpayments” on energy independence and health care reform. With such vague guidance, the Democrats really couldn’t help themselves. They had to put more money into the programs they favor because they have always argued they are good for the economy and represent “investments,” not spending.

There’s now $20 billion in new discretionary appropriations for HHS in the bill (not counting the HIT funding and Medicaid), and there is no real theme to any of it—other than more, pretty much across the board. $2.1 billion for Head Start. $0.5 billion for the NIH campus. $1.5 for university research facilities. $1.5 billion for NIH research grants. A $3.0 billion wellness fund. And on and on.

Regarding this one-time stimulus, the Obama team should be asked: What will happen in 2010? Will they allow the baseline for HHS funding to return to its pre-2009 levels? That would imply deep cuts. It seems far more likely that, if the stimulus passes in its current form, we are witnessing permanent bump up in the size HHS. The cost of this bill is thus far higher than even the staggering sums in the CBO cost estimate.

What’s just as troubling is the large number of far-reaching policy changes tucked away in the bill.

For instance, the Democratic majority is laying the foundation for government rationing of health care—and the public has heard virtually nothing about it.

The bill provides $1.1 billion for a new program of comparative effectiveness research. The idea is to study medical practice patterns, new products, and new technology to determine what is “cost effective.” In the UK, a similar program run by the National Institute for Clinical Evidence (NICE) is used to deny payment by the government for certain drugs and procedures that are said to be “cost ineffective.”

Democratic lawmakers will deny that rationing is their intent, but that is not credible. Why create a government program to study what’s cost effective if not to use the information to inform payment and coverage decisions? The problem is that this kind of research inevitably includes value judgments (how much is an extra year of life worth?) and interpreting the data is more art than science. In the wrong hands (like a distant government bureaucracy), so-called effectiveness research can be very dangerous indeed.

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