Marilyn Singleton: Thought police (oops, Medicare) for all
The new Medicare for All bill (H.R. 1384) has come and hopefully will go the way of the pet rock. Everybody now knows the basics: the government will take care of all medical, dental, vision, pharmacy, and long-term care services with no out-of-pocket expenses. The bill prohibits parallel private insurance, and has the glaring absence of a financing mechanism. But as usual, bills contain hidden gems. Section 104 of the bill tracks the Affordable Care Act’s “anti-discrimination” rule, making it clear that no person can be denied benefits, specifically including abortion and treatment of gender identity issues “by any participating provider.” The bill does not correspondingly reaffirm the federal laws protecting conscience and First Amendment religious freedom rights of medical personnel. Such protections relate to participation in abortion, sterilization, assisted suicide, and other ethical dilemmas. Most sane individuals agree that we do not want our government to control any aspect of our individual lives—particularly not our religious beliefs and moral codes. When the Department of Health and Human Services (HHS) sought to clarify such conscience protections, thousands of commenters offered evidence of discrimination and coercion to violate the tenets of the Oath of Hippocrates and their own ethics. Some left their jobs or left the medical profession entirely when their conscientious objections were not honored. Conscience protections are vital in this time of unabashed devaluing of life. Last year, the Palliative Care and Hospice Education Training Act (PCHETA), passed the House but died in the Senate. This bill would have dedicated $100 million in additional taxpayer dollars to persuade patients to forgo treatment that might prolong life in exchange for a steady stream of increasing doses of narcotics. Already some families feel they are not merely offered hospice as a choice but are steered toward it when their older relatives fall ill, even when the medical prognosis is uncertain. The focus on palliative care and lowering costs by reducing “aggressive” end-of-life treatment is one more incremental under-the-radar step along the road to government control over life and death. A culture of hastening death has gradually evolved, disguised as “death with dignity.” California, Colorado, Oregon, Washington, Montana, Vermont have legalized physician-assisted suicide with 20 other states considering implementing such laws. Subtly devaluing life primes the pump for rationing of medical care at all stages by a government-run program that is the exclusive purveyor of medical “benefits.” Our western counterparts with single payer have discovered that offering fewer benefits is the simplest way to control costs. The “Complete Lives System”—the brainchild of ObamaCare physician architect Ezekiel Emanuel—includes worrisome determinants of who should receive care. The system prioritizes adolescents and persons with “instrumental value,” i.e., individuals with “future usefulness.” This year, legislators were not so subtle. It is bad enough that our elderly are pushed into hospice, but now the compassionate legislators have set their sights on newborns. New York passed, and Virginia floated laws that permit the killing of babies after birth. The U.S. Senate garnered only 53 of the 60 votes needed to pass the Born Alive Survivors Protection Act which would mandate medical care and legal protections to infants born alive after an attempted abortion. Starting in the 1970s, the federal government clearly saw a need to protect medical personnel from the tyranny of the government mandates that could violate religious or moral convictions. Personal liberty is an integral part of our democratic republic. While a physician’s calling is to render treatment to all patients, this is balanced with an individual physician’s moral beliefs. This is no more apparent than in legislation permitting physician assisted suicide and post-delivery “abortions.” Sadly, under threat of discrimination lawsuits, some physicians have acquiesced to patients’ requests for medications and surgical procedures that conflict with their moral code. As anthropologist, Margaret Mead so brilliantly wrote, “One profession, the followers of [Hippocrates], were to be dedicated completely to life under all circumstances…This is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer—to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient. … It is the duty of society to protect the physician from such requests.” We must not let the government bury our conscience and beliefs under layers of bureaucracy. Medicare for All may mean independent thought for none. Dr. Marilyn Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. She lives in Oakland, Ca.
Daniel Sutter: Two paths forward for healthcare
Numerous prominent Democrats now support Medicare for All, the most recent proposal for a single-payer healthcare system. A recent Trump Administration report, Reforming America’s Healthcare System Through Choice and Competition, offers a different path forward, detailing the numerous ways government restricts competition and increases costs. Medicare for All suggests that we would be turning away from markets and private insurance to government healthcare. In truth, government rules have dominated the industry for over fifty years. A handful of economists have argued for more competition. These arguments have been largely ignored. Until now. Market proponent and economist John Goodman describes the new report as “astonishingly bold,” and “the first time any administration has explicitly acknowledged” government as the source of our most serious problems in healthcare. Competition for profits in markets controls costs. Let doctors and hospitals compete and we can see who offers patients the best service for the best price. Yet we do not truly use markets for healthcare. For instance, doctors rarely quote prices for treatments or procedures ahead of time. People seem to fear that profitable medicine must involve cutting costs and offering low quality care. Yet luxury thrives under competition. Luxury hotels succeed because they deliver high quality, albeit costly, service. Examples like the Mayo Clinic demonstrate that reputations for excellence in medicine can be maintained. Concierge doctors provide high quality care for paying customers. Reforming America’s Healthcare System’s list of how government inhibits competition is too long to thoroughly examine. I will consider some highlights. Scope of practice laws often prevent medical professionals like physician assistants, advanced practice nurses, and pharmacists from offering services consistent with their training. These professionals can competently diagnose many routine conditions or prescribe standard drugs but are restricted by law. A Mercatus Center study estimated that eliminating state scope of practice laws would save over $800 million annually. Such restrictions particularly hurt rural areas facing a shortage of physicians. Certificate of Need laws require government-appointed boards to approve new or expanded healthcare facilities. Alabama’s law covers hospitals, nursing homes, and out-patient surgery centers, among others. Executives from hospitals and clinics often staff these boards, letting existing providers deny entry to would-be challengers. This is a dubious idea. Sears would have loved to keep Walmart and Amazon out of retail. Telemedicine promises considerable cost savings. Smart phones can already transmit a significant amount of information to a medical professional. The barriers to telemedicine today are primarily regulatory. And the benefits extend beyond dollars: patients with limited mobility can avoid painful trips to a doctor’s office. America arguably needs more doctors. We have fewer doctors per capita than most other developed nations despite spending a larger percentage of our GDP on healthcare. Medical doctors must be smart and spend years in intensive training, so the supply will always be limited. But the restrictions are artificial, not natural. Medical organizations run by physicians – who benefit from restricted supply – determine the number of slots in America’s medical schools. The report proposes redirecting Federal medical education dollars to gradually increase enrollment in U.S. medical schools. Simplifying the process for approving foreign-trained doctors to practice in the U.S. offers more immediate relief. Residency and licensure burdens could be waived for doctors completing foreign medical training judged comparable to American programs. The alternative to markets and competition is governance by experts. State Certificate of Need laws resulted from one such Federal planning effort in the 1970s. Government experts would avoid investments in unneeded hospitals and facilities to help control costs. Yet the healthcare costs have outpaced inflation since the 1970s. Experts never seem to outperform competition in controlling cost. Government control and markets provide alternative ways to organize our economy. We rely on markets to supply us with food, which is as much a necessity as medical care, with ever-declining prices and an incredible array of options as a result. Perhaps we should give a healthcare market a chance before turning to Medicare for All. ••• Daniel Sutter is the Charles G. Koch Professor of Economics with the Manuel H. Johnson Center for Political Economy at Troy University and host of Econversations on TrojanVision. The opinions expressed in this column are the author’s and do not necessarily reflect the views of Troy University.
Donald Trump trashes Democrats’ Medicare for All plan in op-ed
President Donald Trump is stepping up his attack on Democrats over a health care proposal called Medicare for All, claiming it “would end Medicare as we know it and take away benefits that seniors have paid for their entire lives.” Trump, omitting any mention of improved benefits for seniors that Democrats promise, writes in an op-ed published Wednesday in USA Today, “The Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised.” But Medicare for All means different things to different Democrats. The plan pushed by Sen. Bernie Sanders, the Vermont independent who challenged Hillary Clinton for the 2016 Democratic presidential nomination, would expand Medicare to cover almost everyone in the country, and current Medicare recipients would get improved benefits. Other Democratic plans would allow people to buy into a new government system modeled on Medicare, moving toward the goal of coverage for all while leaving private insurance in place. Trump’s column comes as he is looking to paint Democratic candidates as extreme ahead of next month’s midterm elections. A White House official speaking to The Associated Press on the condition of anonymity to describe internal plans said that Trump’s health care attack will be echoed by the Republican National Committee and other GOP groups and that the president will continue to raise the attack during his campaign rallies. Sanders responded Wednesday in a statement, saying Trump “is lying about the Medicare for All proposal” that he introduced. “No, Mr. President. Our proposal would not cut benefits for seniors on Medicare. In fact, we expand benefits,” Sanders said. As Trump escalates his efforts on behalf of fellow Republicans, he is casting health care as one of an expanding list of choices for the electorate this year while seeking to raise the alarm about the consequences of Democratic control of the House or the Senate. Medicare for All, also called single-payer over the years, was until fairly recently outside the mainstream of Democratic politics, but this year it has become a key litmus test in many party primaries and a rallying cry for progressive candidates. Under the plan by Sanders, all Americans would gain access to government insurance with no copays or deductibles for medical services. Republicans contend that the proposal would be cost-prohibitive and argue it marks government overreach. Trump has already sought to paint Democrats as extremists after the bitter confirmation battle over Supreme Court Justice Brett Kavanaugh, and internal GOP polling obtained last month by the AP shows that the party believes the message will help galvanize Republican voters to the polls. At a rally in Iowa on Tuesday, Trump argued that the only reason to vote for Democrats “is if you are tired of winning.” He will be holding a rally in Pennsylvania on Wednesday evening. Republished with permission from the Associated Press.
