Friday, April 17, 2009
Callie Moore Is a 13 year-old young lady who lives in the Athens area and has a multitude of medical conditions:
Because of strokes she suffered while in her mother's womb, 13-year-old Callie Moore of Danielsville has a host of complex medical problems. They include spastic quadriplegic cerebral palsy, refractory seizure disorder, mental retardation, gastroesophageal reflux disease, cortical blindness, dysphagia, bone cartilage disease, scoliosis, kyphosis and restrictive lung disease.
Because of these she requires many services that are provided by Medicaid:
Callie's condition mandates round-the-clock care and treatment. Under federal and state Medicaid regulations and policies, she is entitled to screening, diagnostic and treatment services and, because she is medically fragile, skilled nursing care. Medicaid is a joint federal-state matching program that pays for medical assistance for low-income families and for people who would require institutional care if they were not receiving alternative services at home.Medicaid reduced Callie's hours of nursing care and her parents sued Medicaid:
The appeal of this decision was heard by the 11th circuit court of appeals. Part of the case was an amicus brief filed by the states of Florida and Alabama. The essence of which was: the state knows better than your physician
The Moores' lawyers convinced U.S. District Judge Thomas W. Thrash Jr. that the reduction was improper. The judge concluded the state must provide for the amount of skilled nursing care that Callie's treating physician deems necessary.
Thrash's June 4, 2008, ruling has states and Medicaid plan managers up in arms. They say that Thrash's order means that states won't have the flexibility they need and the discretion the law allows to allocate Medicaid resources fairly......
....When state authorities notified Callie's mother that her nursing hours were being reduced, they cited, among other things, a policy that the cost of in-home nursing care should be less than the cost of providing that care in an institution. But the state denies in its brief that it considered cost in determining what nursing hours Callie will receive. It says its experts simply disagreed with the judgement of Callie's doctor on how many nursing hours Callie needs.
After Thrash issued multiple injunctions in Callie's favor, he denied the state's motion for summary judgment and granted the Moores' motion in part.
"Treating physicians...cannot be trusted with this sort of discretion," Senior writes. "When left to their own devices, they advocate for their patients and deem all manner of unproven, dangerous, ineffective, cosmetic, unnecessary, bizarre, and controversial treatments as 'medically necessary.'"
He continued: "Case law provides examples of treating doctors claiming medical necessity and attempting to bill Medicaid for: cosmetic procedures; sex-change operations; (unapproved) drugs; abortion on demand; 'treatments' that have never been proven to work; and round-the-clock nursing and personal assistance for patients who obviously do not need it..." (emphasis added)
Amazingly, the omniscience of the government is not mentioned on the website describing the Obama administration's plan:
Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.
Mickey Kaus seems to believe that the government will be so scared of offending anyone that everything will be approved and the promise of cost control evaporates:
The “rational,” cost-cutting, “hard-choices” pitch isn’t just awful marketing–I don’t even think it’s accurate. Put it this way: I’m for universal health care in large part precisely because I think the government will be less tough-minded and cost-conscious when it comes to the inevitable rationing of care than for-profit insurance companies will be. Take Arnold Kling’s example of a young patient with cancer, where “the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200.” No “rational bureaucracy” would spend $20 million to save a life, Kling argues. I doubt any private insurance company is going to write a policy that spends $20 million to save a life. But I think the government–faced with demands from patient groups and disease lobbies and treatment providers and Oprah and run, ultimately, by politicians as terrified of being held responsible for denying treatment as they are quick to pander to the public’s sentimental bias toward life–is less likely to be “rational” than the private sector.But the potential for political interference can be strong. From the Coyote Blog: (Thanks Galen!!)
That is to say, the government’s more likely to pay for the treatment (assuming a doctor recommends it). So it’s government for me.
But Kaus is correct that if some high-powered and well-funded interest group gets behind a certain procedure, cost-effective or not, the government overlords of the program will likely approve it. As a result, for example, no potential treatment for breast cancer will ever be denied given the proven strength of women’s groups lobbying for breast cancer treatment (already, breast cancer research is hugely over-funded vs. other diseases given its mortality, due in large part to this powerful lobbying).
But it is not one dynamic or the other. Both will exist. There will be huge pressures to cut back somewhere, as costs skyrocket. And there will be huge pressure from certain interest groups to fund treatment for certain diseases in unlimited amounts. The result will not be, as Kaus posits, that everything will be funded more than it is today — the result will be that certain procedures and conditions with strong lobbying and political muscle will get funded more, with the difference being made up from cutting funding for conditions and procedures without a well-organized lobby.
And if you think that the current enthusiasts of health care reform will ignore special interest politics, or their own interests please ask them their position on wind energy.
(Hat tip Red State) |