A Chronic Disease

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A Chronic Disease
Obamacare won’t go away on its own By Ramesh Ponnuru
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Conservatives and Republicans in Washington — activists, strategists, politicians — are increasingly embracing a theory about Obamacare: It’s going to collapse of its own weight, and its failure could yield a sharp right turn in the 2014 and 2016 elections. That theory is probably wrong, and dangerously so. To be rid of Obamacare, Republicans will have to do more than just wait for it to go away — and more than they have done so far.

You can see why the theory has caught on. The early implementation of Obamacare is not going well, with every week bringing fresh news embarrassing to the law’s proponents: Insurers are raising premiums, sometimes dramatically; the administration has had to announce that it will miss statutory deadlines; companies are planning to scale back coverage or even drop it completely. Senator Max Baucus, the Montana Democrat who did as much to shape the law as any other person, said that implementation could be a “train wreck” and then said he would not run for reelection next year. And there are reasons for thinking that the law is too badly conceived ever to work well.

The law takes an inefficient model of health financing — in which insurance is used to prepay routine and predictable medical expenses — and extends it to more people while making it more inefficient still. It assumes, unrealistically and against precedent, that government-backed experts can drive efficiency in health markets. It ignores how people respond to incentives: by performing fewer services when price controls are imposed, for example. These flaws are central rather than incidental to the law. They follow from its misdiagnosis of what ails American health care as, essentially, markets that are too free. Eliminating these flaws would require rewriting the entire law, which is to say replacing it.

President Obama, in a press conference on April 30, conceded that there would be some “bumps” on the road to the law’s destination. He suggested, however, that the only people affected by these bumps would be those who lack insurance now but will have it once the law takes full effect. “For the 85 to 90 percent of Americans who already have health insurance, this thing has already happened. And their only impact is that their insurance is stronger, better, more secure than it was before. Full stop. That’s it. They don’t have to worry about anything else. The implementation issues come in for those who don’t have health insurance.”

Those remarks reflect a disturbing disconnection from reality, one that probably comes from reading too many liberal bloggers. People who have insurance now do indeed have to worry that their premiums will go up, their coverage will be dropped or reduced, and medical innovations that could help them will slow down. And the law will leave many people who lack health insurance without it: The Congressional Budget Office estimates that even after all the law’s taxes, spending, and regulation are implemented, 30 million people in our country will not have health insurance.

Because the law is unlikely to work, because it cannot be meaningfully improved while keeping its basic design, and because it remains unpopular, Republicans would be mad to acquiesce to it. (For a more extended version of this argument, see my article with Yuval Levin, “Repeal, Replace, Still,” in the April 8 issue of NR.) They should not worry that in five or six years almost everyone will see the law as a success. It is likely to be a failure by any reasonable measure.

The reasons for thinking the law will fail are not, however, reasons for thinking it will self-destruct in short order, or harmlessly. Critics have, for example, raised the possibility that the law will cause a “death spiral” in insurance markets. The law allows people to buy insurance without prejudice once they are sick. In one scenario, many people will therefore stop buying health insurance when they are well. The law will make them pay a penalty for going without insurance, but the penalty will be much lower than the insurance premiums they will be avoiding. The fewer healthy people are in the insurance pool, the higher premiums will have to go. And the higher premiums go, the more sense it will make for healthy people to drop their coverage.

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ArticlesAuditing CiceroO tempora! O mores!ByKevin D. WilliamsonHard to FireWhy Lois Lerner may linger.ByJohn FundBrother Cornel in BritainPreaching salvation, hugging strangers, rocking the fans.ByAnthony DanielsFeaturesDefending LincolnIn our hearts, we know he’s right.ByRich LowryUKIP Shakes Up WestminsterNigel Farage has more than stirred the Tories.ByMark SteynA Chronic DiseaseObamacare won’t go away on its own.ByRamesh PonnuruThree Brave LivesEncounters with a Chinese legal activist, a Syrian cartoonist, and a Cuban ‘Lady in White.’ByJay NordlingerSpecial Energy SectionWestern PromisesGaze into the abyss of Cali’s cap-and-trade.ByDaniel FosterFree Markets Mean Cheaper EnergyTrue 60 years ago, and true today.ByRupert DarwallUnited American EmiratesDon’t credit the government for increased oil production.ByPatrick BrennanTo Drill or Not to Drill?Governor Cuomo refuses to answer the question.ByIan TuttleWastedAmerica has squandered its lead in nuclear-energy technology.ByWilliam TuckerBooks, Arts & MannersLeviathan FailJonah Goldberg reviews The End Is Near and It’s Going to Be Awesome: How Going Broke Will Leave America Richer, Happier, and More Secure, by Kevin D. Williamson.Brain TeasesTheodore Dalrymple reviews Brainwashed: The Seductive Appeal of Mindless Neuroscience, by Sally Satel and Scott O. Lilienfeld.The UprisingGalen Mac Caba reviews Strange Rebels: 1979 and the Birth of the 21st Century, by Christian Caryl.A Comeback ConcertJay Nordlinger discusses James Levine, one of the great conductors of our age.To Boldly FlunkRoss Douthat reviews Star Trek: Into Darkness.Country Life:Grasping the ThistleRichard Brookhiser discusses summer weeds.SectionsLetters to the EditorThe WeekAthwart  .  .  .  .  .  .  .  .  James LileksThe Long View  .  .  .  .  .  .  .  .  Rob LongPoetry  .  .  .  .  .  .  .  .  Lawrence DuganHappy Warrior  .  .  .  .  .  .  .  .  Mark Steyn © National Review Online 2013. All Rights Reserved. Home  |   NR / Digital Home  |   Donate  |   Media Kit  |   Site Problems  |   Contact Us  |   Privacy Policy var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); pageTracker = _gat._createTracker("UA-1167326-1"); pageTracker._setDomainName(".nationalreview.com"); pageTracker._initData(); pageTracker._trackPageview(); // tracks clicks with google analytics function trackClick(elm,clickCategory,clickEvent,clickLabel,clickValue) {pageTracker._trackEvent(clickCategory,clickEvent,clickLabel);setTimeout('document.location="'+elm.href+'"',100);} // tracks cartoon clicks function track_cartoon_click(label){var pageview='/cartoon_'+label;var label='Cartoon: '+label;pageTracker._trackPageview(pageview);pageTracker._trackEvent('Homepage Cartoon','View',label);} // tracks poll results clicks function track_poll_results_click(label){var pageview='/poll_result_'+label;var label='Result: '+label;pageTracker._trackPageview(pageview);pageTracker._trackEvent('Poll Results','View',label);} // tracks clicks function track_event_click(action,label,track_page_view,category){if (typeof(category)=="undefined"){var category="Event Click"}if (typeof(track_page_view)=="undefined"){track_page_view=true;var pageview="/"+category+"_"+action+"_"+label}if(track_page_view){pageTracker._trackPageview(pageview)}label=action+": "+label;pageTracker._trackEvent(category,action,label)};

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Suicides, Disease: Europe's Sick Economy Costs Lives

Europe's financial crisis is costing lives, with suicides and infectious diseases on the rise, yet politicians are not addressing the problem, health experts said on Wednesday.

Deep budget cuts and growing unemployment are tipping more people into depression, and falling incomes mean fewer people can see their doctors or afford to buy medicines.

The result has been a reversal since 2007 of a long-term decline in suicide rates, coupled with worrying outbreaks of diseases including HIV - and even malaria - in Greece, according to an major analysis of European health in The Lancet journal.

Countering these threats requires strong social protection schemes, researchers argue. But the austerity measures imposed after a string of crises in southern Europe - most recently in Cyprus - has shredded such safety nets.

"There is a clear problem of denial of the health effects of the crisis, even though they are very apparent," said lead researcher Martin McKee of the European Observatory on Health Systems and Policies, a group backed by the World Health Organisation.

"The European Commission has a treaty obligation to look at the health effect of all of its policies but has not produced any impact assessment on the health effects of the austerity measures imposed by the troika."

The so-called troika of the European Commission, European Central Bank and International Monetary Fund is the group of lenders responsible for a series of economic bail-outs.

McKee said the failure of European governments and the European Commission to face up to the health consequences of their policies was reminiscent of the "obfuscation" of the tobacco industry over curbs on smoking.

The case of Iceland, however, suggests there is an alternative.

Despite a devastating financial crisis, Iceland rejected austerity, following a referendum, and instead continued to invest in its social welfare system. As a result, the researchers found there had been no discernible effects on health since the crisis.

Iceland's economy has now returned to growth, but the recovery is patchy and inflation has remained stubbornly high.

By contrast, McKee and colleagues reported that healthcare systems were now under strain in many European countries, including Spain, Portugal and Greece, with a series of negative consequences.

In particular, there is a growing trend for patients to seek care at a later stage, even though this will mean worse outcomes for individuals and higher costs for the healthcare system in the long term.

In Greece, meanwhile, hospitals are struggling to maintain basic standards, resulting in a rise in antibiotic resistant infections, and patients have suffered shortages of a number of medicines, including epilepsy treatments.

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New Discoveries May Help Treat Blood Disease That Plagues African-Americans

Scientists may be close to finding a cure for sickle cell anemia, a blood disease that disproportionately affects African-Americans.

One in 500 African descendants born in the United States suffer from sickle cell; one in 12 carry the gene for it. The disease can cause symptoms as minor as fatigue, or as major as organ damage. A person suffering from sickle cell has defective hemoglobin that leads to abnormally shaped red blood cells, which get caught in the veins and cause circulation issues.

But a long-term experiment run out of the University of Michigan Medical School found that doctors might be able to treat these symptoms by using an antidepressant:

Their study, which includes more than 30 years of research, found that the antidepressant tranylcypromine, or TCP, may essentially reverse the effects of the disorder.[...]

But while U-M scientists say it’s too early to test out TCP as a treatment for sickle cell disease, they’re confident their findings hold promise.[...]

The first clinical trial on TCP and its affect on sickle cell is now being planned with researchers at Wayne State University in Detroit. Further information will be available later this year if it receives approval to go forward.

African-Americans disproportionately struggle to access the health care they need. Socioeconomic and environmental reasons — and the root cause, racism — are, of course, the reason for the disparity. Ultimately, the lack of care for back communities might funnel down to the research level. It’s suspected that less funding is awarded for research toward diseases that affect black people at a higher rate than white.

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National Plan to Address Alzheimer's Disease

Today, as many as 5.1 million Americans suffer from Alzheimer’s. As the baby boomers march past age 65, that number could more than double in just a few decades.

We’ve made considerable progress in the fight against Alzheimer’s and other dementias, but much more needs to be done right away, because people who face the challenges of caring for someone with Alzheimer’s need help now.

The Obama administration has announced an historic $156 million commitment to address what is needed to confront Alzheimer’s disease. The National Plan to Address Alzheimer’s Disease is a roadmap that will help us meet our goal to prevent and effectively treat Alzheimer’s disease by 2025. This is a truly national plan, based on a strong partnership with every part of the Alzheimer’s community, including scientists, patient advocates, and people living with the disease.

This plan lays out a blueprint for expanding research in prevention and treatment and getting the most-promising drugs from discovery into clinical trials. We will also figure out ways to move best practices out of the research journals and into exam rooms as soon as possible.

As we asked for input on the plan, it was crystal clear that our nation couldn’t wait until the strategy became final to start taking action. Thanks to the President’s commitment, work is already underway, including exciting new clinical research projects that may yield breakthroughs in just a few years.

To help those who are dealing with Alzheimer’s today, we have launched a targeted awareness campaign to help people with Alzheimer’s and their caregivers find resources that can help them manage the disease.

We’ve launched www.Alzheimers.gov, a website that caregivers told us they need. This site is a one-stop shop for information about a range of questions that people helping people with Alzheimer’s often face:

What is Alzheimer’s, its symptoms and risk factors?How is it diagnosed?What treatments are available? What are clinical trials and how can I participate?How to pay for care? How to plan for future needs?How can I cope with the everyday challenges?Where can I find help near me?What are my options for home care and residential care?

The TV ad below is part of a national campaign to inform the public about the resources available at  Alzheimers.gov.

In creating this plan we also heard that we needed more information for health care providers. So we have funded Geriatric Education Centers around the country to develop curricula and free training on Alzheimer’s and dementia for health professionals. Videos and fact sheets to help busy providers recognize the symptoms of Alzheimer’s and improve the care they provide will be posted on the new website this summer.

These steps in research and education are the cornerstones of an ambitious and aggressive agenda to improve the lives of people living with Alzheimer’s disease and their families.

Kathleen Sebelius is the Secretary of Health and Human Services

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