Friday, August 23, 2013
Pediatric Research Bill: Obamacare’s Road to Rationing?
Later this month, the House of Representatives could consider legislation regarding pediatric research.[1] Legislation regarding this issue (H.R. 1724) was first introduced in April, and a new version of the bill (H.R. 2019) was introduced in May.
Although largely similar, H.R. 1724 would require the director of the National Institutes of Health (NIH) to provide a justification for any existing grants studying health economics, and would prohibit new grants until “a federal law has been enacted authorizing the National Institutes of Health to use funding specifically for health economics research.”[2] Press reports indicate that H.R. 2019 excludes the restrictions included in H.R. 1724 “in order to please Democrats who favor the research.”[3]
This is a mistake. The House should ensure that H.R. 1724’s proposed restrictions on health economics research remain in any NIH-related legislation that comes to the House floor. To do otherwise would provide tacit approval to Obamacare’s road to government-rationed health care.
Proposed Restriction a Necessary Protection
The provision omitted from H.R. 2019 would have instituted an important and necessary protection on taxpayer-funded research on cost-effectiveness in health care. In recent years, the federal government has funded numerous such studies. For instance, a June 2011 Government Accountability Office report examining projects funded by the “stimulus” highlighted NIH grants studying the cost-effectiveness of various medical treatments, including:
“A Comprehensive Model to Assess the Cost-Effectiveness of Patient Navigation,”“Cost-Effectiveness of Hormonal Therapy for Clinically Localized Prostate Cancer;”“Clinical and Cost-Effectiveness of Biologics in Rheumatoid Arthritis,” and“Cost-Effectiveness of HIV-Related Mental Health Interventions.”[4]Liberals Favor Cost-Effectiveness Research
Setting aside the wisdom of using taxpayer funds to examine the cost-effectiveness of various treatments, such research could eventually be used to deny patients access to certain kinds of care. Quotes from key policymakers reveal how some would use cost-effectiveness research as a way for government bureaucrats to block access to treatments that are deemed too costly:
Former Senator Tom Daschle (D–SD), President Obama’s first choice for Secretary of Health and Human Services, wrote in 2008 that “we won’t be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective. That means taking a harder look at the real costs and benefits of new drugs and procedures.”[5]In a 2009 interview with The New York Times, President Obama argued that “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.… There is going to have to be a very difficult democratic conversation that takes place.”[6]Former Medicare Administrator Dr. Donald Berwick, in his infamous 2009 interview, strongly argued in favor of taxpayer-funded cost-effectiveness research when stating that “the decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”[7]Lawmakers have already expressed their desire to use cost-effectiveness research to restrict access to certain treatments. A report prepared by the House Appropriations Committee in 2009, discussing “stimulus” funding for the types of projects highlighted above, noted that thanks to the research funding, “those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases more expensive will no longer be prescribed.”[8]
Road to Rationing
Although research comparing the relative merits and costs of medical treatments may sound appealing, past experience has demonstrated that such research can, and often is, used as a blunt tool by governments to restrict access to certain kinds of care. At a time when genetic advances have opened the door to personalized medical treatments, Obamacare has moved health policy in the opposite direction, expanding the federal bureaucracy in an attempt to micromanage the health care system.[9]
Imposing the restrictions on cost-effectiveness research included in H.R. 1724 would represent a good first step in restoring the balance between federal bureaucrats and patients.
—Chris Jacobs is Senior Policy Analyst in the Center for Health Policy Studies at The Heritage Foundation.
[2]The Kids First Research Act of 2013, H.R. 1724, § 4.
[3]Newhauser, “Mindful of Previous Defeat.”
[4]U.S. Government Accountability Office, HHS Research Awards: Use of Recovery Act and Patient Protection and Affordable Care Act Funds for Comparative Effectiveness Research, GAO-11-712R, June 14, 2011, http://www.gao.gov/new.items/d11712r.pdf (accessed June 13, 2013).
[5]Tom Daschle, Scott Greenberger, and Jeanne Lambrew, Critical: What We Can Do about the Health Care Crisis (New York: Thomas Dunne Books, 2008), pp. 172–173.
GOP Wins Big In Northwest Florida House District In First Vote Since Rejecting Medicaid Expansion
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« Bondi criticizes judge who sentenced 'Ochocinco' to jail | Main | Obama's bipartisan election commission to hold Miami meeting. » GOP wins big in Northwest Florida House district in first vote since rejecting Medicaid expansion Florida Democrats hoping the fight over Medicaid expansion and the sequester would win them support with those who depend on federal funding won’t find much encouragement in Tuesday’s special election for House District 2.In the first referendum since House Republicans bypassed more than $50 billion in federal aid for health care, Mike Hill, a 55-year-old tea party Republican insurance agent, won 57.9 percent of the vote in a Northwest Florida district that has an economy dominated by hospitals as well as the military -- which is weathering a sequester deal rife with budget cuts forced by congressional Republicans.Hill’s Democratic opponent, Jeremy Lau, mustered 42.1 percent of the vote in a special election held after Rep. Clay Ford died in March. Lau, a 40-year-old aircraft mechanic for L-3 Com Vertex Aerospace, a military contractor at Pensacola Naval Station, had made Medicaid expansion his No. 1 issue.“The failure of the Legislature to expand Medicaid has cost our district jobs,” Lau said. “It’s a huge issue here.”A University of Florida study concluded that expansion of Medicaid would create an average of 1,619 full-time and part-time jobs in Escambia County annually over the next 10 years and help provide coverage for county’s residents, 20 percent of whom don’t have health insurance.But Lau couldn’t overcome the district’s conservative demographics (Mitt Romney won 59 percent of the vote here in 2012) and Hill’s overwhelming financial advantage. The district, which covers parts of Escambia and Santa Rosa counties, leans so hard right that no Democrat ran in either 2010 or 2012 against Ford. Hill raised $200,000 compared to Lau’s $29,500, getting plenty of help from the GOP, which chipped in $51,000. Democrats could manage only $1,090 for Lau.Hill also made the Medicaid expansion a key issue, but as a way to spruce up his conservative credentials.“I’m so proud of Speaker (Will Weatherford) and the House for turning that down,” Hill said. “We can’t afford that in Florida.”Hill, a veteran of the U.S. Air Force, becomes the first black Republican in the Florida House since Jennifer Carroll served there between 2003 and 2010. He’s also the first black legislator from Northwest Florida since Reconstruction.“I know the historical significance,” Hill said. “But it doesn’t matter to me if I’m the first black this or that. I don’t want to be chosen based on my skin color. I want to be chosen based on my character and my value system.” Hill founded the Northwest Florida Tea Party in 2010. He summarizes his value system succinctly: “Limited government, low taxes, personal freedom and individual responsibility.”He said he will aim to eliminate the corporate tax rate, reduce the state sales tax and eliminate rules and regulations for business.“People want jobs, they want business to expand,” Hill said. He lists his net worth, as of April 1, at $1.1 million, deriving about $424,000 a year from his State Farm Insurance agency. He makes another $8,000 a year sitting on the board of Pride Enterprises, which is a St. Petersburg company that makes state license plates using prison inmates. Hill said he supports the program as a board member, but said that as a legislator, he will evaluate the contract independently of his association with PRIDE. Upon running, however, he did step down from his board position with Integrity Florida, a public watchdog group in Tallahassee.This is the first elected office held by Hill, who ran and lost in 2010 a senate race against Greg Evers. He recently got a shout-out from MSNBC talking head Joe Scarborough for his support in his congressional campaigns from the early 1990s.Hill is new to District 2. He moved last week to a Pensacola Beach condo so he could qualify. Florida law requires candidates to live in the district upon getting elected. Hill said he actually lived in Ford’s district, but was drawn out of it when the boundaries were reconfigured last year. He will have a year more in the Legislature than the next class of rooking lawmakers, giving him a headstart in the race for House Speaker. Other recent “red-shirt” freshmen to become speakers or speaker designates are Marco Rubio, who served as speaker in 2008 and 2009, and Jose Oliva, who is designated to become speaker in 2018.But Hill wouldn’t say if he will vie for the Speaker job in 2020.“I don’t know what it means to be Speaker,” Hill said. “I don’t know if it’s something I want.”In a statement from the Republican Party of Florida, Weatherford welcomed Hill.
Posted by Michael Van Sickler at 9:40 PM on Tuesday, Jun. 11, 2013 in 2013 FLORIDA LEGISLATURE, Will Weatherford | Permalink The Miami HeraldCopyright 2013 The Miami Herald. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Comments 
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« Bondi criticizes judge who sentenced 'Ochocinco' to jail | Main | Obama's bipartisan election commission to hold Miami meeting. » GOP wins big in Northwest Florida House district in first vote since rejecting Medicaid expansion Florida Democrats hoping the fight over Medicaid expansion and the sequester would win them support with those who depend on federal funding won’t find much encouragement in Tuesday’s special election for House District 2.In the first referendum since House Republicans bypassed more than $50 billion in federal aid for health care, Mike Hill, a 55-year-old tea party Republican insurance agent, won 57.9 percent of the vote in a Northwest Florida district that has an economy dominated by hospitals as well as the military -- which is weathering a sequester deal rife with budget cuts forced by congressional Republicans.Hill’s Democratic opponent, Jeremy Lau, mustered 42.1 percent of the vote in a special election held after Rep. Clay Ford died in March. Lau, a 40-year-old aircraft mechanic for L-3 Com Vertex Aerospace, a military contractor at Pensacola Naval Station, had made Medicaid expansion his No. 1 issue.“The failure of the Legislature to expand Medicaid has cost our district jobs,” Lau said. “It’s a huge issue here.”A University of Florida study concluded that expansion of Medicaid would create an average of 1,619 full-time and part-time jobs in Escambia County annually over the next 10 years and help provide coverage for county’s residents, 20 percent of whom don’t have health insurance.But Lau couldn’t overcome the district’s conservative demographics (Mitt Romney won 59 percent of the vote here in 2012) and Hill’s overwhelming financial advantage. The district, which covers parts of Escambia and Santa Rosa counties, leans so hard right that no Democrat ran in either 2010 or 2012 against Ford. Hill raised $200,000 compared to Lau’s $29,500, getting plenty of help from the GOP, which chipped in $51,000. Democrats could manage only $1,090 for Lau.Hill also made the Medicaid expansion a key issue, but as a way to spruce up his conservative credentials.“I’m so proud of Speaker (Will Weatherford) and the House for turning that down,” Hill said. “We can’t afford that in Florida.”Hill, a veteran of the U.S. Air Force, becomes the first black Republican in the Florida House since Jennifer Carroll served there between 2003 and 2010. He’s also the first black legislator from Northwest Florida since Reconstruction.“I know the historical significance,” Hill said. “But it doesn’t matter to me if I’m the first black this or that. I don’t want to be chosen based on my skin color. I want to be chosen based on my character and my value system.” Hill founded the Northwest Florida Tea Party in 2010. He summarizes his value system succinctly: “Limited government, low taxes, personal freedom and individual responsibility.”He said he will aim to eliminate the corporate tax rate, reduce the state sales tax and eliminate rules and regulations for business.“People want jobs, they want business to expand,” Hill said. He lists his net worth, as of April 1, at $1.1 million, deriving about $424,000 a year from his State Farm Insurance agency. He makes another $8,000 a year sitting on the board of Pride Enterprises, which is a St. Petersburg company that makes state license plates using prison inmates. Hill said he supports the program as a board member, but said that as a legislator, he will evaluate the contract independently of his association with PRIDE. Upon running, however, he did step down from his board position with Integrity Florida, a public watchdog group in Tallahassee.This is the first elected office held by Hill, who ran and lost in 2010 a senate race against Greg Evers. He recently got a shout-out from MSNBC talking head Joe Scarborough for his support in his congressional campaigns from the early 1990s.Hill is new to District 2. He moved last week to a Pensacola Beach condo so he could qualify. Florida law requires candidates to live in the district upon getting elected. Hill said he actually lived in Ford’s district, but was drawn out of it when the boundaries were reconfigured last year. He will have a year more in the Legislature than the next class of rooking lawmakers, giving him a headstart in the race for House Speaker. Other recent “red-shirt” freshmen to become speakers or speaker designates are Marco Rubio, who served as speaker in 2008 and 2009, and Jose Oliva, who is designated to become speaker in 2018.But Hill wouldn’t say if he will vie for the Speaker job in 2020.“I don’t know what it means to be Speaker,” Hill said. “I don’t know if it’s something I want.”In a statement from the Republican Party of Florida, Weatherford welcomed Hill.
"Representative Hill will be a strong voice for limited government and individual liberty," Weatherford stated.
"His election sends a clear message that Floridians want smaller government, lower taxes, and the freedom to pursue the American Dream," said Rep. Steve Crisafulli, R-Merritt Island, in a statement. "Representative Hill will be a strong conservative voice in our caucus."
Crisafulli, who is set to become Speaker in 2014, shares political consultants with Hill: Meteoric Media Strategies, founded by former Gov. Rick Scott spokesmen Brian Hughes and Brian Burgess.Posted by Michael Van Sickler at 9:40 PM on Tuesday, Jun. 11, 2013 in 2013 FLORIDA LEGISLATURE, Will Weatherford | Permalink The Miami HeraldCopyright 2013 The Miami Herald. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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A lot of Hill's money came from the Insurance Industry. You can expect him to continue the attacks on Citizens and the overblown estimates of storm exposure in Floriduh. In other words, you can expect him to continue the inflated premiums and the corporate welfare system Republicans hold near and dear to their hearts and wallets (that's a redundant statement).
Posted by:Anti-Tallahassee |June 12, 2013 at 12:34 AMJust what Florida needs--another Tea Party Legislator.
Posted by:M.A. Salfinger |June 12, 2013 at 07:26 AMOne more nut for the fruitcake in Tallahassee!!
Posted by:Doug Watson |June 12, 2013 at 10:09 AMGlad to know that corporate welfare will continue to be the primary mission of the Florida Legislature. West Florida has always been much more a part of Alabama than Florida. No real loss if we just partitioned the state at the Apalachicola River.
Posted by:Can't take anymore |June 12, 2013 at 01:12 PM Verify your Comment Previewing your CommentPosted by: |This is only a preview. Your comment has not yet been posted.
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A Chronic Disease
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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
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Comments 53 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.Pages1234Next ›Last » Contents June 17, 2013 | Volume LXV, No. 11
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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
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