The Only Health Care Cost Control Idea the Democrats Have Ever Had

I think this article makes it clear that, no matter what the rhetoric, the only health care cost control idea Obama and the Democrats ever had was saying "no" to care.  Whatever one calls this (managed care, rationing, death panels) it is really not that much different from what insurance companies have been doing for years.  And it is areal irony that Democrats passed this legislation feeding off anger of voters with insurance companies saying "no", when their plan really depends on the government saying "no" even more often  (or else there won't be any cost savings).

The author argues that information is important for patients to make better decisions:

When patients are given information about potential benefits and risks, they seem to choose less invasive care, on average, than doctors do, according to early studies. Some people, of course, decide that aggressive care is right for them "” like the cancer patient (and palliative care doctor) profiled in this newspaper a few days ago. They are willing to accept the risks and side effects that come with treatment. Many people, however, go the other way once they understand the trade-offs.

They decide the risk of incontinence and impotence isn't worth the marginal chance of preventing prostate cancer. Or they choose cardiac drugs and lifestyle changes over stenting. Or they opt to skip the prenatal test to determine if their baby has Down syndrome. Or, in the toughest situation of all, they decide to leave an intensive care unit and enter a hospice.

I agree, but I would go further -- information and incentives are important.  And the absolute most important bit of information when it comes to cost control is price, and patients under Obamacare have absolutely no incentive to give a sh*t about price even if they were informed of it.  Exactly the opposite of the incentives I have had since I took on a high-deductible health care policy several years ago.

Update: Brad Warbiany discusses the proposed IPAB and its powers to shape health care spending in the context of Congress as an addict trying to control its impulses.  However, I think Brad underestimates the power of the board to be captured.  What will result is rulings for more coverage of procedures with powerful lobbies, offset by less coverage of procedures with weaker lobbies, irrespective of the science.   Just look at the diseases the NIH and NSF gives grant money for -- the grants have nothing to do with the science of where research could be most productive and everything to do with diseases that have large and powerful constituencies.

Update #2: Isn't it interesting to see the NY Times, after arguing for months that Obamacare was not about rationing, is now admitting that rationing is the key to success.  It reminds me of this that I wrote a while back:

I have decided there is something that is very predictable about the media:  they usually are very sympathetic to legislation expanding government powers or spending when the legislation is being discussed in Congress.  Then, after the legislation is passed, and there is nothing that can be done to get rid of it, the media gets really insightful all of a sudden, running thoughtful pieces about the hidden problems and unintended consequences of the legislation.


  1. ADiff:

    'Rationing' is similar to "death & taxes" (or "revenue enhancement & negative patient-care outcome" for the bureaucrats out there) ... that is to say: it's inevitable.

    The question is 'on what basis' the rationing is done. In a market model it's done by price, with those who can afford the product getting it, and those who cannot afford it denied. In a 'communist' demand economy model it's done by government decision.

    The problem of the 1st is that the distribution of wealth effecting the rationing may offend our one's sense of 'fairness', even if it achieves economic optimality.

    The problems of the 2nd are more complex. In spite of the protestations of advocates (i.e. probably the beneficiaries thereof) it will to some degree, from minor to dramatic, under-perform with respect to optimality. This is to say that the sum total of all benefits obtained will always be less (and often drastically so) than those produced under free market conditions. Another is that substituting one set of rationing criteria (wealth) for another (political decision-making) often (if not always) fails to reduce 'unfairness' simply changes the mechanisms creating the (usually cumulatively greater) distributive 'injustice'.

    I fail to see how the 'unfairness' inherent in any wealth based rationing system is any less when 'pull' and 'connections' are used instead. And let's face it, when 'politics' decides, that's exactly the criteria involved.

    As we used to say back in my Air Force days referring to government decision making: "There is no such thing as 'pull', there's only 'suck'."

  2. Bob Smith:

    I took on a high-deductible health care policy several years ago.

    I'm pretty sure Obamacare will make that illegal. In order to "save" you from going bankrupt if you have to fork over the deductible for your care, your premiums will skyrocket because of the mandatory low deductible. The Obama official who said that the purpose of mandating low deductibles was to save people from bankruptcy failed to explain why high deductibles lead to bankruptcy but high premiums do not.

  3. Flatland:

    I recently hit my deductable for my high deductible plan due to a birth. My wife just a week ago had to have surgery. I went from caring about the cost last year to doing whatever we wanted because I didn't have to pay for it. Need more Vicodin? No problem... Insurance will pick it up.

  4. caseyboy:

    Update # 2 - concerning the media getting after it after it is too late to stop. I could not agree more. They don't want to interfere with the progressive agenda, but once pieces are in place they feel they must do some critical reporting to maintain some semblance of "objectivity". For the most part they are a corrupt group of elitists who feel they know what is best for the rest of us.

    On a different front I was surprised when the OMB released a statement that our current deficit spending is unsustainable. Hmmmm? You think that might bit of information might have been useful in the debate over Obamacare? Another instance of "CYA" for the history books.

  5. Ironman:

    It's worse than you think - the new incentives are such that for many, it will make more sense to drop their health insurance altogether, and only buy it when actually needed, then drop it again as soon as possible if it should no longer be needed. It's an interesting method of rationing....

  6. mesaeconoguy:

    Isn’t it interesting to see the NY Times, after arguing for months that Obamacare was not about rationing, is now admitting that rationing is the key to success.

    The really funny thing to watch, now that Obamacare is headed straight for a constitutional challenge with the Supremes, is the feverish squirming to use the baseline legal "defense" that the personal mandate constitutes a tax, after all that (flagrantly ignorant) posturing that it's not a tax.

    Seriously. I am very hard-pressed to find or think of a pool of idiots more prone to ordinary stupidity and blunders than this current gaggle of boobs and buffoons.

  7. Not Sure:

    Seriously. I am very hard-pressed to find or think of a pool of idiots more prone to ordinary stupidity and blunders than this current gaggle of boobs and buffoons. - mesaeconoguy

    I don't know- *somebody* voted for them- presumably, without having guns held to their heads.

  8. mesaeconoguy:

    At least voters can argue they were not fully informed (they’re never informed) of Obamalini’s corruption. Shocker, he’s a socialist/fascist, but here, you won’t find the media reacting to that.

  9. Methinks:


    This is exactly how they dealt with Social Security during the Roosevelt administration. The politicians swore up and down that it's not a tax.

    When it was challenged in the Supreme Court, the government lawyers argued that it Social Security is a general tax and the money collected under that general tax can and will be used to fund any number of government whims.

    I think they don't care if the mandate is struck down or not. They'll just replace it with a tax and argue for single payer. They've got the citizens of this country in a vice. This was the intention and they don't much care how exactly it plays out because in the end, they got what they wanted - more power and more centralized power while the citizenry has less disposable income, thus less freedom and more dependency on the politicians.

    They aren't even pretending anymore. They stopped pretending when Obama and Nancy Pelosi made it clear that they couldn't give two shakes of a rat's ass what the vast majority of the population wanted. They were getting their way. The constitution is meaningless.

  10. ilovebenefits:

    Unless we figure out how to cure chronic illness, costs will continue to rise. Example, polio was expensive because we treated symptoms in the 1950s. When the vaccine was discovered, the illness became cheap to occur. We need to follow that path with diabetes, asthma and many more if health care costs are ever to be sustainable. In the meantime, we need to do everything we can think of to keep costs down to that we may save money to save lives.

    There will be much to be done in health care over the next decade and beyond. We have assembled an outstanding group of Benefits Directors, Lean Six Sigma experts, and technology gurus. If you have a question, need to think through a strategy or have a specific project you can reach us at

  11. markm:

    From Warren's first link: "The health act requires Medicare and other agencies to help hospitals and doctors give patients more information — which is practically a no-lose proposition. In the course of receiving more control and more choice, two distinctly American values, patients will probably help hold down costs."

    One of the biggest problems with American medical care is that doctors don't have time to sit down and talk to their patients. Medicare currently pays doctors less than half their usual fees. Payments will be lowered further to help pay for this boondoggle. And they're going to ask the doctors to take more time!

  12. caseyboy:

    To Not Sure - You are correct in that somebody voted the boobs and buffoons into office, other boobs and buffoons. Free loading, nanny state beneficiaries educated in our public school system by left leaning teachers and then further brainwashed by a media with a very progressive tilt.

  13. Ron H.:


    Do I understand you correctly? Your solution to the high cost of treating disease, is to CURE that disease, so expensive treatment is no longer necessary?

    What a novel idea! I would imagine that everyone is in favor of curing diseases. How do you suggest we proceed?

  14. Pablo M. Podhorzer:

    USA, the only developed country without a Universal Health Insurance in place. You are the joke of the world because of this issue. Go live in Europe, get sick, be witness to the wonderful level of treatment that will not cost you a dime other than your taxes, and decide if the US model is crazy or purposely greedy.

  15. Douglas Thompson:

    Health Care Reform Act-intent for Change

    For many years, America’s health brokers have been offering health insurance to individuals, small businesses and large businesses for decades, yet the enrollment statistics have revealed a steady decrease on an annual basis. The number of uninsured Americans is estimated to be as high as 30 million, and the Health Care Reform Act offers a solution. Not only will there be a higher enrollment number for America’s health brokers, but as of 2014, it will be required by law for every American to obtain health insurance. Every single American will be impacted by the New Health Reform Bill, making it one of the most important measures of the 21st Century.
    The main focus will be on businesses of 50 or more employees, in which they will be required to offer individual health plans, as well as family plans to all employees or face some stiff fines from the government. The amount comes to $2000 per uninsured employee, though there are exemptions to this fine. If you as an employer assist an individual with acquiring a personal health insurance plan through an open market called an exchange, then it would result in no fines. This only applies to an individual who makes a certain amount under the Federal Poverty Level, and the premiums are over 8% of his annual income.
    America’s health brokers can rest easy in the fact that there will be expanded coverage, though there may be more competition. With the rise in individuals who will have health insurance, there may not be as large of a risk as one may assume. Though the new bill will require America’s health brokers to enroll individuals with pre-existing conditions, there will also be a new population of young individuals who will be insured with fewer health problems.
    It is understood that larger companies already provide a group insurance plan (HMO, PPO) that covers all areas of needs for the population of employees. These policies will change very little, but there may be some changes in where the funding for the new health care plan will come. It is proposed that those making a certain amount of money, both individuals and couples, will be taxed at a higher percentage than others. This will provide money that can be used for the exchange and making sure that all individuals will be offered an affordable health plan.
    There are still a few years before the plan goes into full effect, though some of the measures will be enforced immediately. There will be plenty of time to sort out the details and iron out the difficulties. As for the plan, anyone who does not have health insurance as of January 1, 2014, will be penalized a certain amount of money, and this amount could become worse if health insurance is continuously neglected. There has never been a better opportunity for America’s health brokers in terms of acquiring a new customer base-a broader customer base. Also, there has never been a better time in history for individuals being provided with the resources for the necessary medical treatment. This is a very unique time, with history in the making. Finally, there will be health care for all.