In his hour long speech on health care, he failed to spend even a moment rebutting the central critique of his program: His inability to provide quality medical care for 30 million new patients without any additional doctors or nurses.
The shortage of medical personnel which will inevitably accompany the expansion of the patient population will leave some element - and perhaps all without adequate care. Like the man who sleeps with a blanket that is too small, either his neck or his feet will get cold unless he gets a bigger blanket.
The result of expanding the demand for medical services without augmenting the supply of doctors or nurses must be the rationing of medical care. And rationing will inevitably take its greatest toll among the elderly, forcing them to forgo elective surgery or, if their remaining quality years are likely to be limited, to do without vital life-prolonging treatment. Inevitably, we will all have to wait many more days, weeks, months or years for care we now receive on demand.
Obama will cut Medicare and that portion of Medicaid which serves the elderly in nursing homes (75 percent) in two ways:
(a) As he said in his speech, he will cut "hundreds of millions in waste and fraud and unwarranted subsidies in Medicare." To identify this "waste and fraud" he proposes to establish a commission within the Executive Branch to investigate the program and initiate cuts. Congress will have only sharply limited power to override these reductions or else they will automatically take effect.
Obama admits that these cuts will largely take the form of reducing reimbursement rates for hospitals and doctors. Paid less per office visit, doctors will spend less time on each patient. Reimbursed less for MRIs or CT Scans, they will order fewer of them. And getting less income, more doctors will retire and fewer will enter the profession aggravating the scarcity.
The president also plans to eliminate the Medicare Advantage program, an approach to managed care which permits the elderly a coherence and a coordination in their treatment that about one-third of them find valuable enough to sign up for.
(b) His newly established panel to cut Medicare will also "encourage the adoption of…common sense best practices by doctors and medical professionals…reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan."
These are code words for the rationing the imbalance in supply and demand will cause. The panel will "encourage" doctors to adopt the "best practices" the panel recommends by limiting reimbursement rates or even banning alternatives. Likely guidelines will govern who can get elective surgery like hip replacements or new knees based on the number of QARYs "quality adjusted remaining years" the patient has.
For example, in Canada, the drug Avastin is barred by just such a panel despite its proven track record as the most effective anti-colon cancer drug on the market. The ban is not because of any safety concerns, but solely due to its $50,000 annual cost. As a direct result, 41% of Canadians with colon cancer die as opposed to 32% of Americans. It is just these kinds of "best practices" that the panel will have to impose to pay for Obama's plan.
The panel will likely recommend limits on testing and screening, worsening rather than improving preventative care. In Canada, for example, there is an eight month wait for colonoscopies which leads to a 25% higher incidence of colon cancer.
Together, these cuts in Medicare will pay for more than half of the subsidies in Obama's program. And what will the money be used for? To pay for medical coverage for people who are too young for Medicare, too wealthy for Medicaid, and too old for the Children's Health Insurance Program. The president claims that this coverage will be "affordable" for those now uninsured. But the guidelines in the bill indicate that a person making about $30,000 a year will have to pay approximately 8% of his income in premiums before the subsidies kick in $2400 a year. Many of those now uninsured will find this expenditure both onerous and unnecessary in view of their current youth and good health.
Obama claims that "our health care problem is our deficit problem. Nothing else even comes close." He's wrong. Medicare and Medicaid costs have risen by about 5% in the past year while the budget deficit has quadrupled. The deficit is caused by the massive overspending in the TARP program bailing out banks and the equally gargantuan stimulus package, throwing money - ineffectually - at the recession.
The president reports that "the reforms I'm proposing will not apply to those who are here illegally." This statement is also a half-truth. Illegal immigrants will be eligible to buy health insurance from the insurance exchange Obama creates, taking advantage of the lower rates he claims it will allow through bulk purchasing. And, without any effective provision for citizenship verification, will inevitably slip through the cracks and get subsidized coverage.
He boasts that "nothing in this plan will force you or your employer to change the coverage or the doctor you have." But the rationing his program will force will make those insurance companies and doctors impotent in the face of federal mandates for reduced care.
The president's plan is, essentially, a program to take medical care away from the elderly and give it to those who are not younger, healthier, and - in the main - richer.