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Kill the law, not the patients

It appears ObamaCare's economic model has led to the deaths of thousands of patients with heart failure



It appears ObamaCare's economic model has led to the deaths of thousands of patients with heart failure I'm sure I don't have to remind you of the derision aimed at Sarah Palin when she talked of ObamaCare resulting in death panels. Liberals shrieked: There are no death panels in the bill! Media "fact checkers" chastised her thoroughly. We pointed out many times that while ObamaCare did create an actual death panel of sorts, the larger death promoter inherent within ObamaCare is the manipulation of dollars to incentivize lower-quality, and thus less expensive, care.
This morning the Wall Street Journal explains how one such incentive is playing out. When Democrats drafted the law, they had the clever idea that they could save money if hospitals were discouraged from re-admitting patients after they'd already been released, and they built in financial incentives for hospitals not to re-admit patients within 30 days of release. The rationale is that re-admissions are very expensive. The obvious problem, of course, is that patients' bodies don't care about the financial incentives. If they need to go back to the hospital, then they need to go back to the hospital - and hospitals are supposed to be responsive first and foremost to what's necessary to care for people. But they want their money, so how is this playing out in real life? Not well, especially for patients suffering from heart failure:
Liberals have touted data showing that readmissions have fallen since the penalties took effect in 2013, but the JAMA researchers examined whether quality of care has improved as a result. Their observational study examined 115,245 fee-for-service Medicare beneficiaries hospitalized with heart failure across the U.S. in the four years prior to and first two years following implementation of the program. Researchers found that the 30-day readmission rate (adjusted for patient risk) declined to 18.4% from 20% after the penalties were introduced. Yet the 30-day mortality rate increased to 8.6% from 7.2%—about 5,400 additional deaths per year. Over a one-year period the readmission rate fell by 0.9 percentage points while the mortality rate rose by five. In other words, while fewer patients were being readmitted, many more were dying.

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The researchers hypothesize that the penalties might “incentivize hospitals to ‘game’ the system, using strategies such as delaying admissions beyond day 30, increasing observation stays, or shifting inpatient-type care to emergency departments.” These tricks may end up hurting patients. Hospitals with above-average readmissions are also more likely to care for low-income patients and deal with complicated medical cases. They are usually financially strapped due to low Medicaid reimbursements, and the ObamaCare penalties may make it even harder to deliver quality care. ObamaCare effectively enrolled Medicare patients and hospitals without their consent in a mandatory policy experiment—you’ll be better off, trust us—but then neglected to evaluate the adverse effects. A drug trial with the same results would have been shut down long ago.
Keep in mind, those 5,400 additional deaths are just among the sample group observed in the study. That's a small sample. No one can say for sure how many times this actually played out across the country. But no one should be surprised it happened. The ObamaCare economic model made it inevitable.

Real world never quite comports with what liberals think should happen

ObamaCare sought to get more people covered by insurance while controlling the premiums people would pay - even people who entered the risk pool with pre-existing conditions. That is economic madness, but Democrats thought they could pull it off by mandating that the healthy buy high-premium, high-benefit policies - thus expanding the risk pool to include more people whose ultilization would be lower - while squeezing providers to wring costs out of the actual care provided. Why didn't it work? Because the real world never quite comports with what liberals think should happen. Liberals have a tendency to make statements like "if only everyone would" . . . do whatever liberals wish everyone would do. Then they try to pass laws mandating that everyone do what they want, and they congratulate themselves for having fixed everything. But nothing is fixed. Not everyone will buy gold-plated health insurance, even if you mandate it and subsidize it - because some people just don't think it's a good value and don't want it, no matter how much you shake your finger at them and tell them they should. And not everyone's health will cooperate with the model that discourages re-admissions within 30 days of the most recent discharge.


You're killing them

So as the Journal points out, hospitals will try to game the system to avoid re-admitting patients within that window so they're in compliance with the regulations. These are actions they would never take if the only thing under consideration was the health of the patient, but ObamaCare has made the health of the patient a secondary consideration in many situations. Can we prove that any or all of these deaths were directly caused by these policies. Maybe the researchers can in some cases. I can't. But that's beside the point. Anyone can reasonably surmise that when admission decisions are manipulated in response to artificial financial incentives, that is not going to work out well for patients who need to be admitted. And when the problem in question is heart failure, no one should be surprised when some of these patients who should have been in the hospital die. The official name of ObamaCare is the Patient Protection and Affordable Care Act. How exactly are you protecting patients when they need to be admitted to the hospital and you're incentivizing hospitals not to admit them? You're not. You're killing them.

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Dan Calabrese -- Bio and Archives

Dan Calabrese’s column is distributed by HermanCain.com, which can be found at HermanCain

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