ObamaCare's Attack on the Elderly

The president's macabre new year's gift: paying hospitals not to treat seniors.


In October of 2012, the Daily Mail exposed the highly disturbing realities of the Liverpool Pathway (LCP), the series of guidelines for treating terminally ill patients developed for Britain's National Health Service (NHS). The most egregious of those realities concerned cash incentives paid to hospitals to ensure a certain percentage of hospital patients would be put on the regime. As healthcare expert Besty McCaughey reveals, a similar horror show is occurring on this side of the Atlantic, courtesy of ObamaCare. Beginning the the same time the LCP scandal was being exposed, the Obama administration began awarding hospitals bonus points for spending the least amount of money on elderly patients. Even worse, the idea was sold to the elderly as a good thing during the 2012 presidential election campaign.

During that campaign, Obama promised seniors that $716 billion in Medicare cuts over the next decade, used to fund the $1.9 trillion in new healthcare spending that expanded Medicaid and created the healthcare exchanges, wouldn't affect them. When Republican Presidential candidate Mitt Romney ran an ad attacking the cuts, Obama spokeswoman Lis Smith called it hypocritical. "The savings his ad attacks do not cut a single guaranteed Medicare benefit," she declared.

Much like everything else this administration contends, the devil is in the very deceiving details. While it's technically true the cuts didn't change the Medicare insurance benefits for those receiving them, $416 billion of that $716 billion in cuts were realized in “updates to fee-for-service payment rates.” That was a euphemism used to obscure the reality that hospitals, doctors, hospice care, home care, and Advantage plans paid to care for seniors would be getting reduced payments.

Elderly Americans were supposed to believe those reduced payments would have no negative consequences whatsoever regarding the quality and/or availability of their healthcare.

This is utter nonsense, and there is data to prove it. As McCaughey further notes, research sponsored by the National Institute on Aging and RAND examined over two million elderly patients treated at 208 California hospitals from 1999 to 2008. Published in 2011, the research revealed that elderly patients treated in lower-spending hospitals received less care and had lower survival rates than those treated at higher-spending hospitals.

The numbers are stark. According to the data, 13,613 seniors with pneumonia, stroke, heart attacks and other common conditions who died at low-spending hospitals would have survived -- and returned home -- had they received treatment at higher-spending institutions. Those totals represent only the state of California, which contains about 10 percent of the Medicare population.

Similar cuts in Medicare payments to hospitals made in 1997 produced similar results. Over the course of four years, $40 billion was cut out of the Medicare program. As a result, one-third of America's hospitals went from being profitable to losing money. Seniors treated for heart attacks at hospitals absorbing the largest cuts had a 6-8 percent greater chance of dying than those treated at other hospitals. Despite claims by ObamaCare defenders that reduced payments to hospitals eliminates “fraud, waste, and abuse,” researchers concluded that hospitals actually reduced something else, namely nursing care, to cope with the shortfalls.

In 2011 testimony given to Congress, Richard Foster, Chief Actuary of Medicare and Medicaid Services for the Obama administration, revealed that the cuts to hospitals engendered by ObamaCare, which amount to $247 billion over ten years, could force as many as 40 percent of them to operate at a loss, and that as many as 15 percent could stop accepting Medicare altogether, even though the program is their largest source of revenue.

Foster also revealed something far more ominous. Because Medicare will eventually pay doctors less than they're getting for the already low-paying Medicaid, and only about one-third of what they get paid for treating someone with private insurance, seniors will have even more trouble finding hospitals and doctors willing to treat them. As disquieting as that reality is, it will be exacerbated: ObamaCare bars doctors from providing their patients with necessary care for an extra fee. Many will simply fall through the cracks on the road to "better care for everyone," even as individual seniors bear the painful -- or deadly -- brunt of this leftist utopian fantasy.

And such cuts will affect far more than critical care. Quality of life procedures, such as knee and hip replacements, angioplasty, bypass surgery and cataract operations will also be pared back. Thus, seniors who have grown accustomed to the active lifestyles made possible by medical advancements may have to lower their expectations.

In 2009, President Obama admitted as much at a White House "town hall" meeting to promote the healthcare bill. A woman named Jane Sturm spoke about her nearly 105-year-old mother, initially denied a pacemaker five years earlier by one doctor, due to her age. Sturm explained that another doctor, who saw the elderly woman's "joy of life," gave her the procedure.

She asked the president to address that reality. “Outside the medical criteria,” Sturm asked Obama, “is there a consideration that can be given for a certain spirit … and quality of life?” Obama responded by talking about the waste that exists in the system "that's not making anybody's mom better" including "loading up on additional tests or additional drugs that the evidence show is not going to improve care" before coming to the conclusion that “maybe you’re better off not having the surgery, but taking a painkiller."

Aside from the callousness of the president's observation, it should be noted that loading up on additional tests or drugs is more familiarly known as practicing "defensive medicine," a reality exacerbated by potential litigation. Because trial lawyers are some of the Democratic Party's main campaign supporters, it is no accident that the massive healthcare bill enacted solely by that party didn't contain a single word about tort reform.

Furthermore, Obama is wrong. Currently Medicare pays hospitals an average of 91 cents on the dollar for the costs associated with caring for seniors. That's a loss, not a profit. And peer-reviewed scientific research reveals that seniors who receive quality of life surgeries, such as a knee replacement to alleviate the pain associated with severe osteoarthritis, have a 50 percent higher chance of being alive five years after the operation than seniors who merely endure the condition. Thus in many cases seniors, are better off having the surgery.

Unfortunately, much like the "tick box" treatment British seniors received until it was condemned as a "national disgrace," individual care matters less than the "greater good" of containing costs. Thus, in addition to across-the-board cuts, hospitals will be forced to cope with an ObamaCare regulation called “Medicare spending per beneficiary.” Bonus points will be awarded to those institutions that spend the least on seniors, while those that don't get demerits. Those spending calculations include up to 30 days of post-discharge treatments, such as physical therapy following surgery for a joint replacement.

In Britain, the LCP is being axed in favor of personal healthcare plans to address end-of-life issues. It is being done because the British government recognized the inevitable cruelty that occurs when treating the aged becomes little more than a numbers game. Yet in America, we are moving in precisely the opposite direction, one bonus point or demerit, after another. For shame.

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