Obama let on that this frenzy to achieve passage of a hugely irresponsible and politically unpopular bill was in large part ego-driven when he started hounding House Democrats to save his presidency. (He, however, has no interest in saving their congressional careers as he demands that they walk the plank to vote against their constituents’ wishes.)

This was the candidate who created a cult of personality, who told us he represented the “New Politics,” who was going to eschew politics-as-usual, and who would be post-partisan, post-racial, and post-ideological. Now he’s a handful of votes away from a humiliating defeat. No wonder it’s desperation time. His possible failure would not be a mere political failure; it would be the obliteration of his own mythology.

Should he squeak it out, Obama’s “victory” would come with a heavy price. Gone is the image of a policy sophisticate (try watching that Bret Baier interview a few times without wincing). Gone is the “moderate” moniker. And gone is the notion that he’d usher in a new era of less contentious and less corrupt politics. (It’s a new era, perhaps, but hardly a better one.) There is no mistaking now the depth of the campaign deception. The public has figured out what he is all about. And increasingly, they dislike what they see.

I think the Senate bill is going to pass the House this weekend and that any bill to enact “fixes” will be quickly mired down.  So the Senate bill will become the law of the land.

Five or ten years from now we will not recognize the health care system we have, and we won’t like what we see there either. For the rest of our lives, unless this thing is repealed (and don’t hold your breath waiting for that to happen) the debate will be like Social Security has been: How much money do we put into this program? That will take place alongside lie after lie about the program’s sustainability.

In fact, what we may have here is a government entitlement that is both unrepealable and unsustainable. The “unrepealable” part is what the Left wants. I’m not sure they care about the “unsustainable” part, because I think their solution to that is for the United States to become like Sweden.   I don’t think that’s what the country voted for in 2008.

And yes, insurance companies are a big problem. But buying health insurance will also be a lot different in the future. By federal law, we will all have to buy health insurance, which is not such a big problem to me, but we will have to buy a one-size-fits all policy that meets government standards. Say good-bye to your choices in the matter. And if you think the cost of your health insurance is going down, you will probably be surprised.

This is a big deal, folks. And it’s being passed despite opposition from a pretty large majority of the American people.

Then things are going to get very interesting.

Glenn Reynolds‘ comment:  “Not living up to the promises they made, is it? But don’t worry, health care will be totally different.“

Chemotherpay at Duke Cancer Clinic

This article in today’s Salt Lake City Deseret News is so vital and informational to those who have or who are or who will confront Cancer in their families, that True North takes the opportunity to excerpt it here and thanks writer Lois M. Collins for her great piece and for spreading the news of the work of Massachusetts firm,  Merrimack Pharmaceuticals, for their innovatoins in Cancer research.

FIRM TAKES ENGINEERING APPROACH TO TREATING CANCER

A Massachusetts company with strong Utah ties is approaching the finding and fixing of cancerous tumors as an engineering challenge. It believes most solid tumors are triggered by one or more of six distinct systemic signaling-mechanism breakdowns and it’s developing treatments to repair them.

Merrimack Pharmaceuticals of Cambridge, Mass., on Thursday announced a $530 million exclusive worldwide licensing agreement with French pharmaceutical giant sanofi-aventis for the development and co-commercialization of a drug targeting the first of those

signaling breakdowns.

Chemotherapy Drugs

Developing drugs to treat diseases including cancer often involves throwing every compound you can think of at it to see what elicits the response you want, says Utahn Gary Crocker, chairman of Merrimack Pharmaceuticals and president of Utah’s Crocker Ventures LLC. But with new technologies that make it easier to look inside cells and see how they “cross talk,” Merrimack decided to view cancer as an engineering problem with an engineered solution. Merrimack uses network biology, which is a combination of computer modeling and efficient analysis of cell signaling networks.

Once you identify the breakdown in the signaling mechanism, it’s possible to engineer a diagnostic test and a fix, he told the Deseret News.

The company has confirmed five critical signaling networks where a breakdown can trigger cancer in different organ tissues. A sixth has been found but not yet confirmed, he said. Merrimack estimates the identified mechanical breakdowns are linked to at least 90 percent of solid tumors. That means the same problem may have occurred in a case of breast cancer and of prostate cancer although distinctly different organs are involved. And the treatment may be the same in both cases, too — a dramatic departure from a traditional chemotherapeutic approach.

“The goal is not to just kill cancer cells, but to actually fix the engineering breakdown that created the cancer,” Crocker said.

Merrimack is in early clinical trials with compounds that target some of the identified mechanism breakdowns. It’s a process being watched closely in Utah, as Beehive State investors hold about 10 percent of the company’s shares, including Crocker, a successful Utah businessman.

Additionally, Merrimack plans to move some of its research to the University of Utah College of Science, which has one of the nation’s top math biology programs. And the phase 2 clinical trials are likely to include Huntsman Cancer Institute, Crocker said.

Under the agreement, sanofi-aventis will pay $60 million cash and will cover all the development costs. The rest of the funding will be paid in chunks as various regulatory and sales milestones are met, said Kathleen Petrozzelli, Merrimack associate director of corporate communications. The company retains the right to co-promote the drug in the United States. The agreement covers only the drug MM-121, a first of its kind, fully human monoclonal antibody that blocks signaling at one of the identified breakdown sites. Once phase 2 “proof of concept” is established, sanofi-aventis will take over development.

The agreement still has to clear antitrust and regulatory reviews.

Switzerland

During the healthcare reform debate (which is really an insurance reform debate) we’ve heard a lot about the British National Health System (almost totally socialized and roundly criticized) and a little about the French system (less socialized, less criticized).   I recently heard a suggestion that the Swiss system might be a model that would work in the USA.  Here’s a summary and analysis of how that little alpine country approaches health insurance:

1.  There is an insurance mandate for all individuals.

Meaning:  Everyone is required by law to have health insurance, and it is not provided through employers.  This is a compromise between two warring positions:  Libertarians hate the “individual mandate,” and so do most conservatives.  But liberals hate the idea of ending employer-based health insurance.  That would be a huge and controversial change in the U.S.

I think such a compromise might be the price we must pay for a system that is both politically feasible and that actually works.  Regina Herzlinger,  a Harvard Business School professor, has studied and written about the U.S. health care system and other countries’ systems for some time:

To revamp the US system, Herzlinger argues that Americans should be required to buy their own insurance, as in Switzerland, instead of having employers purchase it for them.

“When people buy their own health insurance with their own money they think about value,” Herzlinger said. “I don’t want someone else to buy my car, my house, my food or my clothes, so why do I let them buy my health insurance?”

What about people who can’t pay for their own insurance?  (Yes, they have poor people in Switzerland too.)

In Switzerland, about one-third of the Swiss population cannot afford insurance. The Swiss government provides help on a sliding scale with about SFr4 billion a year.

“I don’t think people really understand just how profound that is,” Herzlinger said. “Poor people become dignified consumers. This is what makes Switzerland so unique.”

2.  The government defines a what the insurance benefit will be for all standard health insurers.

Another intervention in the market that is hard for conservatives to swallow.  Essentially, the government establishes a “floor” or minimum benefit.

3.  Insurance companies are not allowed to deny coverage to any individual.

In other words, no “pre-existing conditions.”

4.  Health insurance and medical procedure prices are made publicly available.

Now we’re talking more free enterprise.  Do you have any idea how to find out what medical procedures cost in the U.S.?  If not, you have lots of company.

5.  In exchange for providing health insurance to consumers, insurance companies receive premiums from consumers and risk-adjustment payments from the government in order that insurance companies are not punished if they decide to insure a sicker population.

This is how the Swiss compensate for making insurance companies take everyone, regardless of pre-existing condition:

[A]n insurance company could go broke if it had too many chronically ill clients and no healthy ones.

For Swiss companies, it makes little difference if you’re a beacon of fitness or in need a heart transplant. A joint foundation overseen by government regulators redistributes high profits earned off healthy clients and divides them among companies with expensive, unhealthy ones.

That’s a lot of regulation for the insurance companies.  Maybe we can do better.

6.  Premiums are community rated, meaning that sick and healthy individuals pay the same price within each age group (the age groupings are 0-18, 19-25, >25 years old).

More intervention in the market, but if you have elements 1-3 above you really have to do this too.

7.   Individuals are allowed to purchase supplemental insurance as well (there is no regulated benefit for supplemental insurance).

This is how they keep the offerings from being “one size fits all.”  I like this provision a lot, and it really saves the entire system, in my view.

I’m no expert on the Swiss sytem, but it seems that individuals choosing their own insurance is the key to its success.   The Swiss are not limited to plans their employers make available to them.  In that way their system is a lot like the Federal Employees Health Benefits Program.  Federal employees get a payroll deduction for a certain amount each year, and they can direct the money to any one of a variety of insurance plans during “open season” every December.   If they wish, they can supplement the amount in the payroll deduction and direct their funds to a more expensive plan.   In other words, the employer doesn’t choose the insurance, the employee does.  I’ve always found it interesting that members of Congress get that kind of freedom but can’t seem to bring themselves to offer it to the rest of the country.

8.  There is significant cost sharing in all insurance plans (i.e.: deductibles, 10% coinsurance rates up to an annual ceiling).

This is the individual responsibility piece that is missing from most current American proposals.

9.  Open enrollment occurs twice per year (June and December).

This means twice a year you can switch insurance plans, and it means the insurance companies are competing actively all the time.

How do the Swiss people use this system?

In 2003, 49.7% of Swiss individuals choose ordinary deductible health insurance, 42.0% choose higher deductible health insurance, and 8.2% chose insurance with limited choice of provider networks (HMO-style contracts). Since only 8% of individuals are in managed care insurance firms, quality is fairly homogeneous across insurance companies.

And does the system produce competition for the consumer’s business?  This is where the Swiss system gets really interesting:

[H]igh consumer demand has created 87 private Swiss health insurance companies that offer an enormous menu of services. In Massachusetts, a state about the same size as Switzerland, there are five such companies.

A Swiss model for the USA might even be great for us.  No, it doesn’t follow free market principles strictly, but that’s not possible with healthcare — or, at least, in the USA we’ve made a decision as a society that we will not let the market alone decide whether people get medical care.  I think that’s proper and humane, but regardless of how one feels about it, that’s the decision we’ve made.   Switzerland has made the same decision, but has insisted on competiton among insurance companies, individual involvement in choosing insurance, and transparency of cost — all core free-market principles.

Here’s a little more about the Swiss system.  And more here.

I’d like to see more thinking along these lines instead of the clunky socialized medicine ideas the Democrats are coming up with.  They seem to be asking, “How can we copy the British National Health Service without going all the way to a single-payer system?”  Not a very creative approach.

UPDATE: Meanwhile, Senator Max Baucus claims it’s “too difficult” to put his proposed healthcare bill online so citizens can review it:

A proposal by Sen. Jim Bunning, R-Ky., that would have required the Senate Finance Committee to post the final language of the $900 billion health care reform bill, as well as a Congressional Budget Office cost analysis, on the committee’s website for 72 hours prior to a vote was rejected 12-11.

Too difficult. Yeah, right.

Watch the videos below the break:

The is the Democrats’ ad:

Both are very effective political ads, I think. The Dems’ ad is more clever (some would say cunning and manipulative) in that it attempts to marginalize the opposition as a bunch of crazies. The GOP ad is more substantive, in that it simply quotes the president’s ill-advised public statements about his health care reform agenda.

It remains to be seen whether either ad will resonate with the key bloc of independent voters not already committed to one side or the other in the health care reform debate. I think the Democrats have a bigger problem right now — angry voters nationwide — than the Repubublicans do. If the Democrats weren’t worried about the voter backlash they would not be trying to neutralize it.

In any case, this should be an interesting August.

Do you think the public is unhappy with the way Congress and the Obama Administration are handling health care reform?

(HT: Instapundit, who has several more highly-recommended links.)

“This is not about politics? Then why is it, to take but the most egregious example, that in this grand health-care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?

“When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays? Patients, in higher doctor fees to cover the insurance.

“And with jackpot justice that awards one claimant zillions while others get nothing — and one-third of everything goes to the lawyers — where do you think that money comes from? The insurance companies, which then pass it on to you in higher premiums.

“But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order for no good reason other than to protect themselves from lawsuits. Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

“Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health-care news conference. Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers.”

Unlike too many conservatives, I recognize that the health care system’s financial problems are multi-faceted, and that tort reform will not be a cure-all by any means. But it is inexcusable that the subject of tort reform is not even on the table.  Heck, it’s not even in the same building as the table.

“Although there are some positive provisions in the current House Tri-Committee bill – including insurance for all and payment reform demonstration projects – the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.

“In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.”

I really dislike the Tri-Committee bill, so I agree with what Mayo says.  Their take also seems consistent with what Atul Gawande said in this New Yorker article, “The Cost Conundrum,” which I found presuasive.  I think, however, that the conservatives who are so gleeful about Mayo’s statement should keep in mind that Mayo’s criticism of the Tri-Committee bill is pretty narrow:  Medicare payment policy still encourages more care, rather than the right care.  It would not be hard to amend the Tri-Committee bill to at least attempt to do that, which would be a bad thing.  As a small-government guy, I worry about the federal government trying to exercise oversight over medical decisions.

EVERYONE WHO IS FOLLOWING the debate over the massive health care policy proposals in Congress, and is wondering what the term “public option” means, should read Hugh Hewitt’s post today.  It tells you everything you need to know.  Excerpt:

The fundamental dishonesty [in President Obama's defense of his plan] is that the president refuses to acknowledge that the government option/public plan will be subsidized by the federal government in a number of ways and thus will be cheaper for employers to choose for their employees, and they will choose it, sending tens of millions of Americans now covered by private insurers into the public plan, dramatically driving up federal costs while crippling the private sector insurance industry.  Once dumped into the plan, the employees will wonder what happened to the president’s promise — often repeated — that “if you like your plan you can keep it.”

Read the whole thing, and send it to your friends.  Most important, call members of Congress and the Senate.  Hugh’s post gives you all the phone numbers.